Öğreden Ercan, Oguz Ural, Demirelli Erhan, Sabri Tok Doğan, Akyol Safa, Öksüz Hülya, Aslan Serdar
Department of Urology, Giresun University, Faculty of Medicine, Giresun, Turkey.
Department of Pathology, Giresun University, Faculty of Medicine, Giresun, Turkey.
Curr Med Imaging. 2023 Oct 23. doi: 10.2174/0115734056244676231016094516.
The definition of oligometastasis is still controversial. Cytoreductive nephrectomy and metastasectomy are important approaches in selected patients with oligometastasis for improving survival. We aimed to present our laparoscopic metastasectomy experience in a rare case of contralateral adrenal metastasis in an oligometastatic kidney tumor.
A 52-year-old male patient was admitted to our clinic with the diagnosis of an incidental right renal mass. On contrast-enhanced abdominal CT revealed a mass reaching approximately 8 cm in diameter in the right kidney located in the middle pole. On contrast-enhanced thorax, CT showed a metastatic lesion in the left main bronchus bifurcation. The patient underwent an open radical nephrectomy with the diagnosis of an oligometastatic right renal mass. His pathology was reported as clear cell renal cell carcinoma (ccRCC). The patient was referred to the medical oncology clinic for immunotherapy. The metastatic lesion in the lung completely regressed in the follow-up of the patient who was started on Chek point inhibitors. However, he was referred to our clinic after an incidental metachronous mass was detected in the contralateral left adrenal in FDG PET/CT (SUVmax: 6.7) in 1st year. Dynamic contrast-enhanced MRI was performed to reevaluate and for mass characterization, and a 4 cm mass was observed in the left contralateral adrenal. Laparoscopic metastasectomy was performed for the left adrenal mass. No recurrence or adrenal insufficiency developed in the 6-month follow-up after discharge.
Transperitoneal adrenalectomy is a minimally invasive method that can be safely performed in metastatic adrenal masses. Although contralateral adrenal metastasis is rare in ccRCC, it should be kept in mind that adrenal metastasis may develop in the late period in patients with a history of renal cancer.
寡转移的定义仍存在争议。减瘤性肾切除术和转移灶切除术是部分寡转移患者改善生存的重要方法。我们旨在介绍我们在一例罕见的寡转移肾肿瘤对侧肾上腺转移患者中进行腹腔镜转移灶切除术的经验。
一名52岁男性患者因偶然发现右肾肿块入院。腹部增强CT显示右肾中极有一个直径约8 cm的肿块。胸部增强CT显示左主支气管分叉处有一个转移灶。患者因寡转移右肾肿块诊断接受了开放性根治性肾切除术。其病理报告为透明细胞肾细胞癌（ccRCC）。患者被转至医学肿瘤门诊接受免疫治疗。开始使用检查点抑制剂治疗的患者在随访中肺部转移灶完全消退。然而，在第1年的FDG PET/CT检查中偶然发现对侧左肾上腺有一个异时性肿块（SUVmax：6.7）后，他被转诊至我们的门诊。进行了动态对比增强MRI以重新评估并对肿块进行特征描述，在对侧左肾上腺观察到一个4 cm的肿块。对左肾上腺肿块进行了腹腔镜转移灶切除术。出院后6个月的随访中未出现复发或肾上腺功能不全。
经腹肾上腺切除术是一种可安全用于转移性肾上腺肿块的微创方法。虽然ccRCC中对侧肾上腺转移罕见，但有肾癌病史的患者晚期可能发生肾上腺转移应予以重视。
