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Transperitoneal laparoscopic adrenalectomy for metachronous contralateral adrenal metastasis from renal cell carcinoma: a case report.

Zacharakis E, Ribal MJ, Zacharakis E, Patel HR - Cases J (2008)

Bottom Line: The patient remains in satisfactory condition and no recurrence or adrenal insufficiency has been observed during 12 months follow up.Regular follow up in these patients accompanied with computed tomography imaging may help the surgeon to detect early lesions.Laparoscopic transperitoneal adrenalectomy is feasible, safe and effective, with minimal trauma to the patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of Laparoscopic Urology, The Institute of Urology, University College Hospital, London, UK. evangelos.zacharakis@doctors.org.uk.

ABSTRACT

Background: We report a case of metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland treated by laparoscopic transperitoneal adrenalectomy.

Case presentation: A 58-year-old man presented to our institution for regular follow up, 2 years after a right radical nephrectomy with preservation of the ipsilateral adrenal gland, for a primary renal cell carcinoma. The patient remained asymptomatic but an abdominal computed tomography scan on follow up revealed a 6.5 x 4 cm2 mass in the left adrenal gland. A positron emission tomography scan was also performed to rule out other possible metastases, and a magnetic resonance imaging scan was used for accurate localization and determination of resectability of the adrenal tumour. A bone scan, metabolic screen, liver and renal function tests were all within normal limits. A laparoscopic transperitoneal adrenalectomy was then performed. The postoperative period was uneventful, and the patient was discharged on postoperative day two. The patient remains in satisfactory condition and no recurrence or adrenal insufficiency has been observed during 12 months follow up.

Conclusion: Metachronous contra lateral adrenal metastases from primary renal cell carcinoma are very rare but should always be suspected in any nephrectomised patient presenting with an adrenal tumour. Regular follow up in these patients accompanied with computed tomography imaging may help the surgeon to detect early lesions. Laparoscopic transperitoneal adrenalectomy is feasible, safe and effective, with minimal trauma to the patient.

No MeSH data available.


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CT scan showing an adrenal metastasis to the contralateral gland, 2 years after a right nephrectomy for primary RCC.
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Figure 1: CT scan showing an adrenal metastasis to the contralateral gland, 2 years after a right nephrectomy for primary RCC.

Mentions: A 58-year-old man presented to our institution for regular follow up, 2 years after a right radical nephrectomy for a primary RCC. The patient remained asymptomatic but an abdominal computed tomography (CT) scan on follow up revealed a homogeneous 6.5 × 4 cm2 mass in the left adrenal gland with no calcification (Figure 1). Furthermore, the positron emission tomography scan revealed a fluorodeoxyglucose (FDG)-avid enlarged left adrenal gland, with no evidence of FDG-avid para-aortic lymphadenopathy or any further abnormality of the right renal bed or adjacent areas. Radiological studies (abdominal and chest CT scan) before the radical nephrectomy had revealed a 12 cm heterogeneous soft tissue mass in mid pole in the right kidney consistent with an RCC. There was no involvement of the inferior vena cava or right renal vein and no evidence of distant metastases at that point. The patient then underwent a transperitoneal laparoscopic radical nephrectomy of the right kidney with preservation of the ipsilateral adrenal gland. The pathology report of the nephrectomy specimen had shown a Fuhrman grade 2 stage T2 (T2N0M0) RCC.


Transperitoneal laparoscopic adrenalectomy for metachronous contralateral adrenal metastasis from renal cell carcinoma: a case report.

Zacharakis E, Ribal MJ, Zacharakis E, Patel HR - Cases J (2008)

CT scan showing an adrenal metastasis to the contralateral gland, 2 years after a right nephrectomy for primary RCC.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2562357&req=5

Figure 1: CT scan showing an adrenal metastasis to the contralateral gland, 2 years after a right nephrectomy for primary RCC.
Mentions: A 58-year-old man presented to our institution for regular follow up, 2 years after a right radical nephrectomy for a primary RCC. The patient remained asymptomatic but an abdominal computed tomography (CT) scan on follow up revealed a homogeneous 6.5 × 4 cm2 mass in the left adrenal gland with no calcification (Figure 1). Furthermore, the positron emission tomography scan revealed a fluorodeoxyglucose (FDG)-avid enlarged left adrenal gland, with no evidence of FDG-avid para-aortic lymphadenopathy or any further abnormality of the right renal bed or adjacent areas. Radiological studies (abdominal and chest CT scan) before the radical nephrectomy had revealed a 12 cm heterogeneous soft tissue mass in mid pole in the right kidney consistent with an RCC. There was no involvement of the inferior vena cava or right renal vein and no evidence of distant metastases at that point. The patient then underwent a transperitoneal laparoscopic radical nephrectomy of the right kidney with preservation of the ipsilateral adrenal gland. The pathology report of the nephrectomy specimen had shown a Fuhrman grade 2 stage T2 (T2N0M0) RCC.

Bottom Line: The patient remains in satisfactory condition and no recurrence or adrenal insufficiency has been observed during 12 months follow up.Regular follow up in these patients accompanied with computed tomography imaging may help the surgeon to detect early lesions.Laparoscopic transperitoneal adrenalectomy is feasible, safe and effective, with minimal trauma to the patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Section of Laparoscopic Urology, The Institute of Urology, University College Hospital, London, UK. evangelos.zacharakis@doctors.org.uk.

ABSTRACT

Background: We report a case of metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland treated by laparoscopic transperitoneal adrenalectomy.

Case presentation: A 58-year-old man presented to our institution for regular follow up, 2 years after a right radical nephrectomy with preservation of the ipsilateral adrenal gland, for a primary renal cell carcinoma. The patient remained asymptomatic but an abdominal computed tomography scan on follow up revealed a 6.5 x 4 cm2 mass in the left adrenal gland. A positron emission tomography scan was also performed to rule out other possible metastases, and a magnetic resonance imaging scan was used for accurate localization and determination of resectability of the adrenal tumour. A bone scan, metabolic screen, liver and renal function tests were all within normal limits. A laparoscopic transperitoneal adrenalectomy was then performed. The postoperative period was uneventful, and the patient was discharged on postoperative day two. The patient remains in satisfactory condition and no recurrence or adrenal insufficiency has been observed during 12 months follow up.

Conclusion: Metachronous contra lateral adrenal metastases from primary renal cell carcinoma are very rare but should always be suspected in any nephrectomised patient presenting with an adrenal tumour. Regular follow up in these patients accompanied with computed tomography imaging may help the surgeon to detect early lesions. Laparoscopic transperitoneal adrenalectomy is feasible, safe and effective, with minimal trauma to the patient.

No MeSH data available.


Related in: MedlinePlus