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Context: Microwave ablation (MWA) has been proven as a promising method to treat solid tumors. Aims: This study aims to evaluate the efficacy and safety of ultrasound (US)-guided MWA for treating adrenal metastasis and to explore the factors affecting survival. Settings and Design: This was a retrospective study performed on patients treated at our department. Subjects and Methods: A total of 43 patients with adrenal metastasis (22 hepatocellular carcinoma, eight renal cell carcinoma, five non-small cell lung cancer, four colorectal cancer, three liposarcoma, and one malignant fibrous histiocytoma) were enrolled. All patients were treated at our department at least once. The treatment protocol for each patient, the technique used, and the survival details were recorded. Statistical Analysis Used: Statistical analyses were performed using SPSS 26.0 software. Results: Technical success was achieved in all cases. MWA was a safe technique for treating all types of metastasis. No major complications were observed. The pathology of adrenal lesions was the significant risk factor contributing to overall survival (OS) (P = 0.040). The 1-year and 3-year OS rates for all patients were 0.828 and 0.389, respectively. Conclusions: Percutaneous US-guided MWA is safe and effective in terms of local control and survival of adrenal metastasis
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Objective: The objective of this study is to assess the clinical effect and safety of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional (3D) visualization operative treatment planning system in larger adrenal metastasis (LAM) (D ≥ 4 cm). Materials and Methods: From Dec 2011 to Dec 2017, 12 consecutive LAM patients with pathologically proven with a mean diameter of 5.2±1.3cm (range 4.1-7.6) were treated. Artificial ascites and thermal monitoring system as ancillary technique were used. The patients were followed up with imagings and complications were recorded. Results: The median follow-up period was 31 months (ranged 6–52 m). All LAM achieved completely ablation according to the 3D planning preoperation. Complete ablation was achieved in 10 (10/12, 83.3%) patients by one session and 2 patients (2/12, 16.7%) by two sessions. Recurrence was detected at the treated site in 3 patients (3/12, 25.0%) at 5, 9, and 13 months after ablation and received another ablation. Progression of metastasis disease at extra-adrenal sites occurred in 9 patients (9/12, 75%). Seven (7/12, 58.3%) patients died during the follow-up period. Therefore, the 1-, 2-, and 3-year local tumor control rates were 83.3%, 75.0%, and 75.0%, and 1-, 2-, 3- and 4-year overall survival rates were 91.7%, 75.0%, 50.0%, and 41.7%, respectively. No severe complications related to ablation occurred, except 3 (3/12, 25%) patients developed hypertension during ablation. Conclusions: US-PMWA assisted by 3D visualization preoperative treatment planning system maybe a safe and efficient therapy for LAM, which could promote ablation precision, improve the clinical outcomes
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Presentamos el caso de una paciente con metástasis suprarrenal única de melanoma, que fue some-tida a tratamiento sistémico con vemurafenib (un inhibidor de la quinasa BRAF) en primera instancia y luego a tratamiento quirúrgico. La bibliografia actual recomienda el tratamiento quirúrgico de las metástasis de melanoma y sostenen que, en aquellos pacientes con mutación de la quinasa BRAF, los inhibidores de esta serían seguros acompañando a las metastasectomías y mejorarían el control de la enfermedad de forma más sostenida en el tempo. Conclusión: si bien, durante muchos años, la cirugía fue la única terapia para la enfermedad en estadio IV, con las terapias de drogas modernas la situación se ha vuelto más compleja; esto ha creado el desafo de determinar la combinación óptma y la secuencia de terapias adecuada; en este sentido consideramos fundamental que casos como el presentado aquí se discutan en comité de tumores.
We report the case of a patent presenting with a single melanoma metastasis in the adrenal gland, who underwent systemic treatment with vemurafenib (BRAF kinase inhibitor) in the frst instance and then underwent surgery. Current literature recommends surgical treatment of melanoma metastases and supports the use of inhibitors in patents with a BRAF kinase mutaton since they may improve disease control in a more sustained manner over tme. Although for many years surgery was the only therapy for stage IV disease, with modern drug therapies, the situaton has become more complex; this has created the challenge of determining the optmal combinaton and appropriate sequence of therapies; in this sense we consider it fundamental that cases such as the one presented here are discussed in tumor commitee meetings.
