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Primary adrenal leiomyosarcoma with lymph node metastasis: a case report.

Onishi T, Yanagihara Y, Kikugawa T, Miura N, Noda T, Kakuda T, Kitazawa R, Tanji N - World J Surg Oncol (2016)

Bottom Line: Right adrenalectomy and lymphadenectomy were performed.No adjuvant therapy was performed, and the patient remains recurrence-free at 10 months postoperatively.Aggressive surgical resection including vascular reconstruction may be associated with improved survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.

ABSTRACT

Background: Leiomyosarcomas typically originate in smooth muscle cell. Leiomyosarcoma potentially arising from the adrenal gland is an extremely rare mesenchymal tumors associated with delayed diagnosis and poor prognosis.

Case presentation: A 34-year-old man visited our department complaining of right hypochondriac pain. Computed tomography demonstrated a solid mass measuring 5.2 cm in diameter above the right kidney, corresponding to the right adrenal gland, and a lymph node mass, which appeared to have invaded the IVC wall. Right adrenalectomy and lymphadenectomy were performed. A microscopic examination revealed primary adrenal leiomyosarcoma with lymph node metastasis. No adjuvant therapy was performed, and the patient remains recurrence-free at 10 months postoperatively.

Conclusions: We experienced a very rare case of primary adrenal leiomyosarcoma. Aggressive surgical resection including vascular reconstruction may be associated with improved survival.

No MeSH data available.


Related in: MedlinePlus

Gross appearance of the tumor sections revealed a grayish-white tumor (a). A normal adrenal gland was not identified. The lymph node mass was excised with the IVC wall (b)
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Fig3: Gross appearance of the tumor sections revealed a grayish-white tumor (a). A normal adrenal gland was not identified. The lymph node mass was excised with the IVC wall (b)

Mentions: Under a diagnosis of right adrenal cancer and lymph node metastasis, the patient underwent right adrenalectomy and lymphadenectomy in December 2014. First, right adrenalectomy with the preservation of the ipsilateral kidney was performed (Fig. 2a). Because the adrenal tumor adhered to the lower surface of the liver, the tumor was removed in conjunction with a part of the liver, posterior lateral segment (VII). Next, as the lymph node mass fixed to the IVC and could not be separated, it was resected with the invaded IVC wall (Fig. 2b). A residual tumor, however, appeared on the opposite site of the IVC wall. Then, as shown in Fig. 2c, the IVC was dissected by Endo GIA™ (Covidien Japan, Tokyo) and the right renal vein was re-anastomosed to the IVC. The surgically excised adrenal mass displaced a smooth surface, and the cut surface was solid and grayish-white in color with some mucoid areas (Fig. 3a). Small necrotic areas were also present. No normal or residual adrenal gland was macroscopically identified. The gross appearance of the excised lymph node mass demonstrated that the tumor undeniably penetrated the IVC wall (Fig. 3b). Histologically, the normal adrenal gland was displaced by the tumor and presented at the edge of the tumor (Fig. 4a). It consisted of spindle-shaped cells with eosinophilic cytoplasm and pleomorphic nuclei (Fig. 4b). No infiltration to the liver was shown. An immunohistochemical examination revealed that the tumor cells were diffusely positive for alpha-smooth muscle actin (Fig. 4c) and negative for S-100 and CD34. The Ki67 index was approximately 50 % in the hot spot. In the mass excised as a lymph node, the tumor cells existed with the lymphatic tissue (Fig. 4d). Finally, a pathological diagnosis of primary adrenal leiomyosarcoma with lymph node metastasis was made.Fig. 2


Primary adrenal leiomyosarcoma with lymph node metastasis: a case report.

Onishi T, Yanagihara Y, Kikugawa T, Miura N, Noda T, Kakuda T, Kitazawa R, Tanji N - World J Surg Oncol (2016)

Gross appearance of the tumor sections revealed a grayish-white tumor (a). A normal adrenal gland was not identified. The lymph node mass was excised with the IVC wall (b)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4930559&req=5

Fig3: Gross appearance of the tumor sections revealed a grayish-white tumor (a). A normal adrenal gland was not identified. The lymph node mass was excised with the IVC wall (b)
Mentions: Under a diagnosis of right adrenal cancer and lymph node metastasis, the patient underwent right adrenalectomy and lymphadenectomy in December 2014. First, right adrenalectomy with the preservation of the ipsilateral kidney was performed (Fig. 2a). Because the adrenal tumor adhered to the lower surface of the liver, the tumor was removed in conjunction with a part of the liver, posterior lateral segment (VII). Next, as the lymph node mass fixed to the IVC and could not be separated, it was resected with the invaded IVC wall (Fig. 2b). A residual tumor, however, appeared on the opposite site of the IVC wall. Then, as shown in Fig. 2c, the IVC was dissected by Endo GIA™ (Covidien Japan, Tokyo) and the right renal vein was re-anastomosed to the IVC. The surgically excised adrenal mass displaced a smooth surface, and the cut surface was solid and grayish-white in color with some mucoid areas (Fig. 3a). Small necrotic areas were also present. No normal or residual adrenal gland was macroscopically identified. The gross appearance of the excised lymph node mass demonstrated that the tumor undeniably penetrated the IVC wall (Fig. 3b). Histologically, the normal adrenal gland was displaced by the tumor and presented at the edge of the tumor (Fig. 4a). It consisted of spindle-shaped cells with eosinophilic cytoplasm and pleomorphic nuclei (Fig. 4b). No infiltration to the liver was shown. An immunohistochemical examination revealed that the tumor cells were diffusely positive for alpha-smooth muscle actin (Fig. 4c) and negative for S-100 and CD34. The Ki67 index was approximately 50 % in the hot spot. In the mass excised as a lymph node, the tumor cells existed with the lymphatic tissue (Fig. 4d). Finally, a pathological diagnosis of primary adrenal leiomyosarcoma with lymph node metastasis was made.Fig. 2

Bottom Line: Right adrenalectomy and lymphadenectomy were performed.No adjuvant therapy was performed, and the patient remains recurrence-free at 10 months postoperatively.Aggressive surgical resection including vascular reconstruction may be associated with improved survival.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.

ABSTRACT

Background: Leiomyosarcomas typically originate in smooth muscle cell. Leiomyosarcoma potentially arising from the adrenal gland is an extremely rare mesenchymal tumors associated with delayed diagnosis and poor prognosis.

Case presentation: A 34-year-old man visited our department complaining of right hypochondriac pain. Computed tomography demonstrated a solid mass measuring 5.2 cm in diameter above the right kidney, corresponding to the right adrenal gland, and a lymph node mass, which appeared to have invaded the IVC wall. Right adrenalectomy and lymphadenectomy were performed. A microscopic examination revealed primary adrenal leiomyosarcoma with lymph node metastasis. No adjuvant therapy was performed, and the patient remains recurrence-free at 10 months postoperatively.

Conclusions: We experienced a very rare case of primary adrenal leiomyosarcoma. Aggressive surgical resection including vascular reconstruction may be associated with improved survival.

No MeSH data available.


Related in: MedlinePlus