1
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Billon E, Dalban C, Oudard S, Chevreau C, Laguerre B, Barthélémy P, Borchiellini D, Geoffrois L, Negrier S, Joly F, Thiery-Vuillemin A, Gross-Goupil M, Rolland F, Priou F, Mahammedi H, Tantot F, Escudier B, Chabaud S, Albiges L, Gravis G. Adrenal Metastases Are Associated with Poor Outcomes in Patients with Metastatic Clear Cell Renal Cell Carcinoma Treated with Nivolumab in the GETUG-AFU-26 NIVOREN Phase 2 Trial. Eur Urol Oncol 2024; 7:742-750. [PMID: 37813745 DOI: 10.1016/j.euo.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Glandular metastases (GMs; adrenal gland, pancreas, thyroid, ovary, breast, or prostate) are rare in metastatic clear cell renal cell carcinoma (mccRCC). Previous studies have indicated that GM patients treated with antiangiogenic therapy experience significantly longer overall survival (OS). OBJECTIVES To assess outcomes for mccRCC with or without GMs treated with nivolumab. DESIGN, SETTING, AND PARTICIPANTS The GETUG-AFU-26 NIVOREN phase 2 trial evaluated the activity and safety of nivolumab in patients with mccRCC who experienced failure of antiangiogenic therapies (NCT03013335). In this ancillary study, patients were divided into two groups according to the presence or absence of at least one GM. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was OS; secondary outcomes were progression-free survival (PFS) and the objective response rate (ORR). Survival was estimated using the Kaplan-Meier method. Univariate and multivariable Cox regression models are used to estimate the hazard ratio (HR) with 95% confidence interval (CI) for survival outcomes. Subgroup analyses were performed for patients with pancreatic metastases and patients with adrenal metastases. RESULTS AND LIMITATIONS Among 720 patients treated with nivolumab between February 2016 and July 2017, 217 had GMs, of whom 151/217 had adrenal metastases and 86/217 had pancreatic metastasis. Patients with adrenal metastases had worse 12-mo OS (64% vs 71.1%) and 6-mo PFS (27.2% vs 36.6%) and a lower objective response rate (12.5%, 95% CI 7.6%-19.0%, vs 23.2%, 95% CI 19.8-27.0%; p = 0.005) than patients without adrenal metastases. Conversely, univariate analysis showed that patients with pancreatic metastases had significantly better 12-mo OS (82.3% vs 67.9%; HR 0.59, 95% CI 0.40-0.85) in comparison to patients with nonpancreatic GMs. On multivariable analysis, only adrenal metastasis remained associated with adverse prognosis. CONCLUSIONS Adrenal metastasis is an independent prognostic factor for poor response and survival in the GETUG-AFU-26 NIVOREN trial. Limited activity with nivolumab was observed for patients with mccRCC with adrenal metastases. These results warrant an evaluation of the prognostic value of adrenal metastases in patients treated with immunotherapy combinations with ipilimumab or tyrosine kinase inhibitors. PATIENT SUMMARY Our study showed that metastasis in the adrenal glands could be an independent factor associated with poor response to immunotherapy and survival for patients with metastatic kidney cancer. It would be useful to evaluate the prognostic value of adrenal gland metastasis in patients treated with immunotherapy combinations or immunotherapy agents combined with drugs called tyrosine kinase inhibitors.
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Affiliation(s)
- Emilien Billon
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France.
| | | | - Stephane Oudard
- Hôpital Européen Georges-Pompidou, University of Paris, Paris, France
| | | | | | | | | | - Lionnel Geoffrois
- Institut de Cancérologie de Lorraine, Centre Alexis Vautrin, Vandoeuvre-Lès-Nancy, France
| | | | | | | | - Marine Gross-Goupil
- Centre Hospitalier Universitaire de Bordeaux-Hôpital Saint-André, Bordeaux, France
| | | | - Frank Priou
- CHD Vendee-Hopital Les Oudairies, La Roche-Sur-Yon, France
| | | | | | | | | | | | - Gwenaelle Gravis
- Institut Paoli-Calmettes, Aix-Marseille Université, Marseille, France
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2
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Wang X, Qian L, Qian Z, Wu Q, Cheng D, Wei J, Song L, Huang S, Chen X, Wang P, Weng G. Therapeutic options for different metastatic sites arising from renal cell carcinoma: A review. Medicine (Baltimore) 2024; 103:e38268. [PMID: 38788027 PMCID: PMC11124732 DOI: 10.1097/md.0000000000038268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/26/2024] [Indexed: 05/26/2024] Open
Abstract
Renal cell carcinoma (RCC) stands among the top 10 malignant neoplasms with the highest fatality rates. It exhibits pronounced heterogeneity and robust metastatic behavior. Patients with RCC may present with solitary or multiple metastatic lesions at various anatomical sites, and their prognoses are contingent upon the site of metastasis. When deliberating the optimal therapeutic approach for a patient, thorough evaluation of significant risk factors such as the feasibility of complete resection, the presence of oligometastases, and the patient's functional and physical condition is imperative. Recognizing the nuanced differences in RCC metastasis to distinct organs proves advantageous in contemplating potential treatment modalities aimed at optimizing survival outcomes. Moreover, discerning the metastatic site holds promise for enhancing risk stratification in individuals with metastatic RCC. This review summarizes the recent data pertaining to the current status of different RCC metastatic sites and elucidates their role in informing clinical management strategies across diverse metastatic locales of RCC.
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Affiliation(s)
- Xue Wang
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Lin Qian
- Department of Urologic Surgery, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Zengxing Qian
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Qihang Wu
- Department of Clinical Laboratory, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Dongying Cheng
- Department of community, Ningbo Yinzhou No. 3 Hospital, Ningbo, China
| | - Junjun Wei
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Lingmin Song
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Shuaihuai Huang
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Xiaodong Chen
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
| | - Ping Wang
- Department of Clinical Laboratory, Ningbo Yinzhou No. 2 Hospital, Ningbo, China
| | - Guobin Weng
- Zhejiang Key Laboratory of Pathophysiology, Ningbo University, Ningbo, China
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3
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Lloyd A, Reeves F, Abu-Ghanem Y, Challacombe B. Metastasectomy in renal cell carcinoma: where are we now? Curr Opin Urol 2022; 32:627-633. [PMID: 36111850 DOI: 10.1097/mou.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Metastatic RCC has a variable natural history. Treatment choice depends on disease and patient factors, but most importantly disease burden and site of metastasis. This article highlights key variables to consider when contemplating metastasectomy for RCC and provide a narrative review on the evidence for metastasectomy in these patients. RECENT FINDINGS Tumour subtype is associated with differing patterns of recurrence. Patients with single or few metastatic sites have better outcomes, and those with greater time interval from initial nephrectomy. Local recurrence is particularly amenable to minimally invasive surgical resection and is oncologically sound. Very well selected cases of liver or brain metastases may benefit from metastectomy, although lung and endocrine metastases have more favourable outcomes. Although site and burden of disease is important, the key determinate of outcome in metastasectomy depends mostly on the ability to achieve a complete resection. Adjuvant treatment is not currently advocated. SUMMARY Metastasectomy should be generally reserved for cases where complete resection is achievable, unless the goal of treatment is to palliate symptoms. This field warrants ongoing research, particularly as systemic therapy and minimally invasive surgical techniques evolve. Elucidating tumour biology to inform patient selection will be important in future research.
