Adrenalectomy for solitary adrenal metastasis from colorectal cancer

A 77-year-old man had sigmoidectomy for sigmoid colon cancer. Two years later, a right hepatectomy for a liver metastasis was performed. Two years thereafter, abdominal computed tomography scanning and FDG-PET showed the right adrenal mass. Right adrenalectomy was performed with a diagnosis of solitary adrenal metastasis from sigmoid colon cancer. On pathology, adrenal metastasis was confirmed. The patient underwent adjuvant chemotherapy (IRIS). There have been no signs of recurrence for 6 months after the operation. We conclude that patients with solitary adrenal metastasis from colorectal cancer may benefit from surgical resection.     

Late adrenal metastasis in operable non-small-cell lung carcinoma

Treatment of early-stage (I, II, and some IIIA) non-small-cell lung cancer (NSCLC) is curative resection. Simultaneous isolated adrenal metastasis represents a dilemma. Although many studies addressing the management of adrenal metastasis diagnosed simultaneously with NSCLC have been published, only very few reports of late adrenal metastasis can be found in the literature. Our purpose is to discuss the management of solitary late (metachronous) adrenal metastasis from operable NSCLC based on published experience. We describe a patient with a solitary metachronous adrenal metastasis diagnosed 3 years after resection of NSCLC. Adrenalectomy was done, followed by combination chemotherapy with paclitaxel and carboplatin. MEDLINE literature on similar cases was reviewed and updated. Only 18 cases have been reported from 1965 to 2000. The median interval between the diagnosis of NSCLC and development of adrenal metastasis was 11.5 months. All patients were male. Unilateral adrenal metastases were reported in 15 patients, whereas 3 had bilateral metastases. Five patients were treated with adrenalectomy, and eight patients were treated with adrenalectomy and postoperative adjunctive chemotherapy. Chemotherapy alone was used in two patients and two patients underwent palliative radiation therapy. One patient was treated with intraarterial chemotherapy followed by radiation therapy. Solitary metachronous adrenal metastases are rare. There are no standard treatment guidelines for this group of patients. Review of the literature showed that median survival after treatment was 19 months for the group treated with adrenalectomy followed by chemotherapy; 15 months for the chemotherapy group; 14 months for the adrenalectomy group; and 8 months for the group treated with palliative radiation.     

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.     

Kidney cancer metastasis to the adrenal gland. Role of adrenalectomy

We analysed case records of 2507 patients with renal cell carcinoma treated in the department of onco-urology of Cancer Research Center (Moscow). 1939 of them underwent nephrectomy between 1971 and 1999. The overall incidence of adrenal metastases according to CT and histological findings was 4.7%. Synchronous metastases occurred in 90 and metachronous ones in 30 patients. Radical nephrectomy with adrenalectomy was performed in 18 out of 90 patients with synchronous metastases, palliative nephrectomy in 20 and 52 patients were not considered for surgery. Among 18 patients who underwent complete surgical resection, 12(66%) had either lymph node involvement or distant metastases. A microscopic metastasis was found on histological examination only in 1 patient with normal CT scan and macroscopically intact adrenal on intraoperative assessment. Mean survival after radical nephrectomy with adrenalectomy in 6 patients with solitary lesions was 57 months compared to the longest survival of 31 months in patients with widespread disease. Solitary metachronous ipsilateral and contralateral adrenal involvement was present in 7 patients. The average interval between nephrectomy and appearance of adrenal metastasis in this group was 73 months. One patient was lost for follow-up and one died of adrenal deficiency 4.3 months after adrenalectomy. One patient underwent a consecutive removal of brain and lung metastases 33 and 38 months following adrenalectomy while the remaining 4 were alive in 15, 16, 26 and 34 months with no evidence of the disease. Thus, ipsilateral adrenalectomy is obligatory only in patients with severe disease as shown by CT scan or at nephrectomy. About one-third of the patients will benefit from the surgery. Adrenalectomy should be performed in case of obvious adrenal involvement. The aggressive surgical approach is justified in solitary metachronous adrenal involvement because of long-term survival expected in some of such patients.     

Adrenalectomy for isolated adrenal metastasis after Gamma Knife Surgery for an intracerebral metastasis of non-small-cell lung carcinoma

Only a limited group of patients with non-small-cell lung cancer (NSCLC) is eligible for treatment with a curative intent. Adrenalectomy for a solitary adrenal metastasis of NSCLC may be curative when combined with resection of the primary tumor. It is unclear whether resection of an isolated adrenal metastasis is justified in patients with a second metastasis. We report a case of successful adrenalectomy with adjuvant chemotherapy in a patient who was previously treated with a right lower lobe resection and subsequent Gamma Knife treatment of an intracranial metastasis. At 20-month follow-up, patient was in a good clinical condition without signs of recurrent disease. In selected cases, adrenalectomy with adjuvant chemotherapy for an adrenal metastasis of NSCLC may be performed successfully, with good short-term results, even after earlier treatment of a cerebral metastasis.     

