Distant Metastasis of Renal Adenocarcinoma in Nephrectomized Cases

Shinmoto, Hiroshi; Nakayama, Minoru; Nakamura, Kazuyoshi; Satoh, Tsuyoshi

doi:10.1016/s0022-5347(17)54243-3

Cited by 162 publications

(89 citation statements)

References 12 publications

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“…The contralateral adrenal grand, which was biopsied in the patient, was a rare site of metastasis of RCC, being detected in 2.5% of patients with metastatic RCC at autopsy (2). The spread of RCC to the contralateral adrenal gland in the present case may not have been a recent event since a previous study by Lau et al (12) reported that the mean interval to developing contralateral adrenal metastasis following radical nephrectomy is 5.2 years (12).…”

mentioning

confidence: 54%

“…Around 20% of patients experience recurrence or develop metastatic RCC following nephrectomy (1). Although late recurrence of RCC following curative initial surgery is not a rare event, a previous study demonstrated that contralateral adrenal metastasis of RCC is rare (2). Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a relatively novel modality for obtaining samples from deep-seated lesions.…”

Section: Introductionmentioning

confidence: 99%

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Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration

Tanimoto

Takeuchi

Yaegashi

et al. 2016

Molecular and Clinical Oncology

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Abstract.A 76-year-old female in whom a renal cell carcinoma (RCC) lesion was resected 19 years previously presented to our hospital with cognitive dysfunction. Magnetic resonance imaging and computed tomography revealed nodules in the brain, lung, adrenal gland and a pelvic osteolytic lesion. To identify the primary cancer site, the present study performed endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of the left adrenal lesion. Consequently, the pathological findings of the tissue obtained by EUS-FNA were similar to those of the previous nephrectomy specimen, revealing that the adrenal lesion was the recurrence of RCC. The majority of the metastatic lesions in the patient were reduced in size by the multiple kinase inhibitor, pazopanib. Contralateral adrenal metastasis of RCC is rare and the use of EUS-FNA in the diagnosis of adrenal lesions remains to be elucidated. This is a rare case of adrenal lesion, diagnosed by EUS-FNA. Therefore, EUS-FNA is considered to be a useful diagnostic modality of adrenal metastases from unidentified primary tumor types. IntroductionRenal cell carcinoma (RCC), which accounts for ~5% of all epithelial cancer types, is the ninth most common cancer worldwide. Around 20% of patients experience recurrence or develop metastatic RCC following nephrectomy (1). Although late recurrence of RCC following curative initial surgery is not a rare event, a previous study demonstrated that contralateral adrenal metastasis of RCC is rare (2). Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a relatively novel modality for obtaining samples from deep-seated lesions. In a previous study, adrenal gland samples obtained by EUS-FNA biopsy were adequate for determining a pathological diagnosis (3). The present study reported a rare case of contralateral adrenal metastasis of RCC, which was diagnosed by EUS-FNA. Case reportA 76-year-old female with a complaint of cognitive dysfunction visited the Department of Neurosurgery, Kanazawa University Hospital (Ishikawa, Japan). The patient was previously diagnosed with RCC of the right kidney in the Department of Urology, Public Central Hospital of Matto (Ishikawa, Japan) 19 years previously. The right kidney was removed and the patient received no adjuvant therapy at that time. A physical examination revealed no findings other than disorientation, and laboratory data, including tumor markers, revealed no notable findings. Brain gadolinium contrast-enhanced magnetic resonance imaging uncovered several nodules (Fig. 1), whereas chest and abdominal computed tomography (CT) identified a single nodule in the right lower lobe of the lungs, a mass in the left adrenal gland and an osteolytic lesion in the left pelvis (Data not shown). On the basis of these findings, the patient was diagnosed with a metastatic brain tumor. Following diagnosis, the patient received stereotactic radiosurgery with gamma knife therapy for the brain lesions. To identify the primary lesion, the present case study attempted to obtain histological confirmation...

