Bilateral renal cell carcinoma with bilateral adrenal metastasis: a therapeutic challenge

Pandey, Tanica; Pandey, Siddharth; Singh, Vishwajeet; Sharma, Ashish

doi:10.1136/bcr-2018-227176

Cited by 6 publications

(4 citation statements)

References 3 publications

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“…Specific surgical procedure depends on the condition of patients (Table 1). In a case reported by Akbar, [8] bilateral laparoscopic adrenalectomy for adrenal metastasis is considered to be a feasible approach, while another study by Tanica [9] preferred unilateral adrenal removal followed by immunotherapy in case of development of iatrogenic Addison's disease. Mohammad [10] also performed the operation of unilateral adrenalectomy with the other side adrenal mass preserving due to the poor general condition and to prevent adrenal insufficiency during surgery.…”

Section: Discussionmentioning

confidence: 99%

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy

Li¹,

Ji²,

Wang³

et al. 2021

Medicine

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Rationale: Renal cell carcinoma (RCC) almost metastasizes to every organ, the possibility of adrenal metastasis is relatively low in patients that have undergone radical nephrectomy, only a few cases of bilateral adrenal metastasis are reported on literature. Although surgical treatment of metastases from RCC is preferred and contributes to the rate of survival, it is considered challenging to manage such cases due to the rarity of bilateral metastasis to the adrenal glands.Patient concerns: A 64-year-old Manchus female presented with an incidental ultrasonic finding of a left adrenal mass 4 years after radical nephrectomy for left renal cell carcinoma.Diagnosis: Abdominal contrast enhanced CT scan revealed bilateral adrenal masses, suggesting metastatic lesion. Examinations indicated neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography/Computed Tomography (PET/CT) scan except high radioactive uptake in bilateral adrenal glands.Interventions: Metachronous bilateral adrenalectomy was taken and laparoscopic right adrenalectomy was first performed. She was discharged home on third postoperative day. Pathological examination revealed metastatic renal cell carcinoma. Two months later she was performed laparoscopic left adrenalectomy.Outcomes: The patient healed without obvious complications and no tumor recurrence.Lessons: Bilateral metastatic adrenal recurrence from RCC is very rare. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally. Surgical intervention is a wise option for these patients that may improve survival, and metachronous bilateral adrenalectomy is proved to be safe and effective.Abbreviations: CT = Computed tomography, PET/CT = Positron emission tomography/computed tomography, RCC = Renal cell carcinoma, SUV = Standard uptake value.

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Section: Discussionmentioning

confidence: 99%

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy

Li¹,

Ji²,

Wang³

et al. 2021

Medicine

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“…Increasingly, adrenal metastases are found by accident during cancer diagnosis, staging, and follow-up [ 13 ]. A fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan is useful for detecting oligometastatic disease to the AGM and excludes extra-adrenal metastatic disease if it is not evident on CT or magnetic resonance imaging.…”

Section: Introductionmentioning

confidence: 99%

Lower fluorodeoxyglucose positron emission tomography maximum standardized uptake value may show a better response to stereotactic body radiotherapy of adrenals in oligometastatic disease

Zhelev,

Mihaylova-Hristov,

Conev

et al. 2023

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Introduction Stereotactic body radiotherapy (SBRT) is well established for oligometastatic disease, and it is increasingly used to treat adrenal metastases. Material and methods In this retrospective study we performed an analysis of 75 metastatic adrenal lesions in 64 patients with oligometastatic disease. According to the fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) maximum standardized uptake value (SUV max ) of adrenal metastases, patients were categorized into three groups: low, intermediate, and high SUVmax. Results For all clinicopathological characteristics we found significant relationships for levels of SUV max and objective response rate (Kendall Tau-c = 0.290; p = 0.017). Patients who responded to SBRT had a significantly lower SUV max value than those who did not respond (7.6 ±2.4 vs. 9.7 ±3.8; p = 0.015). At the appropriate SUV max cut-off values, the biomarker distinguished between patients with and without a response significantly and moderately (area under the curve = 0.670, 95% confidence intervals: 0.540–0.790; p = 0.015). Conclusions Lower SUVmax is associated with a better response to SBRT in patients whose disease progressed mainly in the adrenal glands.