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Objective: To analyze the clinical pathological characteristics and prognosis of breast cancer patients with uncommon metastases. Methods: Clinical data of 68 cases of breast cancer with uncommon metastases from 2012 to 2015 was retrospectively analyzed. The definition of uncommon sites of metastases is the metastatic sites except for lymph node, chest wall, breast, bone, liver, lung, brain and peritoneal and pleural metastases. Results: Among the 68 patients, the uncommon metastatic sites included adrenal gland, ovary, pancreas, eyes, uterus, spleen, rectum, bladder, kidney, thyroid gland and parotid gland. The top three common metastatic sites were adrenal gland (44.1%, 30/68), ovary (41.2%, 28/68) and pancreas (11.8%, 8/68); 75.0% (51/68) of the patients had other common metastases. The median survival time after uncommon metastases was 23.5 months (range: 1.4-116.0 months). The univariate analysis showed that the patients without metastases outside the special sites had a better survival than those with common metastases (median survival time were 36.0 and 18.0 months, respectively; P = 0.007). Conclusion: Breast cancer metastasis is widespread, in addition to the common sites, the cancer can be transferred to many other sites. Patients with uncommon metastases from breast cancer may have a favorable prognosis if they do not accompany with other common metastases, and local treatment may improve the survival of some selected patients. Many ovarian metastases are found after the operation, and the possibility of ovarian metastasis should be considered in the selection of the method of ovarian ablation.
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This is a case of follicular thyroid carcinoma with extensive lung, bone and brain metastases. Multi-modality treatments including total thyroidectomy, modified radical neck dissection, cranial radiotherapy and Iodine-131 (RAI) therapy were instituted. Post RAI therapy planar whole body scan showed RAI avid metastases in the skull, cervical spine, bilateral lungs and abdomen. With the use of SPECTCT imaging, rare adrenal metastasis and additional rib metastasis were identified. Besides, management strategy was altered due to detection of non-RAI avid brain and lung metastatic lesions.
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Although it is common to have extra-hepatic metastasis of hepatocellular carcinoma (HCC) at the time of presentation, it is extremely rare to have extra-hepatic metastatic HCC without a detectable primary in the liver. We report a unique case in which a patient presented with bilateral large adrenal masses which were subsequently proven to be metastases from HCC. However, there was no tumour seen in the liver on imaging.
Subject(s)
Carcinoma, HepatocellularABSTRACT
Objective To analyze the characteristics of adrenal metastasis from renal cell carcinoma (RCC),and explore the principles to deal with the ipsilateral adrenal gland during radical nepbrectomy.Methods The data of adrenal metastasis in 19 patients with RCC from January 2003 to December 2012 was retrospectively analyzed,including 8 cases with ipsilateral adrenal metastasis,5 with contralateral adrenal metastasis,and 6 with bilateral adrenal metastasis,respectively.The relationship between RCC location,diameter,TNM stage and adrenal metastases was evaluated,and the clinical features of adrenal metastasis were summarized.Results Diameters of RCC ranged from 1.6 cm to 12.6 cm in the 19 cases,and the average diameter was 6.3 cm.The mean diameter of primary RCC,metastasized to the ipsilateral,contralateral and bilateral adrenal gland,was 5.6,6.5 and 7.1 cm,respectively.Among the 9 patients whose primary RCC located in the upper pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,3,3,respectively.Of the 7 patients with RCC located in the middle and lower pole,the number of patients with bilateral,ipsilateral and contralateral adrenal metastasis was 3,2,2,respectively.Three patients with diffused RCC in the whole kidney occurred ipsilateral adrenal metastases.RCC and adrenal metastasis were simultaneously found in 9 patients,with the average diameter of the primary RCC of 7.4 cm and the clinical stage of T2b-4N0-1 M1.Adrenal metastasis were found in 10 patients during the postoperative follow-up,with the average diameter of the primary RCC of 5.3 cm and the clinical stage of T1a-4N0M0.Nine patients underwent surgery,8 received non-surgical treatment,and 2 had no treatment.Fourteen patients had an average follow-up of 31.9 months,with 1,3 and 5-year survival rates of 84.2％,26.3％ and 15.8％,respectively.Conclusions Adrenal metastasis from RCC may be associated with the diameter and TNM of the primary tumor,regardless of the location.For the patients with normal adrenal gland observed in pre-operative imaging,ipsilateral adrenalectomy is not recommended.
