Extended survival in a patient with recurrent and metastatic adrenal cortical carcinoma by aggressive transarterial embolization--a case report

The prognosis of inoperable recurrent or metastatic adrenal cortical carcinoma is poor due to lack of effective treatment modalities. We report a case of recurrent and metastatic adrenal cortical carcinoma in which prolonged survival of 58 months was achieved with aggressive three sequential transarterial embolization. It is probably the first reported case with the longest survival by transarterial embolization in the literature to date. A 60-year-old man received operation for left adrenal cortical carcinoma. Liver metastases, tumor bed recurrence, and spleen metastasis were noted during follow-up. Three sequential transarterial embolization for metastatic liver tumors, tumor bed recurrence, and metastatic spleen tumor were performed and resulted in relief of symptoms and prolonged survival of 58 months after recurrence verified. Aggressive transarterial embolization seems to be a safe and effective procedure for symptoms relief, and may prolong survival in the management of inoperable adrenal cortical carcinoma. It can be considered in any patient with inoperable adrenal cortical carcinoma if not contraindicated.     

Stage IV-S neuroblastoma involving the liver and ectopic liver. Report of an unusual case

Stage IV-S (special) neuroblastoma involving the liver and ectopic liver attached to the left adrenal gland of a 38-day-old girl was reported. At surgery, the ectopic liver with neuroblastoma metastases was excised, and the liver was biopsied. The histologic features of neuroblastoma involving hepatic tissue were quite similar in the liver and the ectopic liver. Eighteen months after surgery, the patient was doing well after treatment with less intensive chemotherapy. No similar case has been reported in the literature, and study of this case indicates that the hypothesis of fetal hematogenous metastasis proposed by Wieberdink does not suffice to explain the pathogenesis of extensive involvement of the liver in Stage IV-S neuroblastoma.     

肾上腺少见占位性病变的CT表现

 目的 探讨肾上腺少见占位性病变的CT表现特点。方法 回顾性分析10例经病理证实的肾上腺少见占位性病变的CT资料。结果 10例中，右肾上腺皮质癌2例，右肾上腺神经鞘瘤1例，左肾上腺节细胞神经瘤1例，多发内分泌肿瘤Ⅰ型1例，左肾上腺区巨淋巴结增生症1例，肾上腺髓样脂肪瘤3例4个病灶，右肾上腺囊肿1例。结论 不同的肾上腺少见占位性病变，CT诊断难易不同，囊肿及髓样脂肪瘤，易于诊断；肾上腺皮质癌CT表现提示其为恶性；其他少见病变定性诊断困难。但均有一些价值大小不等的CT特点，CT平扫加动态增强扫描有重要价值     

Successful surgical management of pulmonary and adrenal metastases from hepatocellular carcinoma.

This article reports a rare case of successful surgery for both lung and adrenal metastases after hepatic resection of hepatocellular carcinoma (HCC). A 55-year-old Japanese man with a 5-year history of chronic liver disease was admitted with an elevated serum alpha-fetoprotein (AFP) value and a liver tumour detected by ultrasonography. Hepatic angiogram showed a tumour stain with the right hepatic vein as a venous drain from the tumour. He underwent posterior-inferior subsegmentectomy of the right hepatic lobe following preoperative chemoembolization. Sixteen months after the first operation, he received pulmonary resection for a solitary metastasis in the right lung. A further 10 months later, a metastatic tumour was detected in the left adrenal gland without any recurrent or metastatic foci, and he underwent left adrenalectomy as his third operation. He is still alive, 8 months after his last operation, and 34 months after hepatic resection, with a normal value of AFP and without any recurrent or metastatic foci. This may be the first report of a patient who underwent successful surgery for pulmonary and adrenal metastases of HCC.     

Laparoscopic adrenalectomy for the adrenal gland metastasis from hepatocellular carcinoma

We present a case of a 70-year-old man with an anamnesis of intra-cerebral bleeding that resulted in right half of the body paralysis and right diaphragm paralysis, The present clinical history indicated hepatocellular carcinoma (HCC) caused by hepatitis C and liver cirrhosis during a regular hospital visit, and the patient had a total of 4 TAEs enforced from three years before. A 4 x 3.5 cm neoplasm at the left adrenal was detected by CT inspection this time. The diagnosis was a metastatic adrenal gland tumor from HCC. Since HCC is controlled by TAE, the metastatic lesions were not found in other organs and were isolated, of 10 cm or less in size. Hence, laparoscopic adrenalectomy was performed in March, 2006. He started having a meal from the 2nd day after the operation. He left the hospital on the 9th day. Pathologial diagnosis was a metastatic adrenal gland tumor from moderately differentiated hepatocellular carcinoma. When observing the adaptation standard strictly to the high-risk case, it was thought that the metastatic tumor extraction under laparoscopic surgery could become a low stress cure in consideration of QOL being useful as a local treatment for cancer.     

