Isolated pancreatic metastasis from melanoma. Case report

Pancreas is frequently site of isolated metastasis, approximately in the 40% of cases in patient with previous history of malignant neoplasia, more frequently from renal cell carcinoma. The melanoma metastasis can also interest the pancreas in case of disseminated disease (50% of the cases); more rarely the pancreas is site of isolated metastases from melanoma. The treatment of the pancreatic metastases from melanoma is controversial: the therapeutic choices are few and the role of surgery is not well defined. If the metastasis are confined to the pancreas, the surgical treatment can be useful for better long time survival. We report a rare case of melanoma with pancreatic isolated metastasi in a patient with a previous melanotic metastasis to the inguinal lymph nodes without evidence of primitive tumor.     

Giant and bilateral adrenal myelolipoma. Case report

The adrenal myelolipoma is a relatively rare benign tumour of adipose cell and bone marrow elements, non functioning and asymptomatic. Giant and bilateral adrenal myelolipoma is quite rare. The Authors report a case of bilateral adrenal myelolipoma, a giant one (> 15 cm) on the left side and a small one (> 4 cm) on the right with constant pain in a 57-year-old man, shown by computerized tomography. The hormonal blood tests were normal. Surgical excision was performed for large left symptomatic mass, by open laparotomy, and biopsy for right minor adrenal lesion. Histology confirmed diagnosis of myelolipoma for both masses. Follow-up to 6-12 months did'nt show any change of the right myelolipoma. The authors agree with the need to remove the giant adrenal myelolipoma, because the lesion > 10 cm have a high risk of cancer and hemorrhagic complication, while for small myelolipoma (< 6 cm) 6-12 months follow-up is the appropriate choice.     

Case report on metastasis surgery in adrenal cortex cancer]

The authors report on a 39-year-old woman who underwent adrenalectomy because of a carcinoma and developed an isolated metastatic recurrence in the liver 4 years later, which was detected by regular screening of the level of cortisol, testosterone and androstenedione in plasma. After hemihepatectomy, normalization of the hormone levels and complete regression of all symptoms occurred. Regular screening of hormone levels in the blood after operation is of great benefit for the detection of later recurrences in hormone-active carcinomas (over 50% of the total). The surgical approach to isolated metastatic recurrences in special cases seems promising.     

Adrenal failure due to bilateral adrenal metastasis of rectal cancer: A case report

IntroductionIt is rare for a patient to present with adrenal insufficiency secondary to bilateral adrenal metastases from a malignant colorectal tumor.Case presentationAn 82-year-old Japanese man presented to our hospital with high fever and malaise. He was receiving oral chemotherapy for the treatment of rectal cancer with multiple metastases. Computed tomography showed new bilateral adrenal gland metastases. A rapid adrenocorticotropic hormone (ACTH) test showed adrenal insufficiency. Treatment with hydrocortisone provided immediate symptom improvement.DiscussionAdrenal insufficiency secondary to bilateral adrenal metastases from rectal cancer is rare. A rapid ACTH test is useful to diagnose adrenal insufficiency.ConclusionThe incidence of adrenal insufficiency may be underestimated in patients with multiple metastasis. Appropriate therapy with adrenal corticosteroid hormone supplementation may lead to a significant improvement in the patient’s symptoms and quality of life.     

Thyroid metastasis of a renal carcinoma. Case report

The thyroid metastasis of renal carcinoma is a very rare entity; in most cases, the diagnosis is obtained after necropsy. We report one clinical case of thyroid metastasis from a renal carcinoma presenting as a cold node seven years after nephrectomy. We perform a bibliographic review.     

Bilateral adrenal gland metastasis of renal adenocarcinoma--a case report

A 72-year-old male patient, who suffered from a renal adenocarcinoma with bilateral adrenal gland metastasis, is reported herein. The patient consulted the urology clinic with complaints of fever and dysuria. On drip infusion pyelography, a mass lesion was discovered in the upper pole of the left kidney. Computerized tomography (CT) revealed the presence of bilateral adrenal masses. On the basis of aortography and CT studies, the patient was diagnosed as having renal cancer with metastasis in bilateral adrenal glands. No other metastasis could be found. Radical left nephrectomy and bilateral adrenectomy were performed. Thereafter, interferon alpha of 3 million units every day was administered intramuscularly for the first 2 months and then, the same dose was given once a week to the present. Supplementary corticosteroids were also administered. His course was uneventful for 18 months after the operation, with no evidence of recurrence.     