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A liver transplantation is a treatment option in selected patients with hepatocellular carcinoma (HCC). Despite the adequate selection of candidates, recurrences of HCC may still develop. Solitary extrahepatic metastasis from HCC after a liver transplantation is rare. Here we report two cases of HCC demonstrated extrahepatic recurrence to the adrenal gland and spleen, respectively, within one year after a liver transplantation. Since the treatment of solitary extrahepatic metastasis from HCC after a liver transplantation is not standardized, surgical resection was performed. In the case of HCC adrenal metastasis, innumerable intrahepatic metastases were found two months after the adrenalectomy. And 16 months after adrenalectomy, the patient expired due to tumor progression and hepatic failure. In the case of HCC splenic metastasis, postoperative radiation therapy was performed. However, two recurrent HCC nodules were found 15 months after the splenectomy and received transarterial chemoembolization (TACE). And 29 month after the splenectomy, the patient also expired as same causes of former patient.
Subject(s)
Aged , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/complications , Liver Neoplasms/complications , Liver Transplantation , Neoplasm Metastasis/diagnosisABSTRACT
A liver transplantation is a treatment option in selected patients with hepatocellular carcinoma (HCC). Despite the adequate selection of candidates, recurrences of HCC may still develop. Solitary extrahepatic metastasis from HCC after a liver transplantation is rare. Here we report two cases of HCC demonstrated extrahepatic recurrence to the adrenal gland and spleen, respectively, within one year after a liver transplantation. Since the treatment of solitary extrahepatic metastasis from HCC after a liver transplantation is not standardized, surgical resection was performed. In the case of HCC adrenal metastasis, innumerable intrahepatic metastases were found two months after the adrenalectomy. And 16 months after adrenalectomy, the patient expired due to tumor progression and hepatic failure. In the case of HCC splenic metastasis, postoperative radiation therapy was performed. However, two recurrent HCC nodules were found 15 months after the splenectomy and received transarterial chemoembolization (TACE). And 29 month after the splenectomy, the patient also expired as same causes of former patient.
Subject(s)
Aged , Humans , Male , Middle Aged , Carcinoma, Hepatocellular/complications , Liver Neoplasms/complications , Liver Transplantation , Neoplasm Metastasis/diagnosisABSTRACT
OBJECTIVE: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. MATERIALS AND METHODS: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. RESULTS: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). CONCLUSION: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Adrenal Gland Neoplasms/pathology , Biopsy , Diagnosis, Differential , Fluorodeoxyglucose F18 , Lung Neoplasms/pathology , Positron-Emission Tomography/methods , Radiopharmaceuticals , Retrospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed/methodsABSTRACT
A insuficiência adrenal primária é, na maioria das vezes, causada por infecções e adrenalite auto-imune. Metástases adrenais são relativamente comuns em neoplasias de pulmão, mas usualmente são assintomáticas, mesmo quando bilaterais. Há poucos relatos de metástases adrenais levando à insuficiência adrenal. Descrevemos aqui um caso de insuficiência adrenal primária como primeira manifestação clínica de neoplasia pulmonar metastática. Paciente de 59 anos, feminina, branca, tabagista, queixava-se de dor em flanco direito associada a náuseas e emagrecimento. Exames laboratoriais confirmaram o diagnóstico de insuficiência adrenal primária. Iniciou tratamento com prednisona e fludrocortisona, com melhora progressiva dos sintomas. Na investigação da etiologia, tomografia computadorizada (TC) de abdômen mostrou aumento bilateral das adrenais. Foi submetida à biopsia de adrenal, com citopatológico positivo para células malignas. Linfonodo supraclavicular esquerdo foi biopsiado, com anátomo-patológico (AP) confirmando adenocarcinoma metastático, com imunohistoquímica sugerindo pulmão como sítio primário. Atentar para o diagnóstico de insuficiência adrenal nesse contexto é importante, porque os sintomas iniciais são inespecíficos, podendo ser atribuídos à neoplasia