转移性肾上腺癌的临床治疗（附15例报告）

目的:分析我院收治的15例肾上腺转移性恶性肿瘤的临床资料，结合文献复习，总结临床诊治体会。方法:回顾性分析我院2011年1月至2019年5月收治的15例肾上腺转移性恶性肿瘤患者的临床资料。男12例，女3例；平均年龄为63岁(53～73岁)。肾上腺转移瘤的最大径中位值为4.4 cm（2.0~9.8 cm），左侧11例，右侧3例，双侧1例。原发恶性肿瘤来源:肺7例，肝3例，肾2例，子宫1例，胰腺1例，腹膜后肿物1例。本研究中15例肾上腺转移恶性肿瘤为原发肿瘤确诊后诊断，距离原发肿瘤诊断的中位时间为15.6个月(5~28个月)。15例患者均行手术切除治疗。结果:术后病理细胞类型:腺癌4例，肝细胞癌3例，透明细胞癌2例，弥漫性大B细胞瘤2例，神经内分泌癌1例，癌肉瘤1例，肺小细胞癌1例，肺大细胞癌1例。术后定期随访患者，15例患者生存4~78个月。患者最终死于肿瘤广泛转移。结论:我院肾上腺转移性恶性肿瘤的原发肿瘤以肺癌最为常见，多数转移瘤在定期复查中无意发现。我院肾上腺转移瘤以左侧多见。肾上腺转移瘤治疗方式有手术治疗、介入治疗、经皮肿瘤消融、免疫治疗、放疗和化疗等。     

Muscle metastasis as initial manifestation of epidermoid carcinoma of the lung

Typical sites of squamous cell carcinoma of lung metastases include liver, brain, bones, pulmonary and adrenal glands. In advanced dissemination it can rarely involve the skeletal muscle. The patient in this case report was a 46-year-old man, with no significant medical history. He was admitted to hospital because of a large swelling on his left thigh. Investigations resulted in a diagnosis of primary squamous cell carcinoma of the lung. Biopsy of the left great adductor muscle produced similar pathology to that of the lung primary. This case report describes a skeletal muscle metastasis as the first sign of metastatic disease.     

Bilateral adrenal leiomyosarcoma treated with multiple local therapies

A 62-year-old woman presented with right flank pain, and computed tomography (CT) showed bilateral adrenal tumors (right, 8 cm; left, 4 cm). There were no abnormal findings on physical examination, and adrenal hormone levels in serum and urine were within normal limits. Radiological studies showed a right adrenal tumor with intratumoral hemorrhage, a cystic tumor in the left adrenal gland, and no sign of distant metastasis. Because laboratory tests showed normal levels of adrenal hormones, we considered the tumors to be nonfunctioning adrenal tumors. The right adrenal tumor was surgically removed because it was thought to be malignant, and histological examination revealed that it was a leiomyosarcoma. Postoperative CT showed a pleural metastasis in the right chest wall. The patient received combination chemotherapy with cyclophosphamide, vincristine, adriamycin, and dacarbazine. The metastasis was also treated with radiofrequency ablation (RFA). Because the left adrenal tumor grew rapidly despite two courses of the chemotherapy, it too was surgically removed. After the operation, metastasis in the right iliac bone was treated with RFA and radiotherapy. Positron emission tomography detected bilateral femoral metastases, and these were treated with radiotherapy in combination with a low dose of cisplatin. A liver metastasis and a small metastasis in the left kidney were treated with RFA and a metastasis in the pancreatic tail was removed surgically. Sixteen months after the right adrenalectomy, the patient died due to systemic spread of the disease. Multiple local treatments including RFA, radiotherapy, and resection were effective for the local control of metastatic lesions of adrenal leiomyosarcoma.     