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Affiliation(s)
- Alexander Lloyd
- Urology Centre, Guy's & St Thomas' NHS Foundation Trust, London, UK
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4
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Parmar K, Tyagi S, Sharma A, Singh SK. Renal Cell Cancer with Solitary Contralateral Adrenal Gland Metastasis: Feasibility of Simultaneous Metastatectomy with Preservation of Ipsilateral Adrenal Gland. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02295-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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5
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Elective partial and radical nephrectomy in patients with renal cell carcinoma in CT1B stadium. VOJNOSANIT PREGL 2021. [DOI: 10.2298/vsp200520008m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. In renal cell carcinoma (RCC) the choice of surgical
technique, radical (RN) or partial nephrectomy (PN) is still centre
dependant because there still are no absolute recommendations for this
approach. This study aims to analyze the oncological aspects, time until
recurrent disease appears and cancer-specific survival in patients with RCC
in T1bN0?0 depending on the type of surgical procedure partial or radical
nephrectomy. Methods. A clinical observational study of a series of cases
was conducted that analyzed data of 154 patients operated in our institution
with a mean follow up a period not less than five years. The inclusion
criteria included: renal tumours 4-7 cm, histopathological confirmation of
RCC, absence of metastasis and normal serum creatinine. Exclusion criteria
included: the presence of other malignancies, solitary functional kidney or
comorbidities that can compromise renal function, bilateral tumours or
unilateral multiple tumours. Results. The study analyzed data of 154
patients, 97 radical nephrectomies and 57 patients that underwent partial
nephrectomy. Analyzing cancer-specific survival in four patients with RN
there was a disease advancement that led to a lethal outcome, one PN patient
died as a result of local relapse and distant metastasis. Conclusion. Based
on our results PN is a good and safe treatment option for patients with RCC
in T1b stadium. Partial nephrectomy offers a similar tumour control and
better cancer-specific survival.
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6
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Verma Y, Mohith A, Shimjee S, Batra RB, Reddy Aleti S, Verma BS. Adrenal Tumor with Inferior Vena Cava Tumor Thrombus: A Case Report and Review of Literature. J Endourol Case Rep 2020; 6:493-496. [PMID: 33457711 DOI: 10.1089/cren.2020.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To report a rare case of secondary adrenal tumor with tumor thrombus in inferior vena cava (IVC) managed by three-dimensional laparoscopy and review the relevant literature. Case Report: A 60-year-old male patient operated for left-sided renal cell carcinoma 7 years ago, presented with asymptomatic secondary right adrenal tumor with tumor thrombus extending into the IVC through the right adrenal vein. A three-dimensional laparoscopic adrenalectomy with en bloc tumor thrombus evacuation from the IVC was performed. Literature Review and Discussion: The available literature was scanned and reviewed. There was a paucity of literature on the secondary adrenal tumors with IVC thrombus and to the best of our knowledge so far there is no reported case of secondary right adrenal tumor with IVC tumor thrombus that has been managed by three-dimensional laparoscopy. Conclusion: Secondary adrenal tumors with IVC tumor thrombus are rare but challenging and can present after many years of primary surgery. The low-level vena cava tumor thrombus can be managed with three-dimensional laparoscopy.
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Affiliation(s)
| | | | | | | | | | - Balbir S Verma
- Minimally Invasive Urology and Kidney Transplant, Clinique Darne, Floreal and Wellkin Hospital, Moka, Mauritius
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7
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Laparoscopic cytoreductive nephrectomy and adrenalectomy for metachronous RCC metastases-Case report. Int J Surg Case Rep 2020; 74:268-272. [PMID: 32911447 PMCID: PMC7490638 DOI: 10.1016/j.ijscr.2020.08.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/16/2020] [Accepted: 08/23/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION We report the case of a 69 y.o. man with a left solitary kidney presenting 3 tumoral masses and suspicion of a left adrenal nodular tumor. PRESENTATION OF CASE 48 months previously, the patient underwent laparoscopic right radical nephrectomy and adrenalectomy for a clear cell renal carcinoma, with a tumor free adrenal gland. 3D laparoscopic transperitoneal left cytoreductive nephrectomy and left adrenalectomy were performed within 23 min warm ischemia with no need of post operatory hemodialysis. The pathology exam reported metachronous metastases on left adrenal gland and on a left multifocal tumoral solitary kidney from the contralateral clear cell renal carcinoma prior diagnosed and treated at this patient. DISCUSSION Cytoreductive nephrectomy on a solitary kidney brings technical challenges for the laparoscopic approach, especially when the tumor presents as multifocal lesions. Contralateral metachronous metastases and adrenal involvement in case of renal carcinoma are scarcely presented in the literature. CONCLUSION The "en bloc" excision of the tumoral masses optimized warm ischemia time and improved the technical approach, even if the endophytic presentation imposed difficulty.
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8
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Lee MW, Lee HJ. Adrenal insufficiency due to recurrent renal cell carcinoma in the left adrenal gland 3 years after right radical nephrectomy for renal cell carcinoma. Postgrad Med 2019; 132:301-303. [PMID: 31752580 DOI: 10.1080/00325481.2019.1696581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primary adrenal insufficiency due to tumor involvement is very rare. We herein report a case of adrenal insufficiency caused by cancer metastasis to a remaining single adrenal gland in a renal cell carcinoma patient who had undergone radical nephrectomy including removal of the right adrenal gland. The patient presented with abdominal discomfort, nausea, and vomiting which had begun about 3 months earlier. A rapid adrenocorticotropic hormone (ACTH) test showed no cortisol response with upper normal level of baseline ACTH. The patient was treated with prednisolone after diagnosis of primary adrenal insufficiency due to adrenal metastasis. The symptoms improved after prednisolone replacement. The case reminds clinicians the diagnosis of primary adrenal insufficiency due to tumor metastasis should be considered in patients with nonspecific gastrointestinal symptoms.
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Affiliation(s)
- Myung-Won Lee
- Department of Internal Medicine, College of Medicine Chungnam National University and Chungnam National University Hospital , Daejeon, Republic of Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, College of Medicine Chungnam National University and Chungnam National University Hospital , Daejeon, Republic of Korea
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9
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Ahmed HK, Bapir R, Abdula GF, Hassan KMS, Ali RM, Salih MA. Solitary contralateral adrenal metastasis of renal cell carcinoma 15 years following radical nephrectomy: A case report and review of literature. Int J Surg Case Rep 2019; 58:33-36. [PMID: 30999151 PMCID: PMC6468145 DOI: 10.1016/j.ijscr.2019.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Renal cell carcinoma (RCC) is known to metastasize to almost every organ. A well-recognized phenomenon in RCC is late metastatic recurrence after nephrectomy which is arbitrarily defined as more than 10 years. The incidence of solitary ipsilateral and contralateral adrenal metastasis is 3% and 0.7% respectively in patients who have underwent radical nephrectomy. CASE REPORT A57-year-old female presented with an incidental ultrasonic finding of a right adrenal mass 15 years after radical nephrectomy for left side renal cell carcinoma. Further evaluation with abdominal contrast enhanced CT scan revealed a right adrenal mass suggestive of metastatic lesion. The results of laboratory examinations showed the mass to be nonfunctional. Open right adrenalectomy was performed. She was discharged home on 4th postoperative day. Pathological examination revealed morphological and immunohistochemical findings in line with metastatic renal cell carcinoma of the left kidney. During the last 2 years she has being on regular follow up, neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography(PET) scan. DISCUSSION Late metastatic contralateral adrenal recurrence from RCC is very rare and to the best of our knowledge, 5 similar cases have been reported 10 years after radical nephrectomy. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally. CONCLUSION Solitary contralateral adrenal metastatic recurrence of RCC is extremely rare event. Surgical removal is a wise option in these cases that may improve survival.
