Dieckmann K P, Wullbrand A, Krolzig G
Urologische Abteilung Albertinen-Krankenhaus, Hamburg, Germany.
Scand J Urol Nephrol. 1996 Apr;30(2):139-43. doi: 10.3109/00365599609180905.
A 60-year-old female patient presenting with anemia was found to have a left-sided renal tumor and a contralateral adrenal mass of 2 cm in diameter. Imaging studies for metastases were negative. Nephrectomy along with contralateral adrenalectomy was performed and histology disclosed renal cell carcinoma stage pT3a pNO G2 with solitary contralateral adrenal metastasis. In a survey of the literature, 24 previous cases of renal cancer with solitary contralateral adrenal metastasis were identified. The most probable biological pathway to explain this peculiar metastatic pattern is transpulmonal passage of circulating cancer cells and seeding in the adrenal gland on the basis of a particular susceptibility of adrenal tissue to circulating renal cancer cells. The case illustrates that surgery of solitary metastases from renal cell carcinoma may be beneficial to the patient. The case further highlights the caution that is required diagnostically in the interpretation of incidentally found adrenal masses when other malignancies are present.
一名60岁的贫血女性患者被发现左侧肾脏有肿瘤，对侧肾上腺有一个直径2厘米的肿块。转移灶的影像学检查结果为阴性。实施了肾切除术及对侧肾上腺切除术，组织学检查显示为pT3a pNO G2期肾细胞癌，伴有对侧肾上腺孤立转移。在文献检索中，共识别出24例既往有对侧肾上腺孤立转移的肾癌病例。解释这种特殊转移模式最可能的生物学途径是循环癌细胞经肺转移并基于肾上腺组织对循环肾癌细胞的特殊易感性而种植于肾上腺。该病例表明，肾细胞癌孤立转移灶的手术治疗可能对患者有益。该病例进一步强调，当存在其他恶性肿瘤时，在诊断上解读偶然发现的肾上腺肿块需要谨慎。