Retrograde metastasis of hepatocellular carcinoma with an interesting lesion of the stomach--a case report

A 48-year-old man with hepatocellular carcinoma (HCC) showing tumor emboli in the portal vein and a typical retrograde metastasis via the portal vessels, is reported. Metastatic lesions were localized only in the veins of the lesser omentum, stomach, lower esophagus, pancreas, left hemidiaphragm and left adrenal gland, due to the hemodynamic alteration of the portal blood flow caused by liver cirrhosis and HCC. No metastatic lesion was found in the lung, Kidney, bone or intestine. As gastric metastasis Borrmann I, II, III and submusal tumor types were reported, but the present case revealed hard fold-like lesions, as it were, hard white varices.     

Contemporaneous bilateral forearm triceps metastases from adenocarcinoma of the lung

Haematogenous skeletal muscle metastases from non-small-cell lung cancer (NSCLC) are rare, and are even more uncommonly observed bilaterally. Usually, NSCLC metastasizes to the liver, adrenal glands, lung, bone, central nervous system and kidney. We report a case of a long-surviving patient with contemporaneous histologically proven bilateral muscle metastases in the right and left forearm triceps, from adenocarcinoma of the lung.     

Metastasis to gallbladder and adrenal gland of renal cell carcinoma

We studied a case of metastasis to the gallbladder and left adrenal gland of clear cell-type renal cell carcinoma (RCC) in the right kidney. A polypoid gallbladder tumor and left adrenal mass were found 2 years after surgery for clear cell-type RCC in a 50-year-old man. The gallbladder tumor and left adrenal mass showed hypervascularity on diagnostic imaging. Systemic image screening showed no other metastatic lesion. Simple cholecystectomy and left adrenalectomy were performed. A histopathological examination showed tumor cells in a gallbladder polyp. Furthermore, based on various specific and immunohistochemical studies, the patient was pathologically diagnosed to have gallbladder and right adrenal gland metastasis of clear cell-type RCC.     

Surgical Treatment of Adrenal Metastasis Following hepatectomy for Hepatocellular Carcinoma

In three patients who underwent hepatectomy for solitary hepatocellularcarcinoma (HCC), adrenal metastases, on the right sides of twopatients and the left side of the third were subsequently detectedby ultrasonography (US) and/or computed tomography (CT), andsuccessfully resected after an average interval of 16 monthsfrom hepatectomy. There were no metastatic lesions in the lung,lymph node or bone. Two patients, however, who were found tohave metastasis in the right adrenal also had multiple smallrecurrent foci in the residual liver. The latter were controlledby arterial embolization therapy and the patients are aliveat 12 and three months post-adrenalectomy. In the other patient,with left adrenal metastasis, the serum alpha fetoprotein levelof 3,000 ng/ml returned to normal and he is doing well threeand a half years after adrenalectomy. Since there is no effectivetherapy for metastatic adrenal HCC after hepatectomy, surgerywould appear to be indicated, should no other distant metastasisbe recognized clinically.     

双侧肾上腺髓质脂肪瘤病例报道及文献复习

目的:结合文献报道一例双侧肾上腺髓质脂肪瘤病例以提高认识。方法:报道一例双侧肾上腺髓质脂肪瘤病例并对文献进行复习。结果:患者，男，56岁，10年前于常规体检时发现左侧肾上腺占位性病变。外院行手术治疗未能成功切除左侧肾上腺病变。术后随访示左侧肾上腺病变逐年增大。患者遂至我院进一步治疗。入院影像学检查显示双侧肾上腺占位性病变，呈现脂肪及多发软组织密度，直径分别为15.8 cm×13.5 cm和6.3 cm×2.5 cm。诊断为双侧肾上腺髓质脂肪瘤。行开放手术切除左侧肾上腺肿物。术后随访未见异常。结论:双侧肾上腺髓质脂肪瘤多继发于内分泌疾病，诊断时应注意原发疾病，必要时采用手术治疗。     

Hepatocellular carcinoma with rhabdomyoblastic differentiation

An extremely unique case of a liver tumor occurring in a 70-year-old man is documented in this article. The primary tumor was well encapsulated by a thick, connective capsule and was histologically composed of two distinct elements, i.e., a common hepatocellular carcinoma (HCC) and a rhabdomyosarcoma. Metastasis of HCC was only seen in the left adrenal gland, whereas intrahepatic metastatic foci as well as tumor thrombi occluding the portal vein branches were composed exclusively of rhabdomyosarcoma. The possibility that the rhabdomyoblastic component might have come from the preexisting HCC by way of metaplastic proliferation is discussed.     

