Unilateral Adrenal Metastasis Research Articles

SUN-163 Metastatic Spindle Cell Sarcoma Unmasked by Bilateral Adrenal Hemorrhage Resulting in Adrenal Insufficiency

Introduction:Adrenal hemorrhage (AH) is rare and can be life-threatening when bilateral AH causes adrenal insufficiency (AI). Risk factors include trauma, stress, sepsis, anticoagulant and antiplatelet use, hematologic disorders, and underlying adrenal tumors. We describe a patient whose bilateral AH led to a diagnosis of an underlying malignancy and caused AI.Clinical case:A 71-year-old man with well-controlled HIV presented with fatigue, weight loss, and acute lower abdominal pain.Four months prior to presentation, he underwent hip arthroplasty. His post-operative course was complicated by multiple pulmonary emboli and a new left 11.6 x 7.3 x 8.9 cm cystic retroperitoneal lesion with a density of 29 Hounsfield units on CT, thought to be a pancreatic pseudocyst or adrenal or retroperitoneal hemorrhage. Since the size remained stable on repeat CT three days later, he was discharged on rivaroxaban. On the day of presentation, he acutely developed severe abdominal and back pain. CT scan revealed a new 8.0 x 7.8 x 7.8 cm right adrenal collection and increased size of the prior left adrenal lesion to 13.1 x 10.6 x 13.0 cm. MRI confirmed bilateral adrenal masses with intralesional AH, as well as numerous peritoneal and retroperitoneal implants not noted on prior imaging.He remained stable and was managed non-operatively. Sodium (Na) and potassium (K) ranged 134-138 mmol/L (135-145) and 3.7-4.3 mmol/L (3.5-5.1), respectively. On presentation, morning cortisol and ACTH were 11 ug/dL and 27 ng/L (6-50), respectively, with an undetectable aldosterone and PRA 0.65 ng/mL/hr (0.25-5.8). Subsequent ACTH levels were 71 and 102 ng/L, and cortisol levels were 12 and 14 ug/dL. ACTH-stimulated cortisol was 15 ug/dL and free cortisol was 0.88 ug/dL. Plasma metanephrines were normal. Hydrocortisone was started and anticoagulation was held indefinitely. Biopsy of a retroperitoneal implant revealed metastatic spindle cell sarcoma.Three weeks later, given a persistently low Na of 134 mmol/L and increased K of 4.7 mmol/L, although blood pressure and heart rate were normal, he was empirically started on fludrocortisone. He followed up with oncology and was started on palliative chemotherapy.Clinical lessons:AH should prompt evaluation for an underlying etiology. In our patient, we suspect he already had a unilateral adrenal metastasis causing the initial unilateral AH, as he had no other risk factor. Four months later, the subsequent bilateral AH was likely caused by further metastatic spread and exacerbated by anticoagulation therapy.This case also suggests that AH may preferentially affect the zona fasciculata of the adrenal cortex and cause glucocorticoid deficiency, a phenomenon which has been noted on prior case reports. Our patient only needed hydrocortisone replacement initially, followed by fludrocortisone replacement three weeks later.

Unilateral adrenal mass as the sole initial manifestation of differentiated thyroid cancer

Unilateral adrenal metastases without disseminated disease has rarely been reported in differentiated thyroid carcinoma (DTC). A 72-year-old female presented with vague abdominal discomfort and loss of appetite of 2 months...

A case of a male with sigmoid adenocarcinoma which accompanied with an isolated unilateral adrenal metastasis

Although the liver and the lung are the main metastatic sites, the incidence of adrenal metastasis from colorectal cancer in autopsy ranges from 1.9% to 17.4% according to different reports. The most common primary tumors that metastasize to the adrenal glands are the lung, kidney, breast, and rarely colorectal cancer. The alone adrenal metastasis due to colorectal carcinoma is very rare. Due to their rarity, on the basis of international literature and our experience of adrenalectomy could represent the current “gold-standard” therapeutic approach. In this report, we explain the case of a patient who presented with sigmoid cancer and one side adrenal metastasis without any other different distant metastases.

Short-Term Outcomes and Safety of Computed Tomography-Guided Percutaneous Microwave Ablation of Solitary Adrenal Metastasis from Lung Cancer: A Multi-Center Retrospective Study.

