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Renal Cell Carcinoma with Simultaneous Bilateral Adrenal Metastasis: Ipsilateral Radical Nephrectomy with Contralateral Adrenal Preservation.

Moslemi MK, Saghafi H, Firoozabadi MH - Case Rep Oncol (2010)

Bottom Line: Although renal cell carcinoma (RCC) can metastasize to almost every organ, the most common metastatic sites are the lungs, abdomen, bones and brain.Due to the poor general condition of the patient, and also to prevent adrenal insufficiency, the right adrenal mass was preserved, without imposing any hazard to the patient.Systemic immunotherapy was initiated and the patient is still alive 1 year after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran.

ABSTRACT
Although renal cell carcinoma (RCC) can metastasize to almost every organ, the most common metastatic sites are the lungs, abdomen, bones and brain. We present a rare case of a 72-year-old male with a large left RCC with simultaneous bilateral adrenal metastasis. In the process of surgical treatment, he underwent left radical nephrectomy with ipsilateral adrenalectomy. Due to the poor general condition of the patient, and also to prevent adrenal insufficiency, the right adrenal mass was preserved, without imposing any hazard to the patient. Systemic immunotherapy was initiated and the patient is still alive 1 year after surgery.

No MeSH data available.


Related in: MedlinePlus

Abdominal MRI, the left renal mass is evident.
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Figure 3: Abdominal MRI, the left renal mass is evident.

Mentions: The patient is a 72-year-old Iranian man who was admitted due to a left renal mass. He complained of intermittent gross hematuria in the 6 months before admission. He revealed no history of medical disorders like hypertension or diabetes mellitus. No history of any previous surgery was found. He was an obese man with a body mass index of 28. On physical examination, vital signs were normal and, due to a fatty abdomen, no mass was detectable. No lower extremity edema, varicose veins or peripheral lymphadenopathies were noted. Hematological examination was normal. In the biochemistry evaluation, only a serum creatinine level of 1.7 mg/dl was noted. Liver function test was normal. Chest X-ray was unremarkable. In abdominal ultrasonography, a left renal mass of 14 × 8 × 6.5 cm with bilateral adrenal masses (each 4 × 5 cm) were reported. In abdominal magnetic resonance imaging (MRI), the reported mass with BAM was revealed (fig. 1, fig. 2, fig. 3, fig. 4, fig. 5). The clinical TNM stage of the patient was T3N1M1. The patient was scheduled for left radical nephrectomy. With midline abdominal incision, laparotomy was performed. Standard left radical nephrectomy with resection of the ipsilateral adrenal metastasis with splenectomy (due to adhesions) was performed. Due to the poor general condition of the patient, severe adhesion of the mass, its large size and more than 2,000 ml of bleeding, the resection of the CAM was postponed. The weight of the resected mass was 3,375 g. Postoperative condition of the patient was uneventful. Only a mild elevation of the serum creatinine level to 2.5 mg/dl was seen. He was discharged on the 4th postoperative day in good condition. Pathologic examination of the nephrectomy sample was positive for RCC with adrenal metastasis, clear cell type, Fuhrman nuclear grade 3. The greatest tumor diameter was 9.5 cm. The tumor extends through the renal capsule to the peri-renal adipose tissue. Invasion of the renal vein is seen without any lymph node involvement. Due to adrenal metastasis, tyrosine kinase inhibitors were the recommended first line of treatment, but due to financial constraints, the patient refused their use and we were obligated to prescribe immunotherapy as an every day intramuscular injection of a-interferon (5 million units) for 2 consecutive months, without any major systemic reactions. Due to unknown causes, the patient had proceeded to end stage renal disease 3 months after operation, and he underwent regular hemodialysis after that. Finally, he was alive at the end of the first year after operation.


Renal Cell Carcinoma with Simultaneous Bilateral Adrenal Metastasis: Ipsilateral Radical Nephrectomy with Contralateral Adrenal Preservation.

Moslemi MK, Saghafi H, Firoozabadi MH - Case Rep Oncol (2010)

Abdominal MRI, the left renal mass is evident.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2992424&req=5

Figure 3: Abdominal MRI, the left renal mass is evident.
Mentions: The patient is a 72-year-old Iranian man who was admitted due to a left renal mass. He complained of intermittent gross hematuria in the 6 months before admission. He revealed no history of medical disorders like hypertension or diabetes mellitus. No history of any previous surgery was found. He was an obese man with a body mass index of 28. On physical examination, vital signs were normal and, due to a fatty abdomen, no mass was detectable. No lower extremity edema, varicose veins or peripheral lymphadenopathies were noted. Hematological examination was normal. In the biochemistry evaluation, only a serum creatinine level of 1.7 mg/dl was noted. Liver function test was normal. Chest X-ray was unremarkable. In abdominal ultrasonography, a left renal mass of 14 × 8 × 6.5 cm with bilateral adrenal masses (each 4 × 5 cm) were reported. In abdominal magnetic resonance imaging (MRI), the reported mass with BAM was revealed (fig. 1, fig. 2, fig. 3, fig. 4, fig. 5). The clinical TNM stage of the patient was T3N1M1. The patient was scheduled for left radical nephrectomy. With midline abdominal incision, laparotomy was performed. Standard left radical nephrectomy with resection of the ipsilateral adrenal metastasis with splenectomy (due to adhesions) was performed. Due to the poor general condition of the patient, severe adhesion of the mass, its large size and more than 2,000 ml of bleeding, the resection of the CAM was postponed. The weight of the resected mass was 3,375 g. Postoperative condition of the patient was uneventful. Only a mild elevation of the serum creatinine level to 2.5 mg/dl was seen. He was discharged on the 4th postoperative day in good condition. Pathologic examination of the nephrectomy sample was positive for RCC with adrenal metastasis, clear cell type, Fuhrman nuclear grade 3. The greatest tumor diameter was 9.5 cm. The tumor extends through the renal capsule to the peri-renal adipose tissue. Invasion of the renal vein is seen without any lymph node involvement. Due to adrenal metastasis, tyrosine kinase inhibitors were the recommended first line of treatment, but due to financial constraints, the patient refused their use and we were obligated to prescribe immunotherapy as an every day intramuscular injection of a-interferon (5 million units) for 2 consecutive months, without any major systemic reactions. Due to unknown causes, the patient had proceeded to end stage renal disease 3 months after operation, and he underwent regular hemodialysis after that. Finally, he was alive at the end of the first year after operation.

Bottom Line: Although renal cell carcinoma (RCC) can metastasize to almost every organ, the most common metastatic sites are the lungs, abdomen, bones and brain.Due to the poor general condition of the patient, and also to prevent adrenal insufficiency, the right adrenal mass was preserved, without imposing any hazard to the patient.Systemic immunotherapy was initiated and the patient is still alive 1 year after surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran.

ABSTRACT
Although renal cell carcinoma (RCC) can metastasize to almost every organ, the most common metastatic sites are the lungs, abdomen, bones and brain. We present a rare case of a 72-year-old male with a large left RCC with simultaneous bilateral adrenal metastasis. In the process of surgical treatment, he underwent left radical nephrectomy with ipsilateral adrenalectomy. Due to the poor general condition of the patient, and also to prevent adrenal insufficiency, the right adrenal mass was preserved, without imposing any hazard to the patient. Systemic immunotherapy was initiated and the patient is still alive 1 year after surgery.

No MeSH data available.


Related in: MedlinePlus