A case in which TS-1, an orally-administered 5-FU chemotherapeutic agent,showed marked effectiveness against scirrhous type gastric cancer with multiple organ metastases

A 67-year-old woman with anorexia and weight loss was referred to our hospital with a diagnosis of type 4 gastric cancer. Since metastases to the liver, left adrenal gland, and Douglas' pouch were detected in addition to ascites and bilateral hydronephrosis, the tumor was judged unresectable and systemic chemotherapy with TS-1 was begun. Symptoms began to improve after the first course, and the patient was discharged and followed as an outpatient. An upper GI series showed improvement of the primary lesion, and cancer cells became undetectable under biopsy. At the end of the third course, computed tomography confirmed that metastases to the liver, the lymph nodes, and the adrenal gland had disappeared. The ascites diminished significantly, and hydronephrosis began to ameliorate. The effectiveness of the drug continued until the end of the eleventh course, and the patient is currently in her seventeenth month as an outpatient. This case shows the effectiveness of TS-1 against scirrhous type gastric cancer, a cancer generally considered resistant to chemotherapy. Furthermore, treatment on an outpatient basis has greatly improved her quality of life.     

Case report--a patient who has survived more than 4 years with repeated resection for bilateral adrenal metastasis from hepatocellular carcinoma

We report a patient with bilateral adrenal metastasis from hepatocellular carcinoma (HCC) who has survived for a long period as a result of repeated resection. A 55-year-old male patient with C type hepatitis underwent transcatheter arterial chemo-embolization (TACE) for HCC in November 1997. There was no recurrence in the liver, but left adrenal metastasis was detected in January 1998, followed by right adrenal metastasis in November 1998. We performed surgical resection for bilateral adrenal metastasis in March 1999. The histological diagnosis was well approximately moderately differentiated hepatocellular carcinoma. A recurrence in the right adrenal gland was detected eight months later. As there was no distant metastasis, we performed re-operation in December 1999. Recurrence in the liver was detected in October 2000 and was treated by TACE. He has survived more than 4 years since the first detection of adrenal metastasis. We conclude that surgical treatment is useful for patients with adrenal metastasis who have no distant viable lesion.     

Castleman's disease in the left upper retroperitoneal space mimicking an adrenal neoplasm: report of a case and literature review

Castleman's disease is a rare disorder characterized by benign proliferation of lymphoid tissue. Most cases occur as a mediastinal mass, although extrathoracic involvement including nodal and extranodal locations has been reported. The left suprarenal location of this localized disease may be mistaken for an adrenal tumor. We report a case of a 51-year-old woman with a Castleman's tumor located superomedial to the upper pole of the left kidney that mimicked an adrenal neoplasm.     

Primary adrenal lymphoma discovered as an incidentaloma: case report and review of the literature

Primary adrenal lymphoma (PAL) discovered at an early stage is extremely rare. We report a case of PAL incidentally discovered by abdominal computed tomography (CT) scan as a 4.5-cm solid mass in the left adrenal gland. The patient was an 80-year-old man, and, from imaging studies, the left adrenal mass was considered to be a non-functioning adrenal cortical cancer. Left adrenalectomy was performed, and the resected tumor proved to be non-Hodgkin's lymphoma of diffuse large B-cell type. Adjuvant chemotherapy was administered, and the patient has been well with no evidence of the disease for 20 months postoperatively. Received: September 3, 1998 / Accepted: November 30, 1998     

Metachronous bilateral adrenal neuroblastoma

A boy with bilateral adrenal neuroblastoma was presented. The left adrenal neuroblastoma was found when he was at 5 years of age and was curatively excised. The right adrenal neuroblastoma was found when he was at 13 years of age and also was totally excised. The authors consider that the case presented is an extremely rare, metachronous primary bilateral adrenal neuroblastoma, reflecting the multicentric origin of neuroblastoma.     

Malignant pheochromocytoma with remarkable response to CVD chemotherapy--a case report

A 60-year-old man was admitted to our hospital with the chief complaint of a left upper abdominal mass. 131I-MIBG scintiscan revealed a left upper abdominal mass, and the patient's serum catecholamine level was very high. Our diagnosis was pheochromocytoma of the left adrenal gland. On Oct. 19, 1995, a left nephrectomy and adrenectomy were performed. The serum catecholamine level then decreased and blood pressure was normalized. Two years later, it became difficult to control the patient's hypertension, and multiple metastatic liver cancer was found by an abdominal CT scan. The diagnosis of malignant pheochromocytoma was confirmed by the accumulation of 131I-MIBG in the liver. We started CVD chemotherapy. After 10 cycles of this chemotherapy, the serum catecholamine level was almost normalized and the metastatic liver cancer was reduced to one-third in size.