Adrenalectomy for solitary adrenal metastases from non-small cell lung cancer

BACKGROUND: The treatment of patients with adrenal metastases from lung cancer (non-small cell lung cancer, NSCLC) remains controversial. Several studies of adrenalectomy in cases of isolated adrenal metastases from NSCLC suggest that these patients could have improved survival. Our aim is to define the history of patients after resection of solitary metastases to the adrenal gland and to identify characteristics of patients who achieved prolonged survival. METHODS: Between January 1997 and July 2000, 11 patients underwent curative resection for metastatic NSCLC of the adrenal gland in our institution. In all patients who were accepted for curative adrenalectomy, the primary NSCLC had been treated by complete resection. RESULTS: Eleven patients (seven men and four women) with unilateral adrenal metastases of NSCLC entered the study. Median age was 59 years (range 47-67 years). There was no perioperative death. The overall median survival after metastasectomy was 12.6 months (CI: 9.2-16.1 months). Patients with curative resection and metachronous disease (n=6) had a median survival of 30.9 months and tended to do better than patients with synchronous adrenal metastases (n=5) (median survival: 10.3 months). CONCLUSIONS: We conclude that adrenalectomy for clinically solitary, resectable metastases can be performed safely. It appears reasonable that such selected patients should be considered surgical candidates.     

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.     

Surgical management of adrenal metastasis from bronchogenic carcinoma

Surgical treatment for metastatic lesions from lung cancer is seldom performed. We have treated three patients with a unilateral adrenal metastasis with adrenalectomy. Simultaneous resection of primary lung cancer and adrenal metastasis was performed in two cases. This is the first report of such surgical management. Adrenalectomy after lung resection was done in the third case. Two of the patients are alive and well more than 5 years after adrenalectomy. These cases are presented, and the literature is reviewed. © 1995 Wiley-Liss, Inc.     

Metachronous solitary metastasis of renal cell carcinoma to the contralateral adrenal gland after nephrectomy

Background. Metachronous solitary metastasis of renal cell carcinoma (RCC) to the contralateral adrenal gland is very rare. We assessed the clinocopathological findings of such patients who received adrenalectomy. Methods. We retrospectively reviewed the records of all 495 patients who underwent nephrectomy for RCC; excluding those in stage IV, between 1980 and 1993. Of these patients, 5 who showed metachronous solitary metastasis to the contralateral adrenal gland, and also received adrenalectomy were the subjects of this study. Results. The adrenal metastasis was found between 14 and 132 months (median, 81 months) after nephrectomy. After the solitary adrenalectomy, patient survival ranged from 450 to 2160 days (median, 660 days); 2 patients were alive with no evidence of disease at 660 and 1830 days, respectively, and 3 patients died of this disease, at 450, 480, and 2160 days, respectively, after adrenalectomy. The overall survival rate was 100% at 5 years, 80% at 6 years, 60% at 7 years, and 40% thereafter. The 2 patients with no evidence of disease did not receive steroid supplementation, because they had not received ipsilateral adrenalectomy. No significant difference was observed between survivors and non-survivors in terms of clinicopathological factors such as affected side, location of the tumor, tumor size of primary/metastatic lesion, and stage or grade of primary/metastatic lesion. From the viewpoint of outcome, patients with early recurrence tended to show an unfavorable prognosis compared with prognosis in those with late recurrence. Conclusion. The prediction of outcome in patients with RCC who undergo, adrenalectomy for metachronous solitary metastasis to the contralateral adrenal gland is difficult. Although the factors that affect prognosis are uncertain, long-term observation for unusual metachronous metastasis to the contralateral adrenal gland is mandatory in patients with RCC. Received: May 31, 1999 / Accepted: September 20, 1999     

A case of resection of esophageal cancer infiltrating the left main bronchus following preoperative chemo-radiotherapy and resection of metachronous lung metastasis

We herein report a case of T4 esophageal carcinoma, which was resected after chemo-radiation therapy. In addition, the metachronous lung metastasis was also resected. A 59-year-old female with esophageal carcinoma, which invaded the left main bronchus, underwent chemo-radiation therapy (the combination of systemic chemotherapy of 5-FU/CDDP and external radiation therapy) from January 2004. After the therapy, although the imaging showed a downstaging of esophageal carcinoma, a severe esophageal stricture appeared with ingestion defective. So hyper-alimentation was performed. After the state of nutrition was improved, esophagectomy was performed on March 2004 without a complication. Histopathological study revealed that no viable cells remained. Nine months after esophagectomy, chest CT scan revealed that a solitary pulmonary tumor appeared in S6 of the right. The solitary tumor enlarged gradually. On August 2005, a surgical resection for the solitary pulmonary tumor was performed. Histopathologically, the lesion was compatible for metastasis from esophageal carcinoma. The patient is alive without recurrence more than 23 months after the last surgery.     