ObjectiveTo retrospectively evaluate the short-term outcomes and safety of computed tomography (CT)-guided percutaneous microwave ablation (MWA) of solitary adrenal metastasis from lung cancer.Materials and MethodsFrom May 2010 to April 2014, 31 patients with unilateral adrenal metastasis from lung cancer who were treated with CT-guided percutaneous MWA were enrolled. This study was conducted with approval from local Institutional Review Board. Clinical outcomes and complications of MWA were assessed.ResultsTheir tumors ranged from 1.5 to 5.4 cm in diameter. After a median follow-up period of 11.1 months, primary efficacy rate was 90.3% (28/31). Local tumor progression was detected in 7 (22.6%) of 31 cases. Their median overall survival time was 12 months. The 1-year overall survival rate was 44.3%. Median local tumor progression-free survival time was 9 months. Local tumor progression-free survival rate was 77.4%. Of 36 MWA sessions, two (5.6%) had major complications (hypertensive crisis).ConclusionCT-guided percutaneous MWA may be fairly safe and effective for treating solitary adrenal metastasis from lung cancer.

Isolated unilateral adrenal metastasis as a presenting feature of occult hepatocellular carcinoma

Unilateral isolated adrenal metastasis from occult hepatocellular carcinoma (HCC) is extremely rare and seldom reported. We report a case where radiological and biochemical evidence of HCC was absent in a patient with metastatic adrenal mass. A 69-year-old male patient was investigated for abdominal pain which revealed a left adrenal mass. Contrast-enhanced computed tomography was suggestive of adrenocortical carcinoma (ACC). Resection was performed and the histopathology revealed metastasis from HCC. However, the primary in the liver could be radiologically and biochemically demonstrated only 6 months later. Even though rare in occurrence, radiologically undetectable HCC can present as unilateral adrenal mass, which can be mistaken as ACC.

Papillary Thyroid Cancer with Bilateral Adrenal Metastases

Papillary thyroid cancer is the most common type of thyroid malignancy and has an excellent prognosis. Distant organ metastasis is rare. Bilateral adrenal metastases with iodine uptake has not been described before. A 47-year-old woman presented for evaluation because of severe right upper arm pain and weakness. Magnetic resonance imaging of the thoracic spine showed a compression fracture at the third thoracic vertebra associated with a soft tissue mass. Computed tomography (CT)-guided biopsy of the mass showed metastatic papillary thyroid carcinoma. Ultrasonography of the neck showed an enlarged right thyroid lobe with cervical lymphadenopathy. A high-resolution CT scan of the chest showed multiple bilateral pulmonary nodules. Treatment included total thyroidectomy and lymph node dissection, external beam radiation to the thoracic spine, and (131)I therapy. Initial whole body (131)I scintigraphy showed faint uptake in the right upper abdomen, interpreted as a sign of physiologic bowel activity; however, repeat whole body (131)I scintigraphy showed increased uptake in both adrenal glands, consistent with metastatic disease. Serial abdominal CT scans showed progressively enlarging bilateral adrenal masses. Despite additional treatment with (131)I, the patient's disease progressed at all metastatic sites. This patient had bilateral adrenal metastases from advanced papillary thyroid cancer with distant metastasis to lung and bone at initial presentation and poor response to repeated (131)I therapy. Unilateral adrenal metastasis from thyroid cancer has been described previously in six cases; this is the first case report of bilateral adrenal metastases. Bilateral adrenal metastasis is rare in papillary thyroid cancer. Elevated abdominal uptake of (131)I in a high-risk patient may be a sign of abdominal metastatic disease.

Adrenal metastases in a post-radiation malignant fibrous histiocytoma after low-dose radiation for a benign condition

A 29-year-old male presented with an aggressive malignant fibrous histiocytoma of his leg 14 years after he had received low-dose radiation to the area for a benign indication. The other unusual feature of this case was the large unilateral adrenal metastasis. We describe this very rare presentation of sarcoma and briefly review the relevant literature.