Primary adrenal insufficiency is, in most cases, caused by infections and autoimmune adrenalitis. Adrenal metastasis are relatively common in lung cancer, but they are usually asymptomatic, even when bilateral. There are few reports of adrenal metastasis as a cause of adrenal insufficiency. We describe a case of primary adrenal insufficiency presenting as the first clinical manifestation of metastatic lung cancer. A 59 year-old, white, smoker woman, complaining of right flank pain associated with nausea and weight loss. Laboratory exams confirmed the diagnosis of primary adrenal insufficiency. It was started treatment with prednisone and fludrocortisones with progressive improvement. At the etiologic investigation, abdominal computadorized tomography (CT) showed bilateral increase of the adrenal glands. It was performed an adrenal biopsy and the cytologic study was positive for malignant cells. It was made another biopsy, of a supraclavicular lymph node, and the histopathologic study revealed a metastatic adenocarcinoma, immunohistochemistry study suggested lung as the primary site. Awareness of this diagnosis is important because initial symptoms of adrenal insufficiency are unspecific and may misguidedly be attributed to the neoplasm
Subject(s)
Humans , Female , Middle Aged , Adrenal Insufficiency/diagnosis , Adrenal Insufficiency/pathology , Neoplasm Metastasis/pathology , Lung Neoplasms/etiology , Lung Neoplasms/pathology , Adenocarcinoma/etiology , Adenocarcinoma/pathology , Adrenal Insufficiency/etiologyABSTRACT
PURPOSE: The adrenal gland is one of most the common sites for an extrahepatic metastasis from a hepatocellular carcinoma (HCC). However, there are no definitive guidelines for the treatment of adrenal metastasis. This study examined the effect of each therapeutic modality in an attempt to clarify the treatment strategy for adrenal metastases from a HCC. METHODS: This study reviewed the records of 11,770 consecutive HCC patients in the Yonsei University Medical Center from 1991 to 2005. Among the 11,770 patients, 648 were diagnosed with an extrahepatic metastasis. Of the extrahepatic metastases, 45 (6.9%) had an adrenal metastasis. Among these 45 patients, 15 patients with multiorgan metastases including the adrenal gland were excluded leaving 30 patients for review. The survival duration was evaluated according to the treatment modality, which included an adrenalectomy, non-surgical treatment (TACE, Chemotherapy), and conservative treatment. RESULTS: There were 24 men and 6 women, and the average age was 52.3 years (+/-9.1 years). The location of the adrenal metastasis was in the Rt, Lt, and both glands in 17 (56.7%), 9 (30.0%), and 4 (13.3%) patients, respectively. The initial HCC had been treated by a hepatectomy in 6 patients, and by non-surgical treatments such as TACE, chemotherapy and radiotherapy in 24 patients. The adrenal metastasis was treated by an adrenalectomy in 5 patients, by non-surgical treatment in 19 patients, and by conservative treatment in 6 patients. The overall median survival duration in the 30 cases was 11.1 months. The median survival time of the adrenalectomy, non-surgical treatment and conservative treatment groups was 21.4 months, 11.1 months, and 2.2 months respectively. The difference in the cumulative survival according to the treatment modality was statistically significant. CONCLUSION: The prognosis of an adrenal metastasis from HCC is quite poor. However, an adrenalectomy for an adrenal metastasis from a HCC is a safe procedure, and an acceptable way of achieving long-term survival.
Subject(s)
Female , Humans , Male , Academic Medical Centers , Adrenal Glands , Adrenalectomy , Carcinoma, Hepatocellular , Drug Therapy , Hepatectomy , Neoplasm Metastasis , Prognosis , RadiotherapyABSTRACT
A 68 year-old woman visited our hospital because of constipation and hematochezia. Colonoscopy revealed an invasive fungating mass with a narrowing of lumen and severe ulceration at the sigmoid colon. An abdominal/pelvic CT scan showed an irregular wall thickening with a 10cm long narrowing at the sigmoid colon, and a 2 cm long right adrenal mass. We did an anterior resection and adrenalectomy. The histology of the specimens of the resected sigmoid colon and adrenal gland was the same. Finally, we diagnosed this case as being an adrenal metastasis from an advanced sigmoid colon cancer. The patient has been well for a year since the adrenalectomy, and been treated by the oral chemotherapeutic agent: doxifluridine 600 mg, leucovorin 90 mg.