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.     

Preoperative evaluation of adrenal lesions based on imaging studies and laparoscopic adrenalectomy in patients with otherwise operable lung cancer

PURPOSE: An unsuspected adrenal mass (AM) could be discovered in patients with operable non-small-cell lung carcinoma (NSCLC), but it is difficult to determine the nature of AM. The purpose of the study is to answer the question as to which decision should be made when assessing AM in patients with NSCLC. PATIENTS AND METHODS: From 1997 to 2005, 40 patients (31 male; mean age: 63 years) were identified to have both NSCLC and AM. We tried to determine the nature of AM based on imaging studies with or without laparoscopic adrenalectomy. When AM was considered benign on CT or PET-CT, surgical resection of NSCLC was performed (group 1, n=25). When AM was considered indeterminate on CT or PET-CT, we performed MRI to determine the operability. In eight patients, surgical resection of NSCLC was performed, because AM was considered benign on MRI (group 2). In seven patients, adrenalectomy was performed to confirm AM pathologically, because all imaging studies were indeterminate (group 3). RESULTS: Follow-up was complete for all patients with a mean duration of 33.1 months (3-104.5). In group 1, no patients showed adrenal metastases, except one who died of adrenal metastasis. In group 2, three patients revealed that they had had adrenal metastases when staging and two died of adrenal metastasis. In group 3, one patient had an adrenal metastasis and the others had benign lesions. CONCLUSIONS: We suggest that when AM is considered benign on CT or PET-CT, surgical resection of NSCLC is indicated. However, when AM is indeterminate on CT or PET-CT, histopathologic confirmation is needed to determine the nature of AM.     

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.     

Long-term survival in bronchogenic carcinoma with a solitary metastasis

Partial resection of a huge anaplastic large cell carcinoma of the upper lobe of the right lung was performed in a 47-year-old patient in order to relieve symptoms of pulmonary hypertrophic osteoarthropathy. Several months later a solitary metastasis was noted in the muscles of the right forearm. The metastasis was resected and the forearm irradiated. The patient was further treated with injections of autologous tumour cell vaccine and BCG. Today, 7 years later, the patient is alive, without any signs of neoplastic disease.     

Solitary Adrenal Metastasis in a Patient with Sigmoid Colon Cancer; Report of a Case

A 73-year-old man had sigmoidectomy for sigmoid colon cancer in December 2001. Although he was followed regularly with chemotherapy, his serum carcinoembryonic antigen (CEA) increased on August 2002. Abdominal computed tomography and magnetic resonance imaging showed a right adrenal mass and no other abnormality. The preoperative diagnosis was a solitary adrenal metastasis from sigmoid colon cancer; the lesion was removed in September 2002. On pathology, adrenal metastasis was confirmed. Although the patient’s serum CEA normalized soon thereafter, 12 months after adrenalectomy, the CEA again increased; the patient had local recurrence of the resected adrenal lesion and liver metastasis. Therefore, the patient was given systemic chemotherapy, but his condition deteriorated, and he died 38 months after adrenalectomy. Adrenal metastasis from colorectal cancer is not unusual; however, a solitary metastasis is rarely found and resected surgically. As surgical treatment of the metastatic lesion could improve patients’ prognosis to some extent if it is detected early, the possibility of adrenal metastasis should be kept in mind when colorectal cancer patients are followed.     

Long-Term Survival in Two Cases of Resected Gastric Metastasis of Pulmonary Pleomorphic Carcinoma

We report two pulmonary pleomorphic carcinoma patients both of which underwent surgical resection of solitary gastric metastases. A 69-year-old man developed anemia 5 months after right upper lobectomy for pulmonary pleomorphic carcinoma and gastric metastasis was detected endoscopically. He underwent distal gastrectomy and has survived for 5 years without any other recurrence or metastasis. Preoperative abdominal computed tomography detected a submucosal gastric tumor in a 62-year-old man with left upper lobe pleomorphic carcinoma. A gastrointestinal stromal tumor was suspected. Left upper lobectomy was performed followed by partial gastrectomy with splenectomy. The histologic diagnosis was primary pulmonary pleomorphic carcinoma with gastric metastasis. He has survived for 4 years without any other recurrence or metastasis. Resection of gastric metastasis following complete pulmonary pleomorphic carcinoma resection may be indicated if the metastasis is solitary.     

