Ozturk Hakan, Karapolat Inanç, Saklamaz Ali
1 Department of Urology, School of Medicine, Sifa University, Izmir - Turkey.
Urologia. 2015 Apr-Jun;82(2):114-7. doi: 10.5301/uro.5000094. Epub 2014 Nov 25.
The adrenal glands are among the target metastatic organs due to the potential of systemic metastasis from renal cell carcinoma (RCC). The number of cases with bilateral metachronous metastases from RCC is about twenty.
A sixty-one-year-old man presented for routine checks due to an operated left renal tumor (clear cell carcinoma, PT2N0M0, Fuhrman grade III). The patient underwent 18FDG-PET/CT in order to re-stage the disease upon observation of bilateral adrenal masses on ultrasound and CT. A bilateral metachronous metastasis was found, whose SUVmax was 6.7 x 50 x 38 x 20 cm on the left adrenal gland, and another metastasis whose SUVmax was 5.5 40 x 29 x 20 on the right adrenal gland.
The patient underwent a CT-guided biopsy and diagnosis of adrenal metastasis was made by pathological and immunohistochemical examination. The laparoscopic treatment was performed.
There is no standard approach for the treatment of these patients in the literature. But metastasectomy is the most realistic part of the treatment. Making definitive diagnosis with biopsy, following hormonal examination and treatment with minimally invasive adrenal sparing surgical procedure containing frozen-section are strongly recommended. Cancer specific survival significantly increases with metastasectomy.
由于肾细胞癌（RCC）存在全身转移的可能性，肾上腺是常见的转移靶器官之一。RCC双侧异时性转移的病例数约为20例。
一名61岁男性因左侧肾脏肿瘤手术（透明细胞癌，PT2N0M0，Fuhrman三级）前来进行常规检查。在超声和CT检查发现双侧肾上腺肿块后，患者接受了18FDG-PET/CT检查以重新分期疾病。发现双侧异时性转移，左侧肾上腺转移灶的SUVmax为6.7×50×38×20cm，右侧肾上腺转移灶的SUVmax为5.5×40×29×20。
患者接受了CT引导下活检，通过病理和免疫组化检查确诊为肾上腺转移。随后进行了腹腔镜治疗。
文献中对于这些患者的治疗尚无标准方法。但转移灶切除术是最切实可行的治疗手段。强烈建议通过活检进行明确诊断，随后进行激素检查，并采用包含冰冻切片的微创保肾上腺手术进行治疗。转移灶切除术可显著提高癌症特异性生存率。