Solitary thyroid metastasis from colorectal cancer: Case report

Introduction and importanceThyroid metastasis of colorectal cancer is rare and the patient with thyroid metastasis has no symptoms early in the disease course. On the other hand, evaluation of thyroid is not generally included in the routine follow-up of colorectal cancer. Therefore, the diagnosis of thyroid metastasis of colorectal cancer may be delayed.Presentation of caseChest computed tomography revealed a nodule on the right lobe of the thyroid in 53-year-old woman diagnosed with sigmoid colon adenocarcinoma. This nodule was identified having as increased metabolic activity by ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography and confirmed to be consisted of cystic and solid portions by ultrasonography. Fine needle aspiration cytology of the nodule revealed metastasis of colon cancer. The patient underwent laparoscopic anterior resection and a total thyroidectomy. The size of the thyroid tumor was 1.2 cm with free resection margin.DiscussionThe clinical features of thyroid metastasis from colorectal cancer are not typical. In addition, follow-up examinations of patients with colorectal cancer do not include imaging studies of the neck, so the diagnosis of thyroid metastases is delayed. The management strategies for thyroid metastasis from colorectal cancer include a total thyroidectomy without prophylactic neck lymph node dissection and chemotherapy. However, as the penetration of chemotherapeutic drugs into the thyroid is difficult, the effect on the thyroid is considered insignificant.ConclusionSurgical treatment should be considered for treatment of thyroid metastasis.     

Isolated calcaneal metastasis from prostate cancer

We report the first case of an isolated calcaneal metastasis from prostate cancer. This case highlights the importance of considering metastatic disease in patients with persistent bone pain in the presence of known cancer, however unusual the site.     

双侧肾上腺继发性肿瘤的临床分析

目的 了解双侧肾上腺继发性肿瘤的临床特点和发生发展规律，提高对本病的诊治效果。方法 回顾性分析1990年1月至2001年12月收治50例双侧肾上腺继发性肿瘤患者资料。男45例，女5例。中位年龄56岁（23～75）。肾上腺肿瘤直径：左侧2．0～11．0cm，中位3．7cm；右侧1．5～14．0cm，中位4．0cm。结果 50例患者原发肿瘤主要为肺癌、淋巴瘤、黑色素瘤、肾癌等，分别占64．0％、12．0％、6．0％、6．0％。肺癌中以小细胞未分化癌常见（46．9％）。肿瘤发生时间：与原发瘤同时诊断26例（52．0％），原发肿瘤治疗后发现双侧肾上腺转移24例，其中1年内18例（75．0％）。44例在诊断时即有肾上腺外转移（88．0％），单纯性肾上腺转移6例（12．0％）。50例患者总生存时间1～70个月，中位生存期6个月。3例行同期或分期切除后联合放化疗，其中1例食管黑色素瘤患者生存19个月，1例肺腺癌患者15个月，1例肾癌患者生存26个月健在。结论 双侧肾上腺继发性肿瘤的原发肿瘤以肺癌和淋巴瘤常见，大多在原发瘤发现同时或术后1年内诊断，多采用姑息性治疗，预后较差，手术切除联合化疗或化放疗可能延长患者的生存期。     

Bilateral adrenal metastasis from renal cell carcinoma]

A case of renal cell carcinoma with synchronous bilateral adrenal metastasis occurring in a 76-year-old woman is reported. In our case, preoperative computed tomographic evaluation revealed the presence of bilateral adrenal metastasis, and simultaneous right radical nephrectomy and contralateral adrenalectomy were performed. Pathological examination revealed renal cell carcinoma of right kidney metastasizing to both adrenal glands. Bilateral adrenal metastasis from renal cell carcinoma is rare. Our case seems to be the fourth case in the Japanese literature.     

Incidence of adrenal metastasis from renal carcinoma]

We analysed the cases of renal carcinoma undergoing operation or autopsy from 1970 to 1978 in respect of their metastasizing to the adrenals. Of the 31 cases undergoing autopsy 10 adrenal metastases were found mostly as a result of a widespread metastasis. Of the operated 74 patients 37 underwent nephrectomy alone and 37 nephrectomy together with prophylactic adrenalectomy. The histologic evaluation of the 37 removed adrenals revealed metastases only in 4 cases. Only one of them proved to be a single metastasis, the other occurring together with other metastatic lesions. The value of the adrenalectomy will be discussed.     

Isolated splenic metastasis from non small cell lung cancer.

Lung cancer is amongst the commonest cancers in the world. Most patients present in advanced stages precluding curative treatment. Distant metastases usually occur in the liver, brain, bones and adrenals. Isolated splenic metastases are rare and are restricted to anecdotal reports in medical literature. We report a middle-aged man who presented to us with locoregionally advanced non small cell lung cancer, progressed on neoadjuvant chemotherapy and developed isolated splenic metastasis.