Figure 12e. Microwave ablation of an undifferentiated adrenal cortical carcinoma in a 79-year-old man with a history of unsuccessful surgical excision because of involvement of the liver and inferior vena cava. (a) Contrast-enhanced CT scan of the abdomen shows a complex large right adrenal mass (arrows) that invades the right lobe of the liver and compresses the inferior vena cava. (b) CT scan shows three single microwave applicators, which were positioned with fluoroscopic guidance in a triangular configuration and advanced into the center of the large heterogeneous mass. Four 10-minute 45-W ablations were performed. (c) Contrast-enhanced CT scan obtained immediately after the procedure shows complete thermocoagulation of the mass (arrows). The patient tolerated the procedure well and was discharged the same day. Because of the presence of retrocrural adenopathy, he was referred for postablation external-beam radiation therapy to treat these regions. (d, e) On CT scans obtained at 7-month follow-up, the nonenhancing tumor mass (arrows) appears smaller and exerts less mass effect on the inferior vena cava.