Limits...
Bilateral synchronous adrenal metastases of renal cell carcinoma: A case report and review of the literature.

Öztürk H - Oncol Lett (2015)

Bottom Line: The bilateral synchronous adrenal metastases posed a challenge in the diagnosis and treatment of the disease, as there is no standard approach in the literature for the treatment of such patients.However, metastasectomy was selected, as it appears to be the most effective treatment strategy for increasing the rate of cancer-specific survival.As an adrenal mass was present in the current patient, a hormonal examination was recommended and an adrenal-preserving minimally invasive surgical procedure using frozen section examination during surgery was particularly important to prevent the patient from developing adrenal insufficiency.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, School of Medicine, Sifa University, Izmir 35240, Turkey.

ABSTRACT

Renal cell carcinomas (RCCs) metastasize to the adrenal glands via various mechanisms, including lymphatic vessel arterial embolism and retrograde venous embolism. The rate of ipsilateral metastasis is 3-5% and the rate of contralateral metastasis is ~0.7%, however, synchronous bilateral adrenal metastases are extremely rare. Therefore, the optimal diagnosis and treatment strategy for this condition is yet to be thoroughly defined. In the present study, a 50-year-old male patient presented with right flank pain. Ultrasonography (US) revealed a right renal mass and bilateral adrenal metastases, and a computerized tomography (CT) scan determined the size of the lesions: An 86×83×66-mm mass in the lower pole of the right kidney, an 18×12×10-mm mass in the right adrenal gland, and a 69×51×53-mm mass in the left adrenal gland with central necrosis and peripheral contrast uptake. A US-guided biopsy was performed which determined a diagnosis of right RCC and bilateral synchronous adrenal metastasis. Immunohistochemical examination of the biopsy revealed clear cell carcinoma (Fuhrman grade, III). Consequently, right radical nephrectomy, right partial adrenalectomy (with frozen section examination) and left adrenalectomy were planned. The bilateral synchronous adrenal metastases posed a challenge in the diagnosis and treatment of the disease, as there is no standard approach in the literature for the treatment of such patients. However, metastasectomy was selected, as it appears to be the most effective treatment strategy for increasing the rate of cancer-specific survival. As an adrenal mass was present in the current patient, a hormonal examination was recommended and an adrenal-preserving minimally invasive surgical procedure using frozen section examination during surgery was particularly important to prevent the patient from developing adrenal insufficiency.

No MeSH data available.


Related in: MedlinePlus

Computed tomography imaging of the coronal reconstruction indicating the left adrenal metastatic mass (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4356352&req=5

f3-ol-09-04-1897: Computed tomography imaging of the coronal reconstruction indicating the left adrenal metastatic mass (arrow).

Mentions: In April 2014, a 50-year-old male patient was admitted to Basmane Hospital of Sifa University (Basmane, Turkey), presenting with right flank pain. Ultrasonography (US) revealed an 80×81×57-mm mass (Figs. 1 and 2) located in the lower pole of the right kidney with solid-cystic components and heterogeneous echogenicity. Computerized tomography (CT) scans identified a primary mass in the lower pole of the right kidney measuring 86×83×66 mm and the left adrenal metastatic mass (Fig. 1), which extended to the posterior pararenal area in the inferior region, and to the renal pelvis and hilus in the superior region. Furthermore, the metastatic right renal mass demonstrated marked central contrast uptake in the arterial phase. Additionally, two metastatic masses, measuring 69×51×53 mm and 18×12×10 mm, were detected in the left (Fig. 3) and right adrenal gland (Fig. 2), respectively, with central necrosis and peripheral contrast uptake.


Bilateral synchronous adrenal metastases of renal cell carcinoma: A case report and review of the literature.

Öztürk H - Oncol Lett (2015)

Computed tomography imaging of the coronal reconstruction indicating the left adrenal metastatic mass (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356352&req=5

f3-ol-09-04-1897: Computed tomography imaging of the coronal reconstruction indicating the left adrenal metastatic mass (arrow).
Mentions: In April 2014, a 50-year-old male patient was admitted to Basmane Hospital of Sifa University (Basmane, Turkey), presenting with right flank pain. Ultrasonography (US) revealed an 80×81×57-mm mass (Figs. 1 and 2) located in the lower pole of the right kidney with solid-cystic components and heterogeneous echogenicity. Computerized tomography (CT) scans identified a primary mass in the lower pole of the right kidney measuring 86×83×66 mm and the left adrenal metastatic mass (Fig. 1), which extended to the posterior pararenal area in the inferior region, and to the renal pelvis and hilus in the superior region. Furthermore, the metastatic right renal mass demonstrated marked central contrast uptake in the arterial phase. Additionally, two metastatic masses, measuring 69×51×53 mm and 18×12×10 mm, were detected in the left (Fig. 3) and right adrenal gland (Fig. 2), respectively, with central necrosis and peripheral contrast uptake.

Bottom Line: The bilateral synchronous adrenal metastases posed a challenge in the diagnosis and treatment of the disease, as there is no standard approach in the literature for the treatment of such patients.However, metastasectomy was selected, as it appears to be the most effective treatment strategy for increasing the rate of cancer-specific survival.As an adrenal mass was present in the current patient, a hormonal examination was recommended and an adrenal-preserving minimally invasive surgical procedure using frozen section examination during surgery was particularly important to prevent the patient from developing adrenal insufficiency.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, School of Medicine, Sifa University, Izmir 35240, Turkey.

ABSTRACT

Renal cell carcinomas (RCCs) metastasize to the adrenal glands via various mechanisms, including lymphatic vessel arterial embolism and retrograde venous embolism. The rate of ipsilateral metastasis is 3-5% and the rate of contralateral metastasis is ~0.7%, however, synchronous bilateral adrenal metastases are extremely rare. Therefore, the optimal diagnosis and treatment strategy for this condition is yet to be thoroughly defined. In the present study, a 50-year-old male patient presented with right flank pain. Ultrasonography (US) revealed a right renal mass and bilateral adrenal metastases, and a computerized tomography (CT) scan determined the size of the lesions: An 86×83×66-mm mass in the lower pole of the right kidney, an 18×12×10-mm mass in the right adrenal gland, and a 69×51×53-mm mass in the left adrenal gland with central necrosis and peripheral contrast uptake. A US-guided biopsy was performed which determined a diagnosis of right RCC and bilateral synchronous adrenal metastasis. Immunohistochemical examination of the biopsy revealed clear cell carcinoma (Fuhrman grade, III). Consequently, right radical nephrectomy, right partial adrenalectomy (with frozen section examination) and left adrenalectomy were planned. The bilateral synchronous adrenal metastases posed a challenge in the diagnosis and treatment of the disease, as there is no standard approach in the literature for the treatment of such patients. However, metastasectomy was selected, as it appears to be the most effective treatment strategy for increasing the rate of cancer-specific survival. As an adrenal mass was present in the current patient, a hormonal examination was recommended and an adrenal-preserving minimally invasive surgical procedure using frozen section examination during surgery was particularly important to prevent the patient from developing adrenal insufficiency.

No MeSH data available.


Related in: MedlinePlus