Kidney Adrenal Gland Tumor: A Case Report

A 58-year-old Iraqi male was referred to our center three months after an unsuccessful operation for removing a subhepatic mass, probably adrenal mass. The patient had experienced general weakness, fatigue, and weight loss in the last several months.

During physical examination, vital signs were normal. In abdominal examination, a scar of previous surgery in the right subcostal area (subcostal incision) with near 15 cm length was noted. Serum levels of cortisole and aldosterone were normal, while serum and urinary catecholamines were also within normal limits. Mild elevations of hepatic enzymes were observed.

Imaging studies including CT scan with intravenous and oral contrast revealed a large mass located in the subhepatic area intervening with the upper pole of the right kidney (Figure 1). The tumor's total size was 14 cm x 10 cm, weighing approximately 2250 grams.

Due to severe bleeding from the subhepatic bed, subcapsular resection of the mass with adherent kidney was performed. The mass was severely adhered to the peripheral tissues, making differentiation from the kidney or adrenal gland difficult. After opening the layers, the mass was located in the lodge of the upper pole of the right kidney.

The patient was scheduled for right adrenalectomy with midline laparotomy incision. In a previous report, tumorectomy had failed due to severe adhesions of the mass to peripheral tissues. The patient's hematological examination revealed an Hb level of 11 g/dl.

In conclusion, we present a case of a large subhepatic mass that discrimination of its origin from neighboring organs was difficult preoperatively. The tumor was successfully resected through subcapsular tumorectomy in our center.

Kidney adrenal gland tumor