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Laparoscopic adrenalectomy for solitary adrenal metastasis from lung cancer.

Kawai N, Tozawa K, Yasui T, Moritoki Y, Sasaki H, Yano M, Fujii Y, Kohri K - JSLS (2014 Jul-Sep)

Bottom Line: The surgical results of all 10 patients were examined.The findings of positron emission tomography-computed tomography were positive in 8 patients, including the 2 cases with pleomorphic carcinomas.Laparoscopic surgery was successfully performed in 9 cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

ABSTRACT

Background and objectives: Several studies have been reported on the problem of determining when laparoscopic adrenalectomy is indicated for solitary adrenal metastasis of malignant tumors. Our efforts at answering this question constitute the basis of this report.

Methods: From June 2010 to June 2011, laparoscopic adrenalectomy was performed in 10 lung cancer patients with solitary adrenal metastases (5 adenocarcinomas, 1 squamous cell carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, and 2 pleomorphic carcinomas). The surgical results of all 10 patients were examined.

Results: Adrenal swelling was detected by computed tomography in all patients except 1 case of pleomorphic carcinoma. The findings of positron emission tomography-computed tomography were positive in 8 patients, including the 2 cases with pleomorphic carcinomas. Laparoscopic surgery was successfully performed in 9 cases. In the eighth patient (a case of pleomorphic carcinoma with adrenal swelling), laparoscopic adrenalectomy was attempted but conversion to open surgery was required because of clear evidence of pancreatic invasion.

Conclusion: The results obtained in this study, along with other published reports, support 4 criteria as operative indications for laparoscopic adrenalectomy in solitary adrenal metastasis from the lung: (1) the primary lung cancer is resected or can be cured by radical chemotherapy, (2) metastasis is limited to the adrenal gland only, (3) adrenal metastasis does not invade the surrounding organs, and (4) the size of the adrenal tumor does not exceed 10 cm. In cases of pleomorphic carcinoma, laparoscopic adrenalectomy should be performed when positron emission tomography-computed tomography results are positive.

No MeSH data available.


Related in: MedlinePlus

CT and PET-CT findings obtained from a patient with pleomorphic carcinoma in whom complete laparoscopic adrenalectomy was performed. CT showed an adrenal gland (solid triangle) that was normal in size (no swelling). PET-CT of the adrenal gland indicated a positive result (dashed triangle).
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Figure 2: CT and PET-CT findings obtained from a patient with pleomorphic carcinoma in whom complete laparoscopic adrenalectomy was performed. CT showed an adrenal gland (solid triangle) that was normal in size (no swelling). PET-CT of the adrenal gland indicated a positive result (dashed triangle).

Mentions: Regarding the other case of pleomorphic carcinoma (patient 9), CT showed no changes in the adrenal gland; however, adrenal metastases were diagnosed on the basis of positive PET-CT findings (Figure 2). Laparoscopic adrenalectomy was accomplished without any problems in this patient. Mass formation was not macroscopically evident in the resected sample. In the adrenal gland, invading tumor cells formed a duct-like structure. Positive staining for thyroid transcription factor 1 (TTF-1), which is expressed in lung adenocarcinomas,11,12 was evident. However, TTF-1–positive cells that grew by forming a duct structure were observable in the primary lung lesion of this patient; thus the adrenal lesion was diagnosed as an adrenal metastasis of lung origin (Figure 3).


Laparoscopic adrenalectomy for solitary adrenal metastasis from lung cancer.

Kawai N, Tozawa K, Yasui T, Moritoki Y, Sasaki H, Yano M, Fujii Y, Kohri K - JSLS (2014 Jul-Sep)

CT and PET-CT findings obtained from a patient with pleomorphic carcinoma in whom complete laparoscopic adrenalectomy was performed. CT showed an adrenal gland (solid triangle) that was normal in size (no swelling). PET-CT of the adrenal gland indicated a positive result (dashed triangle).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4208896&req=5

Figure 2: CT and PET-CT findings obtained from a patient with pleomorphic carcinoma in whom complete laparoscopic adrenalectomy was performed. CT showed an adrenal gland (solid triangle) that was normal in size (no swelling). PET-CT of the adrenal gland indicated a positive result (dashed triangle).
Mentions: Regarding the other case of pleomorphic carcinoma (patient 9), CT showed no changes in the adrenal gland; however, adrenal metastases were diagnosed on the basis of positive PET-CT findings (Figure 2). Laparoscopic adrenalectomy was accomplished without any problems in this patient. Mass formation was not macroscopically evident in the resected sample. In the adrenal gland, invading tumor cells formed a duct-like structure. Positive staining for thyroid transcription factor 1 (TTF-1), which is expressed in lung adenocarcinomas,11,12 was evident. However, TTF-1–positive cells that grew by forming a duct structure were observable in the primary lung lesion of this patient; thus the adrenal lesion was diagnosed as an adrenal metastasis of lung origin (Figure 3).

Bottom Line: The surgical results of all 10 patients were examined.The findings of positron emission tomography-computed tomography were positive in 8 patients, including the 2 cases with pleomorphic carcinomas.Laparoscopic surgery was successfully performed in 9 cases.

View Article: PubMed Central - PubMed

Affiliation: Department of Nephro-Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

ABSTRACT

Background and objectives: Several studies have been reported on the problem of determining when laparoscopic adrenalectomy is indicated for solitary adrenal metastasis of malignant tumors. Our efforts at answering this question constitute the basis of this report.

Methods: From June 2010 to June 2011, laparoscopic adrenalectomy was performed in 10 lung cancer patients with solitary adrenal metastases (5 adenocarcinomas, 1 squamous cell carcinoma, 1 large cell carcinoma, 1 small cell carcinoma, and 2 pleomorphic carcinomas). The surgical results of all 10 patients were examined.

Results: Adrenal swelling was detected by computed tomography in all patients except 1 case of pleomorphic carcinoma. The findings of positron emission tomography-computed tomography were positive in 8 patients, including the 2 cases with pleomorphic carcinomas. Laparoscopic surgery was successfully performed in 9 cases. In the eighth patient (a case of pleomorphic carcinoma with adrenal swelling), laparoscopic adrenalectomy was attempted but conversion to open surgery was required because of clear evidence of pancreatic invasion.

Conclusion: The results obtained in this study, along with other published reports, support 4 criteria as operative indications for laparoscopic adrenalectomy in solitary adrenal metastasis from the lung: (1) the primary lung cancer is resected or can be cured by radical chemotherapy, (2) metastasis is limited to the adrenal gland only, (3) adrenal metastasis does not invade the surrounding organs, and (4) the size of the adrenal tumor does not exceed 10 cm. In cases of pleomorphic carcinoma, laparoscopic adrenalectomy should be performed when positron emission tomography-computed tomography results are positive.

No MeSH data available.


Related in: MedlinePlus