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Affiliation(s)
| | - Rawa Bapir
- Sulaymaniyah Surgical Teaching Hospital, Urology Department, Sulaymaniyah, Iraq; Shaheed Shawkat Haji Musheer Hospital, Urology Department, Said Sadiq/Sulaymaniyah, Iraq.
| | | | | | - Rawa Muhsin Ali
- Shorsh General Teaching Hospital, Pathology Department, Iraq
| | - Mahabad Abdalaziz Salih
- University of Sulaymaniyah, Faculty of Medical Sciences, School of Medicine, Department of Radiology, Iraq
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10
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Wang W, Li H, Li Y, Gao Z, Feng F, Lin C. Metachronous metastasis to contralateral retroperitoneal adipose tissue after radical nephrectomy: a case report and review of the literature. J Int Med Res 2018; 47:1035-1042. [PMID: 30556455 PMCID: PMC6381487 DOI: 10.1177/0300060518816174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Renal cell carcinoma (RCC) metastasis to the adrenal gland, perirenal adipose tissue, and ureter on the contralateral side is rare. We report a case of solitary metachronous clear cell renal cell carcinoma (ccRCC) metastasis to the contralateral retroperitoneal adipose tissue, which was identified after radical nephrectomy. A patient had undergone retroperitoneal laparoscopic radical nephrectomy for RCC in the right kidney in December 2012. Postoperative pathological analysis showed Fuhrman grade I ccRCC, T1bN0M0. Three years after surgery, a solitary tumor of 1.0 × 1.0 cm was identified by an abdominal computed tomographic scan inside the retroperitoneal fat pad in front of the left posterior abdominal wall, without adhesion to the abdominal wall. The tumor was then completely resected by retroperitoneal laparoscopic resection. Pathological analysis showed that it was a metastasized lesion from a previous tumor. Nine months after surgery, there was no sign of recurrence confirmed by radiographic follow-up. Findings from this case indicate the unpredictability of dissemination of RCC. Our findings support a follow-up regimen that includes regular postoperative computed tomographic scans to identify early metastasis. To the best of our knowledge, this is the first reported case of contralateral retroperitoneal adipose metastasis after laparoscopic tumorectomy.
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Affiliation(s)
- Wenting Wang
- 1 The Central Laboratory Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hui Li
- 2 Department of Pediatrics, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yongwei Li
- 3 Department of Urological Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Zhenli Gao
- 3 Department of Urological Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Fan Feng
- 3 Department of Urological Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Chunhua Lin
- 3 Department of Urological Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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11
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Nouralizadeh A, Afyouni A, Shakiba B, Radhi FK. Simultaneous Bilateral Laparoscopic Adrenalectomy for Adrenal Metastases of Renal Cell Carcinoma: A Case Report. J Endourol Case Rep 2017; 3:142-145. [PMID: 29098197 PMCID: PMC5655842 DOI: 10.1089/cren.2017.0062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The possibility of bilateral adrenal gland metastasis from renal cell carcinoma (RCC) has been extremely rarely reported. Surgery may be the preferred treatment strategy for adrenal metastasis from RCC. In this article, we present a patient with bilateral large adrenal metastases from the left RCC, which was managed with simultaneous bilateral laparoscopic excision. A 64-year-old woman had undergone left adrenal sparing radical nephrectomy for a left RCC 7 years ago. Her abdominal CT scan revealed bilateral large adrenal metastasis. She underwent bilateral laparoscopic adrenalectomy. The operation was uneventful and the patient was discharged after 4 days with no complications. Bilateral laparoscopic adrenalectomy for adrenal metastasis seems to be a feasible and safe procedure in such cases, but this needs to be confirmed by further studies with a larger sample size.
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Affiliation(s)
- Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Afyouni
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Shakiba
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahad Khalid Radhi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Urology, Aljomhori General Hospital, Basrah, Iraq
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12
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Metastases of Renal Cell Carcinoma to the Contralateral Adrenal Gland Managed by Laparoscopic Adrenalectomy. Indian J Surg Oncol 2017; 8:326-330. [DOI: 10.1007/s13193-017-0662-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 04/24/2017] [Indexed: 11/26/2022] Open
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13
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Fergany AF. Adrenal masses: A urological perspective. Arab J Urol 2016; 14:248-255. [PMID: 27900213 PMCID: PMC5122797 DOI: 10.1016/j.aju.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/07/2016] [Accepted: 09/13/2016] [Indexed: 11/24/2022] Open
Abstract
Adrenal masses have become increasingly common due to widespread use of sectional imaging. Urologists are commonly faced with management decisions in patients with adrenal masses. Systemic review of available literature related to surgical adrenal disease was performed to summarise the most pertinent information related to adrenal masses, diagnostic evaluation and surgical treatment. Detailed hormonal evaluation of adrenal disease was not included, being part of endocrinological rather than urological practice. Adrenal masses exhibit a wide spectrum of presentation and pathology, and treatment requires different surgical techniques. Full understanding of the pathology and management of such masses should be completely familiar to practicing urologists.
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Affiliation(s)
- Amr F Fergany
- Glickman Urological and Kidney Foundation, 9500 Euclid Ave - Q10, Cleveland, OH 44195 USA
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14
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Taguchi T, Karashima T, Terada Y. Adrenal and thyroid metachronous metastases from renal cell carcinoma. Endocrine 2016; 53:335-6. [PMID: 26611247 DOI: 10.1007/s12020-015-0815-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Takafumi Taguchi
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan.
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan
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15
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Wu C, Zhou Z, Ye X, Hu W. Synchronous renal cell carcinoma metastasis to the contralateral adrenal gland and pancreas: A case report with 7-year follow-up subsequent to surgical therapy. Oncol Lett 2016; 11:4144-4146. [PMID: 27313756 DOI: 10.3892/ol.2016.4510] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/08/2016] [Indexed: 12/16/2022] Open
Abstract
Metastatic renal cell carcinoma (RCC) disseminates to a number of organ sites and few patients demonstrate long-term survival following surgery. However, synchronous metastasis of RCC to the contralateral adrenal gland and pancreas is rare. In the present report, a case of synchronous RCC metastasis to the contralateral adrenal gland and pancreas in a 55-year-old patient, with an 116×92×61 mm right renal tumor and a 96×79×57 mm left adrenal lesion, is described. In April 2007, right nephrectomy was performed to treat the RCC, left adrenalectomy was performed to treat the adrenal tumor and the pancreatic metastases were resected. The patient remained alive at the 7-year follow-up appointment.
