A 58-year-old woman was seen by the gastrointestinal department for pain in the right hypochondrium of 6 months' duration, accompanied by alterations in bowel habits. She had no general syndrome or urological symptoms.
Physical examination revealed a good general state of health, normal hydration, normal colour and moderate obesity. There is no cushingoid habitus or stigmata of virilisation. Blood pressure is normal.
Cardiopulmonary auscultation is normal. The abdomen was globular, soft and depressible, making palpation of possible masses or organomegaly difficult, showing slight pain on deep pressure in the right hypochondrium, with no Murphy's sign.
As for the complementary examinations, the routine biochemical and haematological analysis, as well as the adrenal function tests were within normal ranges.
Ultrasonography shows the presence of a tumour in the right adrenal area measuring approximately 6x6 cm. No liver metastases are observed.
The CT scan confirms the mass in close contact with the wall of the inferior vena cava, which it apparently displaces, and infiltration of the latter cannot be ruled out. There is no evidence of retroperitoneal lymph node involvement or metastasis elsewhere. There was also no evidence of tumour thrombosis.
In view of these findings, it was decided to perform MRI for a correct definition of the involvement of neighbouring tissues, reporting identical CT findings and without being able to definitively predict parietal infiltration.

With the diagnosis of an adrenal mass, the decision was made to intervene, which was carried out through a transperitoneal right subcostal incision. The right adrenal region was approached, revealing a large tumour at this level. Dissection of the tumour was begun, but no plane of separation was found in the area of contact with the lateral and posterior wall of the vena cava, so it was decided to excise it after venous control proximal and distal to the mass and suturing with polypropylene of the wall of the inferior vena cava.
The patient followed a favourable postoperative course, without developing complications. She was discharged on the seventh postoperative day.
The macroscopic histological study showed a 6 x 8 cm piece of elastic consistency, easy to cut, with a fleshy appearance and greyish-brown colouring. Remains of adrenal tissue can be seen in the periphery, of apparently normal appearance.
Microscopy reveals a proliferation of cellular elements of stromal lineage, with large pleomorphic nuclei, with multinucleated cells adopting a fascicular pattern. The mitotic index is high (7 m/10 high-magnification fields). There are areas of intratumoral necrosis and invasion of adrenal tissue present in the peripheral area.
The definitive diagnosis is LEIOMIOSARCOMA OF CAVA.
With regard to the evolution, both analytical and imaging tests performed in the early post-surgical period showed normality. The case was referred to the Oncology Department, which decided on consolidation radiotherapy treatment on the surgical site, which began 40 days after the operation.
Further check-ups were carried out at six, nine, twelve and twenty-four months, all of which were normal.

The patient is currently alive and free of disease, after 28 months of follow-up.