Unilateral Adrenal Metastasis From Non–Small-Cell Lung Cancer Demonstrating Very High FDG Uptake With a Standardized Uptake Value in Excess of Sixty

We report the case of a 52-year-old man who presented with a 2-week history of dyspnea and wheeze. CT scan of the chest showed a large soft-tissue lesion in the right main bronchus extending into the trachea. Pathologic examination of endoscopic tracheal biopsies showed features consistent with a non–small-cell lung carcinoma. 18F-FDG PET/CT showed very high uptake of FDG in the bronchial tumor (high standardized uptake values: 25.1) and unexpected very intense uptake in the left adrenal gland (high standardized uptake values: 62.5). Laparoscopic adrenalectomy was performed, and subsequent histopathological examination confirmed metastatic non–small-cell carcinoma in the adrenal gland. Although adrenal malignancies are generally metabolically active, such high uptake of FDG within a metastatic lesion has not been reported previously.

V854 ROBOTIC ADRENALECTOMY FOR A PREVIOUSLY IRRADIATED METASTASIS FROM SMALL-CELL LUNG CANCER

You have accessJournal of UrologyReconstruction, Transitional Cell Carcinoma & Adrenal1 Apr 2011V854 ROBOTIC ADRENALECTOMY FOR A PREVIOUSLY IRRADIATED METASTASIS FROM SMALL-CELL LUNG CANCER Humberto Kern Laydner, Rakesh Khanna, Riccardo Autorino, Fatih Altunrende, Bo Yang, Michael White, Wahib Isac, Gregory Spana, Shahab Hillyer, Georges-Pascal Haber, Jihad Kaouk, and Robert Stein Humberto Kern LaydnerHumberto Kern Laydner Cleveland, OH More articles by this author , Rakesh KhannaRakesh Khanna Cleveland, OH More articles by this author , Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Fatih AltunrendeFatih Altunrende Cleveland, OH More articles by this author , Bo YangBo Yang Cleveland, OH More articles by this author , Michael WhiteMichael White Cleveland, OH More articles by this author , Wahib IsacWahib Isac Cleveland, OH More articles by this author , Gregory SpanaGregory Spana Cleveland, OH More articles by this author , Shahab HillyerShahab Hillyer Cleveland, OH More articles by this author , Georges-Pascal HaberGeorges-Pascal Haber Cleveland, OH More articles by this author , Jihad KaoukJihad Kaouk Cleveland, OH More articles by this author , and Robert SteinRobert Stein Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.676AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Metastases are the second most common type of adrenal mass, with the lungs being the most frequent primary site. Although robotic assistance has been largely used by urologists for radical prostatectomy, adrenalectomy is still mostly done via standard laparoscopy. Herein, we report a case of robot-assisted resection of a previously irradiated left solitary adrenal metastasis from small-cell lung cancer (SCLC). METHODS A 66 year-old male, diagnosed with SCLC since 2007, who had a documented increase in the size of a left adrenal metastasis after treatment with chemotherapy and radiotherapy, underwent robotic left adrenalectomy at our institution. Operative and postoperative outcomes were evaluated. RESULTS Dissection was extremely difficult, due to the large amount of edema and adherent tissue, consistent with the patient's previous radiation therapy. The full range of motion of the robotic instruments allowed us to achieve different angles of dissection, cutting and clipping. These characteristics were critical in order to complete all the steps of the procedure safely, without conversion to open surery. Operative time was 262 minutes with an estimated blood loss of 500 milliliters. In the postoperative period, patient had athelectasis (Clavien grade I). Analgesic consumption was equivalent to 20 mg of morphine per day and visual analog pain scale was zero at discharge. Lenght of stay was 5 days. Histopathology analysis confirmed small-cell lung cancer. With 2 months of follow-up, patient is currently asymptomatic. CONCLUSIONS Robotic assisted resection of a solitary unilateral adrenal metastasis after radiotherapy can be safely performed. Robotic endowrist technology provides wide maneuverability and represents a valuable tool for complex cases of adrenalectomy. A longer follow-up is awaited to assess the oncological outcome. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e343 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Humberto Kern Laydner Cleveland, OH More articles by this author Rakesh Khanna Cleveland, OH More articles by this author Riccardo Autorino Cleveland, OH More articles by this author Fatih Altunrende Cleveland, OH More articles by this author Bo Yang Cleveland, OH More articles by this author Michael White Cleveland, OH More articles by this author Wahib Isac Cleveland, OH More articles by this author Gregory Spana Cleveland, OH More articles by this author Shahab Hillyer Cleveland, OH More articles by this author Georges-Pascal Haber Cleveland, OH More articles by this author Jihad Kaouk Cleveland, OH More articles by this author Robert Stein Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Adrenal metastases: CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy