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Affiliation(s)
- Cunzao Wu
- Transplantation Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325003, P.R. China
| | - Zhenxu Zhou
- Transplantation Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325003, P.R. China
| | - Xueting Ye
- Transplantation Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325003, P.R. China
| | - Weilie Hu
- Department of Urology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, P.R. China
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16
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Tanimoto A, Takeuchi S, Yaegashi H, Kotani H, Kitai H, Nanjo S, Ebi H, Yamashita K, Mouri H, Ohtsubo K, Ikeda H, Yano S. Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration. Mol Clin Oncol 2016; 4:537-540. [PMID: 27073657 DOI: 10.3892/mco.2016.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/21/2016] [Indexed: 11/05/2022] Open
Abstract
A 76-year-old female in whom a renal cell carcinoma (RCC) lesion was resected 19 years previously presented to our hospital with cognitive dysfunction. Magnetic resonance imaging and computed tomography revealed nodules in the brain, lung, adrenal gland and a pelvic osteolytic lesion. To identify the primary cancer site, the present study performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the left adrenal lesion. Consequently, the pathological findings of the tissue obtained by EUS-FNA were similar to those of the previous nephrectomy specimen, revealing that the adrenal lesion was the recurrence of RCC. The majority of the metastatic lesions in the patient were reduced in size by the multiple kinase inhibitor, pazopanib. Contralateral adrenal metastasis of RCC is rare and the use of EUS-FNA in the diagnosis of adrenal lesions remains to be elucidated. This is a rare case of adrenal lesion, diagnosed by EUS-FNA. Therefore, EUS-FNA is considered to be a useful diagnostic modality of adrenal metastases from unidentified primary tumor types.
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Affiliation(s)
- Azusa Tanimoto
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shinji Takeuchi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Ishikawa 920-8641, Japan
| | - Hiroshi Kotani
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hidenori Kitai
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Shigeki Nanjo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiromichi Ebi
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Kaname Yamashita
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hisatsugu Mouri
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Koushiro Ohtsubo
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
| | - Hiroko Ikeda
- Division of Pathology, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan
| | - Seiji Yano
- Division of Medical Oncology, Cancer Research Institute, Kanazawa University, Kanazawa, Ishikawa 920-0934, Japan
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Piotrowicz S, Muśko N, Kozikowski M, Nyk Ł, Borówka A, Dobruch J. Contralateral adrenal metastasis from renal cell carcinoma with tumor thrombus in the adrenal vein: a case report. J Ultrason 2016; 15:438-42. [PMID: 26807301 PMCID: PMC4710695 DOI: 10.15557/jou.2015.0041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
A 64-year-old woman presented with contralateral right adrenal metastasis with adrenal vein thrombus, which was diagnosed many years after left nephrectomy with adrenalectomy due to renal cell cancer. The patient underwent right adrenalectomy with adrenal vein tumor thrombectomy for treatment. The pathologic examination confirmed metastatic clear cell carcinoma. The remote but existing risk of developing contralateral adrenal metastasis (CAM) after primary radical nephrectomy supports the idea of sparing the adrenal gland in suitable patients who undergo radical nephrectomy. Contralateral adrenal metastasis from RCC is a rare finding with the potential benefit of cure after resection. Care must be taken in preoperative diagnostics, as this metastasis is capable of causing inferior vena cava tumor thrombus via the suprarenal venous route. According to our knowledge, our case is the second similar entity described in literature so far.
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Affiliation(s)
- Sebastian Piotrowicz
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Natalia Muśko
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Mieszko Kozikowski
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Łukasz Nyk
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Andrzej Borówka
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
| | - Jakub Dobruch
- Department of Urology, Centre of Postgraduate Medical Education, European Health Centre Otwock, Poland
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18
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Metastatic renal cell carcinoma without evidence of a renal primary. Int Urol Nephrol 2015; 48:73-7. [PMID: 26527083 DOI: 10.1007/s11255-015-1145-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/22/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Metastatic renal cell carcinoma (RCC), without an identified kidney primary, has been reported rarely. We report a patient with RCC metastatic to bilateral adrenal glands and liver, without an apparent renal primary. We detail the immunohistochemical and molecular studies employed to substantiate the diagnosis of RCC and direct therapy. METHODS Histopathologic findings were correlated with imaging data and supplemented by a panel of immunohistochemical stains, as well as tumor sequence analysis. RESULTS Despite the presence of bilateral adrenal masses and lack of tumor within kidney parenchyma, the diagnosis of RCC was substantiated by immunohistochemistry (RCC+/PAX2+/PAX8+/Melan-A-/SF-1- among others) and molecular genetic analysis, harboring mutations in VHL, TP53, KDM5C, and PBRM1. After debulking surgery, based on the diagnosis of RCC and the molecular profile, the patient was treated with a tyrosine kinase inhibitor (sunitinib), resulting in stablilization of disease. CONCLUSIONS This case illustrates the role of mutational analysis in carcinomas with rare or unusual presentations, such as metastatic RCC without a renal primary.
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Weight CJ, Mulders PF, Pantuck AJ, Thompson RH. The Role of Adrenalectomy in Renal Cancer. Eur Urol Focus 2015; 1:251-257. [PMID: 28723393 DOI: 10.1016/j.euf.2015.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 11/19/2022]
Abstract
CONTEXT Since the 1960s, routine ipsilateral adrenalectomy (IA) has been considered an integral step in the removal of renal tumors as a part of a radical nephrectomy. However, recent data from the past decade have narrowed the indications for adrenalectomy and called into question the need for adrenalectomy at all in the treatment of renal cell carcinoma (RCC). OBJECTIVE We sought to identify the role of adrenalectomy in the treatment of RCC. Specifically, we wanted to answer the following questions: What is the incidence of ipsilateral adrenal involvement by cancer? How reliable is preoperative imaging? What is the rate of ipsilateral and contralateral metachronous recurrence? And finally, what are the potential noncancer sequelae from unnecessary removal of the adrenal gland? EVIDENCE ACQUISITION A systematic literature search of Embase, PubMed, Cochrane, and Ovid Medline was performed to identify studies evaluating the role of adrenalectomy during RCC surgery. Only articles published in English from the years 2000-2015 were included. Case reports, articles about primary adrenal tumors, letters to the editor, and surgical technique papers were excluded. EVIDENCE SYNTHESIS We found little evidence to suggest that routine IA is associated with a higher risk of short-term surgical or medical complications. We did not find evidence that IA is associated with improved cancer control. Tomographic preoperative imaging of the adrenal gland demonstrating no cancer involvement is rarely wrong (<1% of the time), and the few adrenal lesions missed on imaging can often be identified intraoperatively. Some evidence indicates that IA may be associated with worse long-term survival. Adrenalectomy rates have been decreasing in recent years, reflecting a changing practice pattern. CONCLUSIONS IA at the time of kidney surgery for a renal mass should be performed only if radiographic or intraoperative evidence indicates adrenal gland involvement. PATIENT SUMMARY We sought to define the role of adrenalectomy in patients with kidney cancer. Although there are not high-quality studies to answer this question definitively, we conclude that the adrenal gland should be spared unless there is clinical evidence of adrenal involvement.
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Affiliation(s)
| | - Peter F Mulders
- Radbount University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Allan J Pantuck
- University of California at Los Angles, Los Angeles, CA, USA
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20
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Wang K, Wang J, Sun JI, Zhong D, Tai S, Xu D, Fan YI. Renal cell carcinoma with metachronous metastasis to the contralateral adrenal gland and urinary bladder: A case report. Oncol Lett 2015; 10:2749-2752. [PMID: 26722236 PMCID: PMC4665907 DOI: 10.3892/ol.2015.3722] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 07/30/2015] [Indexed: 12/21/2022] Open
Abstract
The adrenal gland and urinary bladder are rare localizations of metastases of renal cell carcinoma (RCC). In the present study, a case of metastasis to the contralateral adrenal gland and urinary bladder of clear cell-type RCC (ccRCC) in the left kidney is reported in a male who had undergone left radical nephrectomy at 55 years of age. Computed tomography (CT) revealed a mass in the right adrenal gland 5 years following surgery, and type-B ultrasound demonstrated a 1.0-cm solid space-occupying lesion in the right wall of the bladder. Consequently, laparoscopic right adrenalectomy and transurethral resection of the bladder tumor were performed. Furthermore, based on histopathological examination and immunohistochemical staining, the patient was pathologically diagnosed with contralateral adrenal gland and urinary bladder metastasis of ccRCC. CT performed at the 1-year follow-up detected multiple solid space-occupying lesions in the right kidney. Therefore, the patient was treated with sunitinib targeted therapy. To date, the patient is generally in good condition, without evident drug side effects or complaints of discomfort.