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confidence: 54%

Section: Introductionmentioning

confidence: 99%

Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration

Tanimoto

Takeuchi

Yaegashi

et al. 2016

Molecular and Clinical Oncology

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“…Moreover, contralateral adrenal involvement in RCC is extremely rare. In an autopsy study made with > 400 RCC patients who had undergone nephrectomy, contralateral adrenal gland was the only site of metastatic involvement in only 2.5% [2]. Saitoh et al's study made in order to study the frequency of metastasis in RCC patients with a series of 1,828 autopsies revealed that solitary and synchronous CAM was seen only in 0.19% of the patients [2].…”

Section: Discussionmentioning

confidence: 99%

“…In an autopsy study made with > 400 RCC patients who had undergone nephrectomy, contralateral adrenal gland was the only site of metastatic involvement in only 2.5% [2]. Saitoh et al's study made in order to study the frequency of metastasis in RCC patients with a series of 1,828 autopsies revealed that solitary and synchronous CAM was seen only in 0.19% of the patients [2]. Another retrospective study made with 610 radical nephrectomy cases has shown that CAM incidence was 1.1% [11] and that all metastases to the contralateral adrenal glands were clear cell tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the fact that RCC can metastasize to almost every organ, the most common organs and areas of metastasis are the lungs, liver, bones, lymph nodes and mediastinum [1]. Adrenal metastases from RCC are also evident in patients who underwent nephrectomy with an incidence of 3% of solitary adrenal metastasis to the ipsilateral gland and of 0.7% to the contra lateral gland [2].…”

Section: Introductionmentioning

confidence: 99%

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Contralateral Adrenal Metastasis After Renal Cell Carcinoma Treatment

et al. 2015

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Renal cell carcinoma (RCC) is highly metastasizing. Metastasis may occur synchronously with the primary tumor or in various organs many years after the treatment of the primary RCC. However, isolated contralateral adrenal metastasis (CAM) following the treatment of primary RCC is quite rare. The present study is a case report of a 58-year-old female patient diagnosed with CAM who had been surgically treated 5 years earlier for primary RCC.

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Eligibility and Radiologic Assessment for Adjuvant Clinical Trials in Kidney Cancer

Agrawal

Haas²,

Lane

et al. 2020

JAMA Oncol

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To harmonize the eligibility criteria and radiologic disease assessment definitions in clinical trials of adjuvant therapy for renal cell carcinoma (RCC).METHOD On November 28, 2017, US-based experts in RCC clinical trials, including medical oncologists, urologic oncologists, regulators, biostatisticians, radiologists, and patient advocates, convened at a public workshop to discuss eligibility for trial entry and radiologic criteria for assessing disease recurrence in adjuvant trials in RCC. Multiple virtual meetings were conducted to address the issues identified at the workshop. RESULTSThe key workshop conclusions for adjuvant RCC therapy clinical trials were as follows. First, patients with non-clear cell RCC could be routinely included, preferably in an independent cohort. Second, patients with T3-4, N+M0, and microscopic R1 RCC tumors may gain the greatest advantages from adjuvant therapy. Third, trials of agents not excreted by the kidney should not exclude patients with severe renal insufficiency. Fourth, therapy can begin 4 to 16 weeks after the surgical procedure. Fifth, patients undergoing radical or partial nephrectomy should be equally eligible. Sixth, patients with microscopically positive soft tissue or vascular margins without gross residual or radiologic disease may be included in trials. Seventh, all suspicious regional lymph nodes should be fully resected. Eighth, computed tomography should be performed within 4 weeks before trial enrollment; for patients with renal insufficiency who cannot undergo computed tomography with contrast, noncontrast chest computed tomography and magnetic resonance imaging of the abdomen and pelvis with gadolinium should be performed. Ninth, when feasible, biopsy should be undertaken to identify any malignant disease. Tenth, when biopsy is not feasible, a uniform approach should be used to evaluate indeterminate radiologic findings to identify what constitutes no evidence of disease at trial entry and what constitutes radiologic evidence of disease. Eleventh, a uniform approach for establishing the date of recurrence should be included in any trial design. Twelfth, patient perspectives on the use of placebo, conditions for unblinding, and research biopsies should be considered carefully during the conduct of an adjuvant trial. CONCLUSIONS AND RELEVANCEThe discussions suggested that a uniform approach to eligibility criteria and radiologic disease assessment will lead to more consistently interpretable trial results in the adjuvant RCC therapy setting.

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Distant Metastasis of Renal Adenocarcinoma in Nephrectomized Cases

Cited by 162 publications

References 12 publications

Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration

Recurrence of renal cell carcinoma diagnosed using contralateral adrenal biopsy with endoscopic ultrasound-guided fine-needle aspiration

Contralateral Adrenal Metastasis After Renal Cell Carcinoma Treatment

Eligibility and Radiologic Assessment for Adjuvant Clinical Trials in Kidney Cancer

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