肾上腺转移癌21例临床分析

背景与目的:近年来肾上腺转移癌的发生率在临床上呈逐年上升趋势,但早期诊断、鉴别诊断有时仍比较困难。肾上腺转移癌是否需要手术切除、何时切除及怎样切除仍然存有争议。本研究旨在探讨肾上腺转移癌手术指征及腹腔镜下肾上腺切除的价值。方法:回顾性分析中山大学附属第一医院1997年3月至2004年3月收治的21例肾上腺转移癌的临床资料及复习有关肾上腺转移癌诊断与治疗方面的文献。结果:本组患者经B超和CT检查,对肾上腺肿物的诊断率分别为70.0%(7/10)与84.6%(11/13)。10例行肾上腺转移癌手术切除,其中4例患者于术后1个月至5年间行腹腔镜肾上腺转移癌切除,切缘均无癌细胞。患者生存1～67个月,中位生存时间18个月,其中1例患者行肾上腺转移癌切除术后67个月仍生存,2例失访。未手术组共11例,生存5～28个月,中位生存时间13个月,1例失访。两组生存率的差异无统计学意义(P=0.346)。结论:B超及CT是诊断肾上腺转移癌的重要检查方法。对转移癌局限在肾上腺包膜内、无局部淋巴结肿大、肾上腺外无转移的应尽可能的行手术治疗。而腹腔镜下肾上腺切除也是安全的、有效的。     

肺黏液表皮样癌1O例临床分析

目的回顾病理证实的肺黏液表皮样癌（pulmonary mucoepidemoid carcinoma,PMEC）临床资料,结合文献分析,为PMEC的诊治提供参考。方法全部病例均行胸部X线、CT和纤维支气管镜检查,近期2例行符合线路显像（SPECT）检查。肿瘤分化程度的确定参照WHO关于涎腺肿瘤的分类,分为高分化（4例）、中分化（2例）、低分化（4例）。结果10例中男6例,女4例;年龄18—62岁,平均43岁。其中7例有临床症状。9例行手术治疗,无手术相关死亡。4例低分化者中2例肺门淋巴结有转移,细胞异型性明显;4例高分化者中1例有肺门淋巴结转移。高、中分化者共6例,术后随访3-15年均存活,未发现复发与转移。低分化4例中1例确诊时广泛转移,未经治疗,3个月后死亡;另3例手术治疗,其中1例确诊时已出现肾上腺转移,行左。肾上腺转移瘤切除,左肺下叶切除＋纵隔淋巴结清扫,术后化疗6个周期,随访8个月,无复发、转移;另2例肺叶切除术后分别随访25和37个月,均存活。结论PMEC起病隐匿,易误诊、漏诊,诊断依赖病理检查。PMEC可见远处转移。建议常规行肺门淋巴结清扫,并至少对纵隔淋巴结进行采样。     

Pancreatic resection for metastatic tumors to the pancreas

We report 3 cases of resectable pancreatic metastasis. CASE 1: A 76-year-old woman was followed after nephrectomy for renal cell carcinoma for 13 years. CT examination demonstrated a high vascular lesion in the pancreatic body and tail. We conducted distal pancreatectomy and diagnosed with metastatic tumor from renal cell carcinoma. She died of liver metastasis 8 years after pancreatic resection. CASE 2: A 64-year-old man, who had undergone right lower lobectomy for lung cancer a year ago, was found to have a mass in the pancreatic tail. We performed distal pancreatectomy and diagnosed with metastatic tumor from lung cancer. He died of lung metastasis 12 months after pancreatic resection. CASE 3: A 62- year-old woman, who had undergone left nephrectomy for renal cell carcinoma 3 years ago, was found to have a mass in the pancreatic body. With a diagnosis of metastatic pancreatic tumor from renal cell carcinoma, distal pancreatectomy was done. She died of liver and lung metastases 15 months after pancreatic resection. Long-term survival can be achieved in patients undergoing a pancreatic standard resection including lymphadenectomy for isolated metastasis from nonpancreatic sites.     

Isolated pancreatic metastasis of hepatocellular carcinoma after curative resection

Hepatocellular carcinoma (HCC) is a highly malignant tumor and extrahepatic metastasis is not rare. The most common organ of HCC metastasis is lung, followed by bone and adrenal gland. To the best of our knowledge, isolated pancreatic metastasis of HCC that developed after curative resection has not been described previously. We report a case of solitary pancreatic metastasis of HCC, which was found 28 mo after left hemihepatectomy for HCC. The lesion was successfully resected with the pancreas, and no other metastatic lesions have been found in follow-up.