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Affiliation(s)
- Kai Wang
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Junkai Wang
- Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - J I Sun
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Dachuan Zhong
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Shengcheng Tai
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
| | - Danfeng Xu
- Department of Urology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, P.R. China
| | - Y I Fan
- Department of Urology, Zhejiang Xiaoshan Hospital, Hangzhou, Zhejiang 311202, P.R. China
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21
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Bex A. Integrating metastasectomy and stereotactic radiosurgery in the treatment of metastatic renal cell carcinoma. EJC Suppl 2015. [PMID: 26217128 PMCID: PMC4041303 DOI: 10.1016/j.ejcsup.2013.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Axel Bex
- The Netherlands Cancer Institute, Department of Urology, Amsterdam, The Netherlands
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22
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Ploumidis A, Spinoit AF, De Naeyer G, Ficarra V, Mottrie A. Robot-assisted radical adrenalectomy with clamping of the vena cava for excision of a metastatic adrenal vein thrombus: a case report. Int J Med Robot 2015; 11:413-7. [PMID: 25727563 DOI: 10.1002/rcs.1641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/06/2014] [Accepted: 12/12/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND Renal or adrenal neoplastic vein thrombi are relative contra-indications for laparoscopic treatment. To the best of our knowledge, we present the first robot-assisted radical adrenalectomy (RARA) with the presence of a thrombus in the adrenal vein. METHODS A 54 year-old male with a history of laparoscopic left radical nephrectomy for clear cell carcinoma was referred to our department with a diagnosed right adrenal tumour extending into the adrenal vein. A RARA was planned through a trans-peritoneal approach, and an en bloc resection of the adrenal and its vein with clamping of the vena cava was performed. RESULTS Console time was 94 min and the estimated blood loss was 44 ml. The pathology report confirmed clear cell carcinoma with negative surgical margins. Convalescence was uneventful. CONCLUSION RARA with thrombectomy and vascular reconstruction can be safe, effective and feasible in experienced hands, using robotic bulldogs.
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Affiliation(s)
- Achilles Ploumidis
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.,Department of Urology, Ghent University Hopsital, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium
| | - Vincenzo Ficarra
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium.,Department of Experimental and Clinical Medical Sciences, Urologic Clinic, University of Padoua, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV Vattikuti Robotic Surgery Institute, Aalst, Belgium
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23
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Öztürk H. Bilateral synchronous adrenal metastases of renal cell carcinoma: A case report and review of the literature. Oncol Lett 2015; 9:1897-1901. [PMID: 25789064 PMCID: PMC4356352 DOI: 10.3892/ol.2015.2915] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/31/2014] [Indexed: 11/23/2022] Open
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.
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Affiliation(s)
- Hakan Öztürk
- Department of Urology, School of Medicine, Sifa University, Izmir 35240, Turkey
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24
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Dabestani S, Bex A. Metastasectomy. KIDNEY CANCER 2015. [DOI: 10.1007/978-3-319-17903-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Bilateral Metachronous Adrenal Metastases of Operated Renal Cell Carcinoma. Urologia 2014; 82:114-7. [DOI: 10.5301/uro.5000094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 11/20/2022]
Abstract
Background The adrenal glands are among the target metastatic organs due to the potential of systemic metastasis from renal cell carcinoma (RCC). The number of cases with bilateral metachronous metastases from RCC is about twenty. Patients and Methods A sixty-one-year-old man presented for routine checks due to an operated left renal tumor (clear cell carcinoma, PT2N0M0, Fuhrman grade III). The patient underwent 18FDG-PET/CT in order to restage the disease upon observation of bilateral adrenal masses on ultrasound and CT. A bilateral metachronous metastasis was found, whose SUVmax was 6.7 × 50 × 38 × 20 cm on the left adrenal gland, and another metastasis whose SUVmax was 5.5 40 × 29 × 20 on the right adrenal gland. Results The patient underwent a CT-guided biopsy and diagnosis of adrenal metastasis was made by pathological and immunohistochemical examination. The laparoscopic treatment was performed. Conclusions There is no standard approach for the treatment of these patients in the literature. But metastasectomy is the most realistic part of the treatment. Making definitive diagnosis with biopsy, following hormonal examination and treatment with minimally invasive adrenal sparing surgical procedure containing frozen-section are strongly recommended. Cancer specific survival significantly increases with metastasectomy.
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26
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Ozturk H, Karaaslan S. Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison's disease. Can Urol Assoc J 2014; 8:E744-8. [PMID: 25408818 DOI: 10.5489/cuaj.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Metachronous adrenal metastasis from contralateral renal cell carcinoma (RCC) surgery is an extremely rare condition. Iatrogenic Addison's disease occurring after metastasectomy (adrenalectomy) is an even rarer clinical entity. We present a case of a 68-year-old male with hematuria and left flank pain 9 years prior. The patient underwent left transperitoneal radical nephrectomy involving the ipsilateral adrenal glands due to a centrally-located, 75-mm in diameter solid mass lesion in the upper pole of the left kidney. The tumour lesion was confined within the renal capsule, and the histo-pathological examination revealed a Fuhrman nuclear grade II clear cell carcinoma. The patient underwent transperitoneal right adrenalectomy. The histopathological examination revealed metastasis of clear cell carcinoma. The patient was diagnosed with iatrogenic Addison's disease based on the measurement of serum cortisol levels and the adrenocorticotropic hormone (ACTH) stimulation test, after which glucocorticoid and mineralocorticoid replacement was initiated. The patient did not have local recurrence or new metastasis in the first year of the follow-up. The decision to perform ipsilateral adrenalectomy during radical nephrectomy constitutes a challenge, and the operating surgeon must consider all these rare factors.
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Affiliation(s)
- Hakan Ozturk
- Department of Urology, School of Medicine, Sifa University, Izmir, Turkey
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27
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Josephides E, Rodriguez-Vida A, Galazi M, Chowdhury S, Suder A. The role of metastasectomy in renal cell carcinoma. Expert Rev Anticancer Ther 2014; 13:1363-71. [PMID: 24236818 DOI: 10.1586/14737140.2013.856762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite significant advances in the systemic treatment of metastatic renal cell carcinoma, long-term survival remains low. A potential way to improve outcomes in selected cases is the use of metastasectomy, which is part of the multimodal treatment of this disease. Although the evidence supporting this approach is limited, we believe it is a reasonable option for certain patients. This review summarizes the evidence supporting this approach.