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“…Изолированные синхронные билатеральные метастазы в надпочечные железы являются крайне редкой ситуацией. В мировой литературе преимущественно представлены единичные клинические сообщения о таких пациентах [5][6][7][8][9]. Лечение данных больных включает билатеральную адреналэктомию или резекцию надпочечников [10][11][12][13].…”

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“…Суммарный опыт хирургического лечения синхронных метастазов ПКР в оба надпочечника весьма небольшой. К настоящему времени описано менее тридцати подобных наблюдений [5][6][7][8][9]. Клинические ситуации у этих пациентов в большинстве случаев являются весьма сложными, как в отношении хирургической тактики, выбора техники оперативного вмешательства, так и с точки зрения послеоперационной курации данных больных.…”

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Synchronous Bilateral Metastases of Renal Cell Carcinoma

Balarabe¹,

Shchukin²

2021

Ukr. ž. med. bìol. sportu

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Adrenal metastases of renal cell carcinoma represent one of the forms of distant spread of this tumor. The world medical literature has isolated clinical reports about such cases. Treatment for these patients includes bilateral adrenalectomy or adrenal resection. These techniques are often complicated by adrenal insufficiency, which can lead to sudden death of the patient even with substitution therapy. The aim. Therefore, nephrectomy with ipsilateral adrenalectomy and subsequent dynamic observation of metastasis in the contralateral adrenal gland are used in some patients. Material and methods. The study included 4 patients with this pathology, who were treated and observed in Municipal Non-Commercial Enterprise of Kharkiv Regional Council “Regional Medical Clinical Center of Urology and Nephrology named after V. I. Shapoval” from 2010 to 2020. The studied sample was dominated by men (3: 1). The average age of the patients was 57.8±5.3 years. The blood cortisol level in all patients before the operation was within the normal range. The patients also did not show a tendency to arterial hypotension. The average size of renal tumors reached 8.7±2.8 cm. The stage of the neoplasm was assessed as pT3a in 3 out of 4 observation cases. At the same time, there was invasion only in the perinephric fat. The renal tumor did not penetrate into the venous system in any of the cases. The histological structure of neoplasms in all patients was represented by clear-cell renal cell carcinoma. The size of adrenal metastases averaged 38.5±11.9 mm (from 24 to 56 mm). Left-sided metastases on average did not exceed 43±12.9 mm, while right-sided metastases were 34±10.6 mm. Macroscopic spread of both adrenal tumors into the venous system took place in one case (on the left - into the main renal vein, on the right - into the inferior vena cava). The average follow-up period in the entire group averaged 21.8±17.6 months. Surgical treatment included nephrectomy and bilateral adrenalectomy or adrenalectomy with adrenal resection. All patients underwent simultaneous removal of the kidney and metastases of both adrenal glands. Operations were performed using the chevron laparotomic approach. After surgery, three patients received systemic therapy (sutent, pazopanib, axitinib). Results and discussion. The mean operation time was 195±19.1 min, and the volume of blood loss was 800±81.6 ml. Complications of Clavien-Dindo grade was ≥III, and we did not record perioperative mortality in our study. Despite hormone replacement therapy, three patients had crises of Addison's disease at different times, which led one patient to death. The examination protocol included an ultrasound scan every 3 months, and multislice computed tomography of the lungs and abdominal organs every 6 months, a study of the blood cortisol level once every 2-3 weeks. Targeted therapy was used in three patients after surgery, but two of them died from cancer progression, and one patient stayed alive with tumor progression within 48 months. Conclusion. Synchronous bilateral metastases of renal cell carcinoma to the adrenal glands are not only a difficult surgical problem, but also a major therapeutic problem. Our study has demonstrated the efficacy and safety of the synchronous surgical approach in these patients. The prognosis in patients of this group is predominantly poor, but in some patients, long-term survival is possible. The question of the possibility of targeted therapy on the background of adrenal deprivation requires further study

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Bilateral renal cell carcinoma with bilateral adrenal metastasis: a therapeutic challenge

Cited by 6 publications

References 3 publications

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy

Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy

Lower fluorodeoxyglucose positron emission tomography maximum standardized uptake value may show a better response to stereotactic body radiotherapy of adrenals in oligometastatic disease

Synchronous Bilateral Metastases of Renal Cell Carcinoma

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