Tani Masaru, Abe Toyofumi, Fukuhara Shinichiro, Fujita Kazutoshi, Uemura Motohide, Kiuchi Hiroshi, Imamura Ryoichi, Nonomura Norio
The Department of Urology, Osaka University Graduate School of Medicine.
Hinyokika Kiyo. 2020 Mar;66(3):77-80. doi: 10.14989/ActaUrolJap_66_3_77.
A 66-year-old man was referred to our hospital because of positive fecal occult blood test. Gastric and rectal cancers were diagnosed by upper and lower endoscopic biopsy, respectively. Enhanced computed tomography (CT) indicated a pulmonary tumor and a left adrenal mass with a diameter of 15 mm presenting heterogenous enhancement. The pulmonary tumor was diagnosed as adenocarcinoma by bronchoscopic biopsy. F18 fluoro-2-deoxy D-glucose (FDG) PET/CT showed abnormal FDG accumulation (maximum standardized uptake value=26. 1) in the left adrenal mass consistent with a metastatic adrenal tumor. Although radical surgical therapy was performed for the synchronous triple cancers of gastric, colon, and lung cancer, the patient refused adrenalectomy for the left adrenal tumor. One year after surgery, CT revealed an increase in the adrenal tumor diameter to 18 mm without development of new metastases. Laparoscopic adrenalectomy was performed for the left adrenal tumor which was strongly suspected of being a metastatic tumor. Pathological diagnosis was adrenal cortical adenoma. There has been no recurrence for 5 years after surgery for simultaneous triple cancer.
一名66岁男性因粪便潜血试验阳性转诊至我院。分别通过上消化道和下消化道内镜活检诊断为胃癌和直肠癌。增强计算机断层扫描(CT)显示肺部有一肿瘤,左肾上腺有一肿块,直径15 mm,呈不均匀强化。经支气管镜活检,肺部肿瘤诊断为腺癌。F18氟脱氧葡萄糖(FDG)PET/CT显示左肾上腺肿块有异常FDG摄取(最大标准化摄取值=26.1),符合肾上腺转移瘤表现。尽管对同时发生的胃、结肠和肺癌三联癌进行了根治性手术治疗,但患者拒绝接受左肾上腺肿瘤切除术。术后一年,CT显示肾上腺肿瘤直径增至18 mm,无新转移灶出现。因高度怀疑左肾上腺肿瘤为转移瘤,遂行腹腔镜肾上腺切除术。病理诊断为肾上腺皮质腺瘤。同时性三联癌手术后5年无复发。