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Affiliation(s)
- Eleni Josephides
- Department of Medical Oncology, Guy's Hospital, London, SE1 9RT, UK
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28
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Zakoji H, Miyamoto T, Inuzuka H, Sawada N, Takeda M. Contralateral Adrenal Metastasis of Renal Cell Carcinoma Arising From a Horseshoe Kidney: An Initial Case Report. Urol Case Rep 2014; 2:131-3. [PMID: 26839790 PMCID: PMC4735484 DOI: 10.1016/j.eucr.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 04/16/2014] [Indexed: 11/25/2022] Open
Abstract
A 71-year-old woman with a right adrenal mass detected by computed tomography was referred to our institution. Before 33 months, she had undergone a radical heminephrectomy for an 11-cm renal cell carcinoma (RCC) in the left moiety of a horseshoe kidney. The adrenal tumor was diagnosed as the metastasis of RCC. The tumor was subsequently removed in a laparoscopic adrenalectomy by a retroperitoneal approach. Pathologic examination revealed the mass to be the adrenal metastasis of RCC. To our knowledge, this is the initial report of a laparoscopic adrenalectomy for the adrenal metastasis of renal cell carcinoma arising from a horseshoe kidney.
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Affiliation(s)
- Hidenori Zakoji
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi, Japan
| | - Tatsuya Miyamoto
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi, Japan
| | - Hideyasu Inuzuka
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi, Japan
| | - Norifumi Sawada
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi, Japan
| | - Masayuki Takeda
- Department of Urology, Faculty of Medicine, University of Yamanashi, Chuo-city, Yamanashi, Japan
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Hirayama T, Fujita T, Koguchi D, Nishi M, Kurosaka S, Tsumura H, Tabata KI, Iwamura M. Laparoscopic adrenalectomy for metastatic adrenal tumor. Asian J Endosc Surg 2014; 7:43-7. [PMID: 24251723 DOI: 10.1111/ases.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 09/22/2013] [Accepted: 10/02/2013] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Treating adrenal metastases from primary malignancies with laparoscopic adrenalectomy (LA) remains controversial. The aim of this study was to evaluate the feasibility, effectiveness and efficiency of LA for solitary adrenal metastasis. METHODS From November 2003 to September 2012, eight consecutive patients with adrenal metastasis were treated with LA. A retrospective study was conducted, and clinical and histological data were analyzed. RESULTS All LA were successfully performed. There were no major complications, blood transfusions or conversions to open adrenalectomy. The patients included seven men and one woman with a median age of 59 years at the time of operation. Adrenal metastases were most commonly noted to be from non-small-cell lung cancer (four patients) and renal cell carcinoma (four patients). The majority of adrenal metastases were unilateral (right: one patient; left: seven patients). One patient had bilateral metastases. The median overall survival was 14 months. Four patients (two with non-small-cell lung cancer; two with renal cell carcinoma) were alive with no evidence of metastatic disease as of October 2013. CONCLUSION LA is a safe and effective procedure for patients with isolated metastases. Surgical resection with LA for a solitary adrenal metastasis from primary malignancy can achieve a good prognosis.
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Affiliation(s)
- Takahiro Hirayama
- Department of Urology, Kitasato University School of Medicine, Sagamihara, Japan
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30
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Bradley CT, Strong VE. Surgical management of adrenal metastases. J Surg Oncol 2013; 109:31-5. [PMID: 24338382 DOI: 10.1002/jso.23461] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/10/2013] [Indexed: 12/15/2022]
Abstract
In the presence of a history of cancer, adrenal masses are commonly, but not exclusively, metastases. Depending upon the status of the patient's ongoing cancer therapy, overall tumor burden, and performance score, adrenalectomy is a viable treatment option. Herein we review the prevalence, diagnostic evaluation, and selection for surgical treatment of adrenal metastases. Additional attention is paid to recent data supporting the safety and oncologic efficacy of laparoscopic adrenalectomy.
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Affiliation(s)
- Ciarán T Bradley
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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31
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Metachronous periadrenal Fatty tissue metastasis from contralateral renal cell carcinoma. Case Rep Urol 2013; 2013:206078. [PMID: 23533927 PMCID: PMC3603165 DOI: 10.1155/2013/206078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 02/10/2013] [Indexed: 11/17/2022] Open
Abstract
Contralateral adrenal metastases from renal cell carcinomas are not commonly seen. To our knowledge, we are presenting the first case of extraadrenal metastasis in the English literature, from the contralateral RCC 6 months after radical nephrectomy. Patient was treated with robotic right adrenalectomy for continuous growing of a de novo right adrenal mass of 6 × 4 × 3 cm in diameter. Tissue between vena cava, renal capsule, and inferior diaphragmatic surface was removed en block. Pathological evaluation revealed renal cell carcinoma within the fatty tissue abutting the adrenal capsule from outside with negative surgical margins. Our experience dictates that removing adrenal tissue only after identifying the adrenal borders may sometimes result in insufficient tumor removal. Therefore, adrenal containing tissue within the anatomic boundaries should be removed en block, if surgical removal is planned for metachronous tumor metastasis in the treatment of renal cell carcinoma.
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32
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Bex A. Metastasectomy. KIDNEY CANCER 2012. [DOI: 10.1007/978-3-642-21858-3_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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33
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Sancho JJ, Triponez F, Montet X, Sitges-Serra A. Surgical management of adrenal metastases. Langenbecks Arch Surg 2011; 397:179-94. [DOI: 10.1007/s00423-011-0889-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
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34
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Eldaya RW, Paulino AC, Blanco AI, Chiang S, South M, Lehane D, Teh BS. Preservation of adrenal function after successful stereotactic body radiation therapy of metastatic renal cell carcinoma involving the remaining contralateral adrenal gland. Pract Radiat Oncol 2011; 2:270-273. [PMID: 24674163 DOI: 10.1016/j.prro.2011.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/04/2011] [Accepted: 11/10/2011] [Indexed: 12/31/2022]
Affiliation(s)
- Rami W Eldaya
- University of Texas Medical Branch, Galveston, Texas
| | - Arnold C Paulino
- Department of Radiation Oncology, The Methodist Hospital/The Methodist Hospital Research Institute, Houston, Texas
| | - Angel I Blanco
- Department of Radiation Oncology, The Methodist Hospital/The Methodist Hospital Research Institute, Houston, Texas
| | - Stephen Chiang
- Department of Radiology (Nuclear Medicine), The Methodist Hospital/The Methodist Hospital Research Institute, Houston, Texas
| | - Michael South
- Department of Radiation Oncology, The Methodist Hospital/The Methodist Hospital Research Institute, Houston, Texas
| | - Daniel Lehane
- Department of Academic Medicine, The Methodist Hospital, Houston, Texas
| | - Bin S Teh
- Department of Radiation Oncology, The Methodist Hospital/The Methodist Hospital Research Institute, Houston, Texas.
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Wiesner C, Haferkamp A. [Metastatic renal cell carcinoma: therapeutic concepts for non-medicinal treatment]. Urologe A 2011; 50:853-60. [PMID: 21678107 DOI: 10.1007/s00120-011-2599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Metastatic renal cell carcinoma has a poor prognosis with a median overall survival rate of approximately 2 years. The current standard medicinal therapy includes the use of tyrosine kinase inhibitors or antiangiogenic substances, such as VEGF receptor antagonists. Improvement in clinical response is to be expected when surgical tumor debulking by nephrectomy or metastasectomy is performed before medicinal therapy is started and should be considered especially in patients with a good performance status. Additionally, complete resection of solitary or at least a limited number of metastases can potentially be done with curative intent. Radiotherapy remains the standard procedure for palliative therapy of brain metastases to reduce clinical symptoms and to improve intracerebral tumor control.
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Affiliation(s)
- C Wiesner
- Klinik für Urologie und Kinderurologie, Klinikum der Johann-Wolfgang-Goethe-Universität, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Deutschland.
