Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043, Orbassano, Italy.
Radiology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy.
J Endocrinol Invest. 2020 Sep;43(9):1301-1307. doi: 10.1007/s40618-020-01219-3. Epub 2020 Mar 16.
Up to 70% of adrenal masses detected in patients affected by extra-adrenal malignancy are metastatic lesions. Therefore, detection of an adrenal mass in patients with active or previous malignancy requires a careful differential diagnostic workup. F-Fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG-PET/CT) is increasingly being used to determine the malignant potential of adrenal lesions.
We report the case of a 64-year-old man who had a single adrenal metastasis due to non-small-cell lung carcinoma developing on a pre-existing benign adrenal lesion. This metastasis occurred in a phase of perceived oncological remission and was detected thanks to F-FDG-PET/CT showing a focal adrenal uptake. Contrast-enhanced computed tomography (CT), performed as part of oncological follow-up, and MRI with chemical shift sequences did not lead to the correct diagnosis. The patient underwent laparoscopic adrenalectomy and the pathological evaluation confirmed a lung carcinoma metastasis.
The present case highlights the peculiarity of the follow-up of adrenal masses in cancer patients and the primary role of F-FDG-PET/CT in the management of such patients.
在患有肾上腺外恶性肿瘤的患者中，多达 70%的检测到的肾上腺肿块是转移性病变。因此，在有活动性或既往恶性肿瘤的患者中检测到肾上腺肿块需要仔细的鉴别诊断。氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG-PET/CT）越来越多地用于确定肾上腺病变的恶性潜能。
我们报告了一例 64 岁男性的病例，他因非小细胞肺癌而在先前存在的良性肾上腺病变上发生了单一肾上腺转移。该转移发生在肿瘤学缓解的阶段，通过 F-FDG-PET/CT 显示局灶性肾上腺摄取而被发现。作为肿瘤学随访的一部分进行的增强 CT 和化学位移序列 MRI 未导致正确诊断。患者接受了腹腔镜肾上腺切除术，病理评估证实为肺癌转移。
本病例强调了癌症患者肾上腺肿块随访的特殊性，以及 F-FDG-PET/CT 在这类患者管理中的主要作用。