The aim of the study was to evaluate the feasibility, safety and effectiveness of CT-guided and MR-thermometry-controlled laser-induced interstitial thermotherapy (LITT) in adrenal metastases. Nine patients (seven male, two female; average age 65.0 years; range 58.7-75.0 years) with nine unilateral adrenal metastases (mean diameter 4.3 cm) from primaries comprising colorectal carcinoma (n = 5), renal cell carcinoma (n = 1), oesophageal carcinoma (n = 1), carcinoid (n = 1), and hepatocellular carcinoma (n = 1) underwent CT-guided, MR-thermometry-controlled LITT using a 0.5 T MR unit. LITT was performed with an internally irrigated power laser application system with an Nd:YAG laser. A thermosensitive, fast low-angle shot 2D sequence was used for real-time monitoring. Follow-up studies were performed at 24 h and 3 months and, thereafter, at 6-month intervals (median 14 months). All patients tolerated the procedure well under local anaesthesia. No complications occurred. Average number of laser applicators per tumour: 1.9 (range 1-4); mean applied laser energy 33 kJ (range 15.3-94.6 kJ), mean diameter of the laser-induced coagulation necrosis 4.5 cm (range 2.5-7.5 cm). Complete ablation was achieved in seven lesions, verified by MR imaging; progression was detected in two lesions in the follow-up. The preliminary results suggest that CT-guided, MR-thermometry-controlled LITT is a safe, minimally invasive and promising procedure for treating adrenal metastases.

A PATIENT WITH RECCURENT HEPATOCELLULAR CARCINOMA IN THE RIGHT ADRENAL GLAND, WHO SURVIVED WITHOUT TUMOR RECCURENCE FOR A LONG PERIOD

We experienced a case of hepatocellular carcinoma with tumor recurrence in the right adrenal gland, who survived for a long period after a right adrenectomy. A 59-year-old man diagnosed as having a hepatocellular carcinoma with chronic hepatitis C underwent a partial hepatectomy (S7+S8) in 1988. PIVKA-II was markedly increased and tumor recurrence in the right adrenal gland was diagnosed. The right adrenectomy was performed in 1990 and no tumor reccurence was detected for about 7 years. Multiple intrahepatic recurrence was detected in November 1997 and died 6 months thereafter.In autopsy cases of hepatocellular carcinoma, adrenal metastasis is frequent and its incidence has been reported to reach 13.1% However, reported clinical cases are quite rare. Fourteen cases including the present case have been reported so far. Surgical resection seems to be the best treatment for the patient with unilateral adrenal metastasis, unless other distant metastases or uncontrollable intrahepatic recurrences are detected.

SIMULTANEOUS RESECTION FOR HEPATOCELLULAR CARCINOMA WITH ADRENAL METASTASIS -A CASE REPORT-

A 65-year-old male complaining of a lower abdominal dull pain was admitted to the hospital because liver dysfunction was found by blood examinatin. CT scan and angiography revealed a hepatocellular carcinoma (HCC) with metastasis to the right adrenal gland. Posterior-segmentectomy of the liver combined with chlecystectomy and right adrenalectomy was performed. The patient had a recurrence in the liver and lung metastais but is alive for 16 month after the surgery. Although metastases to the adrenal glands are reported to be found in 8.8% of all autopsy cases of the HCC, cases undergoing an adrenalectomy are very rare. We discussed the effectiveness of the resection of adrenal metastasis in the HCC patients in 11 cases, from a review of the literature combined with our case. Four cases underwent resections of both primary and metastatic lesion simultaneously, and remaining seven cases, nonsimultaneously. There were no major complications with surgery in any cases except for the only one case which underwent bilateral adrenalectomy. We suggest that the adrenalectomy should be taken into consideration as an effective approach for improving the prognosis of the HCC with unilateral adrenal metastasis.