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36
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Weight CJ, Kim SP, Lohse CM, Cheville JC, Thompson RH, Boorjian SA, Leibovich BC. Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland. Eur Urol 2011; 60:458-64. [PMID: 21514718 DOI: 10.1016/j.eururo.2011.04.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/07/2011] [Indexed: 01/24/2023]
Abstract
BACKGROUND The indications for the removal of the ipsilateral adrenal gland in patients with renal cell carcinoma (RCC) and the long-term outcomes have not been well studied. OBJECTIVE We evaluated the risk of synchronous and asynchronous adrenal involvement in patients with RCC and the effect of adrenalectomy on recurrence and survival in a large, single-institution cohort. DESIGN, SETTING, AND PARTICIPANTS From 1970 to 2006, 4018 consecutive patients with RCC treated by surgical extirpation (radical nephrectomy [RN]: 3107; partial nephrectomy [PN]: 911) from Mayo Clinic were studied for adrenal involvement. Risk of asynchronous adrenal metastasis and cancer-specific survival (CSS) were also compared between those who underwent concomitant ipsilateral adrenalectomy (n = 1541) and those who did not (n = 2477) using multivariate Cox models. INTERVENTION Surgical removal of the adrenal gland at the time of kidney tumor resection. MEASUREMENTS Primary outcome is cancer specific survival; secondary outcomes are incidence of synchronous and asynchronous adrenal metastases. RESULTS AND LIMITATIONS Median postoperative follow-up among those still alive was 8.2 yr (interquartile range [IQR]: 5.3-13.6). Synchronous ipsilateral adrenal involvement was rare (n = 88; 2.2%). Ipsilateral adrenalectomy at the time of nephrectomy did not lower the risk of subsequent adrenal metastasis (hazard ratio [HR]: 0.96; 95% confidence interval [CI], 0.64-1.42) or improve CSS (HR: 1.08; 95% CI, 0.95-1.22). The development of asynchronous adrenal metastasis occurred in 147 patients (3.7%) at a median of 3.7 yr (IQR: 1.2-7.7) after initial surgery. The risk of developing an ipsilateral versus a contralateral asynchronous adrenal metastasis was equivalent at 10 yr in those who did not undergo adrenalectomy at initial surgery. This study is limited by its single-institution, nonrandomized nature. CONCLUSIONS Routine ipsilateral adrenalectomy in patients with high-risk features does not appear to offer any oncologic benefit while placing a significant portion of patients at risk for metastasis in a solitary adrenal gland. Therefore, adrenalectomy should only be performed with radiographic or intraoperative evidence of adrenal involvement.
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Hijioka S, Sawaki A, Mizuno N, Hara K, Mekky MA, El-Amin H, El-Abdeen Ahmed Sayed Z, Tajika M, Niwa Y, Yamao K. Contrast-enhanced endoscopic ultrasonography (CE-EUS) findings in adrenal metastasis from renal cell carcinoma. J Med Ultrason (2001) 2011; 38:89-92. [PMID: 21836820 PMCID: PMC3150819 DOI: 10.1007/s10396-010-0297-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/26/2010] [Indexed: 01/30/2023]
Abstract
Solitary adrenal metastasis is often difficult to distinguish from benign adrenal tumor using only plain computed tomography (CT) scanning. We describe a solitary left adrenal gland mass in a patient who had undergone simultaneous gastrectomy and right nephrectomy for advanced gastric cancer and renal cell carcinoma (RCC), respectively. Contrast-enhanced endoscopic ultrasonography (CE-EUS) findings indicated a hypervascular adrenal mass, and EUS-guided fine needle aspiration (EUS-FNA) revealed clear cell carcinoma. Adrenalectomy confirmed metastatic clear cell carcinoma of the kidney.
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Ishida M, Kojima K, Ohtomo K. Renal cell carcinoma with double synchronous contralateral adrenal metastases. Korean J Urol 2010; 51:879-81. [PMID: 21221210 PMCID: PMC3016436 DOI: 10.4111/kju.2010.51.12.879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Accepted: 09/01/2010] [Indexed: 11/18/2022] Open
Abstract
A 63-year-old male patient visited our hospital with a right incidental renal tumor, which was found by ultrasonography for the follow-up study of chronic hepatitis B virus infection and diabetes mellitus. Consecutive computed tomography revealed a right renal tumor and two left adrenal tumors. Further systemic imaging study and hormonal examination suggested one right renal cell carcinoma and left adrenal metastases. We performed right nephrectomy and left adrenalectomy. The pathological diagnoses of all resected tumors were renal cell carcinoma. The patient has been in good health without any recurrence for 12 months since the operation. In patients with renal cell carcinoma, contralateral adrenal metastasis is usually associated with multiple metastases to other organs. There are a few cases of solitary and synchronous contralateral adrenal metastasis in the English literature. To our knowledge, this is the first report of a case of renal cell carcinoma with double synchronous contralateral adrenal metastases.
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Affiliation(s)
- Masanori Ishida
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
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Moslemi MK, Saghafi H, Firoozabadi MHD. Renal Cell Carcinoma with Simultaneous Bilateral Adrenal Metastasis: Ipsilateral Radical Nephrectomy with Contralateral Adrenal Preservation. Case Rep Oncol 2010; 3:372-379. [PMID: 21113346 PMCID: PMC2992424 DOI: 10.1159/000321717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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.
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Affiliation(s)
- Mohammad Kazem Moslemi
- Department of Urology, Kamkar Hospital, School of Medicine, Qom University of Medical Sciences, Qom, Iran
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Surgical management of metastases to the adrenal gland: open, laparoscopic, and ablative approaches. Curr Urol Rep 2009; 10:67-72. [PMID: 19116098 DOI: 10.1007/s11934-009-0012-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The adrenal gland is a potential site of metastasis for various malignancies. Metastases to the adrenal gland are the second most common type of adrenal mass lesion after adenomas. Differentiation of a metastatic lesion from a primary adrenal lesion can be challenging and requires the selective use of radiologic imaging, serologic testing, and adrenal biopsy. In patients who present with an isolated adrenal metastasis, adrenalectomy is often considered to aid in cancer control. Numerous studies have reported improved survival with resection of solitary adrenal metastases for various types of primary tumors. Traditionally, open adrenalectomy was the preferred option for these patients. More recently, laparoscopic adrenalectomy has offered a minimally invasive approach, with its resultant advantages of improved perioperative parameters. Proper patient selection for the laparoscopic versus open approach remains paramount in deciding the best treatment for the individual patient.
