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

Immunohistochemistry of the metastatic mass demonstrating positive staining for renal cell carcinoma (magnification, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5-ol-09-04-1897: Immunohistochemistry of the metastatic mass demonstrating positive staining for renal cell carcinoma (magnification, ×200).

Mentions: The specimens obtained from the right kidney using the US-guided biopsy technique demonstrated characteristics typical of clear cell RCC, and high magnification examination of the right radical nephrectomy, right partial adrenalectomy and left adrenalectomy specimens revealed tumor cells with an alveolar structure, clear cytoplasm and small nucleolus (hematoxylin and eosin staining; magnification, ×200; Fig. 4). Furthermore, immunohistochemical examination revealed positive staining for RCC and cluster of differentiation 10 (Figs. 5 and 6). Thus, a diagnosis of bilateral adrenal metastasis from clear cell RCC was established.


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

Öztürk H - Oncol Lett (2015)

Immunohistochemistry of the metastatic mass demonstrating positive staining for renal cell carcinoma (magnification, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f5-ol-09-04-1897: Immunohistochemistry of the metastatic mass demonstrating positive staining for renal cell carcinoma (magnification, ×200).
Mentions: The specimens obtained from the right kidney using the US-guided biopsy technique demonstrated characteristics typical of clear cell RCC, and high magnification examination of the right radical nephrectomy, right partial adrenalectomy and left adrenalectomy specimens revealed tumor cells with an alveolar structure, clear cytoplasm and small nucleolus (hematoxylin and eosin staining; magnification, ×200; Fig. 4). Furthermore, immunohistochemical examination revealed positive staining for RCC and cluster of differentiation 10 (Figs. 5 and 6). Thus, a diagnosis of bilateral adrenal metastasis from clear cell RCC was established.

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