Healthy Soch
India
healthysoch
Noida/New Delhi, October 17, 2026:
In a complex and challenging cancer surgery, the Urology team at Yatharth Super Speciality Hospital, Noida Extension, successfully treated a 38 year-old woman diagnosed with a large left adrenal tumour measuring approximately 17 × 12 cm, with tumour thrombus extending from the left adrenal vein into the left renal vein and further into the inferior vena cava (IVC).
The patient had initially presented with complaints of abnormal uterine bleeding. During evaluation for her gynaecological symptoms, imaging incidentally revealed a large mass arising from the left adrenal region. Detailed evaluation using contrast-enhanced CT, MRI and whole-body FDG PET-CT showed a large heterogeneous left suprarenal mass with extensive involvement of the venous system. Hormonal evaluation revealed markedly elevated DHEA-S, raising suspicion of an adrenocortical origin. PET-CT demonstrated intense metabolic activity within the tumour, with no obvious evidence of distant metastatic disease.
Considering the considerable size of the tumour and its extension into major abdominal veins, the patient underwent open left adrenalectomy with removal of the tumour thrombus from the IVC.
Left kidney successfully preserved
One of the most challenging aspects of the surgery was the management of tumour thrombus extending from the left adrenal vein through the left renal vein into the IVC. Despite the extensive venous extension, the thrombus had not invaded the walls of either the left renal vein or the IVC. This enabled the surgical team to carefully separate and remove the thrombus completely, avoiding unnecessary resection of the major vessels and allowing preservation of the left kidney.
A circumferential incision around the adrenal vein was performed to establish vascular control and facilitate removal of the thrombus. The tumour thrombus was subsequently removed in toto, while maintaining the structural integrity of the left renal vein and IVC. The kidney-sparing approach was a significant achievement in this highly complex cancer surgery.
Postoperative histopathological examination confirmed adrenocortical carcinoma (ACC), pathological stage pT4. Importantly, the surgical margins were free of tumour, indicating complete surgical resection.
Dr. Pragnesh Desai, Senior Director & HOD, Urology, Renal Transplant, Robotics & Uro-Oncology, Yatharth Super Speciality Hospital, Noida Extension, said, “Large adrenal tumours with vascular involvement demand meticulous imaging, hormonal assessment, surgical planning and multidisciplinary expertise. In this case, complete tumour and thrombus removal was achieved while preserving the left kidney.”
Adrenocortical carcinoma is an uncommon and potentially aggressive malignancy arising from the adrenal cortex. In locally advanced disease, the tumour may extend into major blood vessels, making surgical treatment technically demanding and requiring careful oncological and vascular planning.
The successful procedure highlights the capability of the Urology team at Yatharth Super Speciality Hospital, Noida Extension, in managing complex adrenal and retroperitoneal malignancies involving major blood vessels. The hospital offers comprehensive cancer care supported by advanced imaging, pathology, critical care and multidisciplinary clinical expertise.