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The Necessity of Adrenalectomy at the Time of Radical Nephrectomy: A Systematic Review. J Urol 2009; 181:2009-17. [PMID: 19286216 DOI: 10.1016/j.juro.2009.01.018] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Indexed: 11/20/2022]
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Lane BR, Tiong HY, Campbell SC, Fergany AF, Weight CJ, Larson BT, Novick AC, Flechner SM. Management of the adrenal gland during partial nephrectomy. J Urol 2009; 181:2430-6; discussion 2436-7. [PMID: 19371896 DOI: 10.1016/j.juro.2009.02.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Indexed: 01/03/2023]
Abstract
PURPOSE Nephron sparing surgery is an increasingly used alternative to Robson's radical nephroadrenalectomy. The indications for adrenalectomy in patients undergoing partial nephrectomy are not clearly defined and some surgeons perform it routinely for large and/or upper pole renal tumors. We analyzed initial management and oncological outcomes of adrenal glands after open partial nephrectomy. MATERIALS AND METHODS Institutional review board approval was obtained for this study. During partial nephrectomy the ipsilateral adrenal gland was resected if a suspicious adrenal nodule was noted on radiographic imaging, or if intraoperative findings indicated direct extension or metastasis. RESULTS Concomitant adrenalectomy was performed in 48 of 2,065 partial nephrectomies (2.3%). Pathological analysis revealed direct invasion of the adrenal gland by renal cell carcinoma (1), renal cell carcinoma metastasis (2), other adrenal neoplasms (3) or benign tissue (42, 87%). During a median followup of 5.5 years only 15 patients underwent subsequent adrenalectomy (0.74%). Metachronous adrenalectomy was ipsilateral (10), contralateral (2) or bilateral (3), revealing metastatic renal cell carcinoma in 11 patients. Overall survival at 5 years in patients undergoing partial nephrectomy with or without adrenalectomy was 82% and 85%, respectively (p = 0.56). CONCLUSIONS Adrenalectomy should not be routinely performed during partial nephrectomy, even for upper pole tumors. We propose concomitant adrenalectomy only if a suspicious adrenal lesion is identified radiographically or invasion of the adrenal gland is suspected intraoperatively. Using these criteria adrenalectomy was avoided in more than 97% of patients undergoing partial nephrectomy. Even using such strict criteria only 13% of these suspicious adrenal nodules contained cancer. The rarity of metachronous adrenal metastasis and the lack of an observable benefit to concomitant adrenalectomy support adrenal preservation during partial nephrectomy except as previously outlined.
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Affiliation(s)
- Brian R Lane
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Bahrami A, Truong LD, Shen SS, Krishnan B. Synchronous renal and adrenal masses: an analysis of 80 cases. Ann Diagn Pathol 2009; 13:9-15. [DOI: 10.1016/j.anndiagpath.2008.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Metachronous adrenal metastases (AM) from renal cell carcinoma (RCC) are rare. We report our experience of surgical resection in this setting, with particular respect to laparoscopic approach and long-term outcome. METHODS A retrospective review of 11 patients who underwent adrenalectomy for metachronous AM from RCC was conducted between 2002 and 2005 in a tertiary referral center. RESULTS CT scan findings were those of an adrenal mass ranging from 2 to 13 cm in diameter with a basal density of 12 to 28 Hounsfield Units and strong heterogeneous enhancement following contrast injection. The surgical procedure consisted of controlateral (n = 5), ipsilateral (n = 2), and bilateral (n = 1) laparoscopic adrenalectomy, whereas three patients underwent controlateral open adrenalectomy for adrenal mass >10 cm. Nine patients were recurrence-free with a median follow-up of 34 months. In the remaining two patients, lung metastases were discovered at postoperative months 28 and 11, respectively. The former patient is alive and free of disease recurrence 32 months after lung metastasis resection, whereas the latter is currently being treated with sunitinib. CONCLUSIONS This study confirms that prolonged overall and disease free-survival can be achieved in selected patient after laparosocpic adrenalectomy for AM from RCC.
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Hwang EC, Ki HC, Jung SI, Park JB, Im CM, Kim SO, Kang TW, Kwon DD, Park K, Ryu SB. Metachronous Solitary Contralateral Adrenal Metastasis of Renal Cell Carcinoma. Chonnam Med J 2009. [DOI: 10.4068/cmj.2009.45.3.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eu Chang Hwang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun Chong Ki
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Seung Il Jung
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Jun Back Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Chang Min Im
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Sun-Ouck Kim
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Kwangsung Park
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
| | - Soo Bang Ryu
- Department of Urology, Chonnam National University Medical School, Gwangju, Korea
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Utsumi T, Suzuki H, Nakamura K, Kim W, Kamijima S, Awa Y, Araki K, Nihei N, Naya Y, Ichikawa T. Renal cell carcinoma with a huge solitary metastasis to the contralateral adrenal gland: A case report. Int J Urol 2008; 15:1077-9. [DOI: 10.1111/j.1442-2042.2008.02182.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zacharakis E, Ribal MJ, Zacharakis E, Patel HR. Transperitoneal laparoscopic adrenalectomy for metachronous contralateral adrenal metastasis from renal cell carcinoma: a case report. CASES JOURNAL 2008; 1:185. [PMID: 18822119 PMCID: PMC2562357 DOI: 10.1186/1757-1626-1-185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 09/26/2008] [Indexed: 11/16/2022]
Abstract
Background We report a case of metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland treated by laparoscopic transperitoneal adrenalectomy. Case presentation A 58-year-old man presented to our institution for regular follow up, 2 years after a right radical nephrectomy with preservation of the ipsilateral adrenal gland, for a primary renal cell carcinoma. The patient remained asymptomatic but an abdominal computed tomography scan on follow up revealed a 6.5 × 4 cm2 mass in the left adrenal gland. A positron emission tomography scan was also performed to rule out other possible metastases, and a magnetic resonance imaging scan was used for accurate localization and determination of resectability of the adrenal tumour. A bone scan, metabolic screen, liver and renal function tests were all within normal limits. A laparoscopic transperitoneal adrenalectomy was then performed. The postoperative period was uneventful, and the patient was discharged on postoperative day two. The patient remains in satisfactory condition and no recurrence or adrenal insufficiency has been observed during 12 months follow up. Conclusion Metachronous contra lateral adrenal metastases from primary renal cell carcinoma are very rare but should always be suspected in any nephrectomised patient presenting with an adrenal tumour. Regular follow up in these patients accompanied with computed tomography imaging may help the surgeon to detect early lesions. Laparoscopic transperitoneal adrenalectomy is feasible, safe and effective, with minimal trauma to the patient.
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Affiliation(s)
- Evangelos Zacharakis
- Section of Laparoscopic Urology, The Institute of Urology, University College Hospital, London, UK.
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Delis SG, Bakogiannis A, Ciancio G, Soloway M. Surgical management of large adrenal tumours: the University of Miami experience using liver transplantation techniques. BJU Int 2008; 102:1394-9. [DOI: 10.1111/j.1464-410x.2008.07792.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huang JG, O'Malley PJ, Khaira HS, Costello AJ. Contralateral adrenal metastasis from renal cell carcinoma. ANZ J Surg 2007; 77:705-6. [PMID: 17635292 DOI: 10.1111/j.1445-2197.2007.04196.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Featherstone JM, Bass P, Cumming J, Smart CJ. Solitary, late metastatic recurrence of renal cell carcinoma: two extraordinary cases. Int J Urol 2007; 13:1525-7. [PMID: 17118029 DOI: 10.1111/j.1442-2042.2006.01577.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Late recurrence of renal cell carcinoma (RCC) has been well documented in the literature. We present two extraordinary cases of solitary, late metastatic recurrence of RCC. The first is a case of a solitary, adrenal metastasis excised 38 years after nephrectomy and the second is a case in which two solitary metastatic deposits were resected 14 and 26 years after excision of the primary tumor. In each of these patients the solitary metastases were initially believed to be primary tumors at other sites; however, on histological examination they were found to be metastatic RCC recurrences. In patients with a previous history of RCC presenting with apparently new solitary lesions, metastatic RCC must first be excluded.
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Affiliation(s)
- Jonathan M Featherstone
- Department of Urology, Southampton University Hospitals National Health Services Trust, Southampton, Hampshire, UK.
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