Right atrial extension of adrenocortical carcinoma. Surgical management using hypothermia and cardiopulmonary bypass.

A patient with right adrenocortical carcinoma extending into the inferior vena cava and right atrium is presented. Tumor extension was demonstrated by magnetic resonance imaging (MRI) preoperatively. Successful resection of the adrenal tumor and its intravascular extension was achieved with the help of cardiopulmonary bypass and hypothermia. The patient was maintained on mitotane (o,p'-DDD), and was well for 12 months after surgery. It was concluded that intravascular extension of adrenocortical carcinoma is not a contraindication to radical surgery.