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Suzuki S, Takahashi N, Sugo M, Ishiwata K, Ishida A, Watanabe S, Igarashi K, Ruike Y, Naito K, Fujimoto M, Koide H, Imamura Y, Sakamoto S, Ichikawa T, Kubota Y, Wada T, Yamazaki Y, Sasano H, Ikeda JI, Tatsuno I, Yokote K. Challenges in the diagnosis of the enigmatic primary adrenal leiomyosarcoma: two case reports and review of the literature. BMC Endocr Disord 2023; 23:276. [PMID: 38110958 PMCID: PMC10726553 DOI: 10.1186/s12902-023-01530-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/11/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Primary adrenal leiomyosarcoma is a rare and aggressive mesenchymal tumor derived from the smooth muscle wall of a central adrenal vein or its tributaries; therefore, tumors tend to invade the inferior vena cava and cause thrombosis. The great majority of tumors grow rapidly, which makes the disease difficult to diagnose in its early clinical stages and needs differentiation from adrenocortical carcinomas for the selection of chemotherapy including mitotane which causes adrenal insufficiency. CASE PRESENTATION We presented two patients with adrenal leiomyosarcoma who were referred to our hospital with abdominal pain and harboring large adrenal tumors and inferior vena cava thrombosis. The endocrine findings, including serum catecholamine levels, were unremarkable. These two patients were considered clinically inoperable, and CT-guided core needle biopsy was performed to obtain the definitive histopathological diagnosis and determine the modes of therapy. The masses were subsequently diagnosed as primary adrenal leiomyosarcoma based on the histological features and positive immunoreactivity for SMA (smooth muscle actin), desmin, and vimentin. CONCLUSIONS Adrenal leiomyosarcoma derived from the smooth muscle wall of a central adrenal vein or its tributaries is rare but should be considered a differential diagnosis in the case of nonfunctioning adrenal tumors extending directly to the inferior vena cava. CT-guided biopsy is considered useful for histopathological diagnosis and clinical management of patients with inoperable advanced adrenal tumors without any hormone excess.
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Affiliation(s)
- Sawako Suzuki
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan.
| | - Naoya Takahashi
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masafumi Sugo
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ishiwata
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Akiko Ishida
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Suzuka Watanabe
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Katsushi Igarashi
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yutaro Ruike
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Kumiko Naito
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masanori Fujimoto
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hisashi Koide
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yusuke Imamura
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Takeshi Wada
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yuto Yamazaki
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University School of Medicine, Sendai, Japan
| | - Jun-Ichiro Ikeda
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Ichiro Tatsuno
- Chiba Prefectural University of Health Sciences, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
- Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
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Rodríguez Escobedo R, Ares Blanco J, Lanes Iglesias S, Fernández Fernández LM, Menéndez Torre EL. Primary adrenal leiomyosarcoma: A case report. ENDOCRINOL DIAB NUTR 2021; 68:516-517. [PMID: 34863418 DOI: 10.1016/j.endien.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 04/04/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Raúl Rodríguez Escobedo
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
| | - Jessica Ares Blanco
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain; Grupo de Investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
| | - Soraya Lanes Iglesias
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - Edelmiro Luis Menéndez Torre
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain; Grupo de Investigación en Endocrinología, Nutrición, Diabetes y Obesidad (ENDO), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA)
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Rodríguez Escobedo R, Ares Blanco J, Lanes Iglesias S, Fernández Fernández LM, Menéndez Torre EL. Leiomiosarcoma suprarrenal primario: a propósito de un caso. ENDOCRINOL DIAB NUTR 2021. [DOI: 10.1016/j.endinu.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sakellariou M, Dellaportas D, Peppa M, Schizas D, Pikoulis E, Nastos K. Review of the Literature on Leiomyoma and Leiomyosarcoma of the Adrenal Gland: A Systematic Analysis of Case Reports. In Vivo 2021; 34:2233-2248. [PMID: 32871746 DOI: 10.21873/invivo.12034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND/AIM To date few cases of smooth muscle-derived tumors of the adrenal gland have been reported and their treatment remains a medical challenge. The aim of this manuscript was to systematically review the literature and present the tumor characteristics and their management in order to provide a standardized approach to their diagnosis and management. MATERIALS AND METHODS We searched five databases (PubMed, Scopus, Elsevier, ResearchGate, Google scholar) for relevant articles published until March 2020. RESULTS Twenty-two cases of adrenal leiomyoma, four cases of adrenal smooth muscle tumor and forty-five cases of adrenal leiomyosarcoma were included. CONCLUSION We present the demographic, clinical, radiological, pathological and oncological characteristics and prognosis of tumors of the adrenal gland arising from smooth muscle cells, as well as describe the common clinical investigations and therapeutic modalities that have been reported as part of their management.
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Affiliation(s)
- Maria Sakellariou
- Third Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dionysios Dellaportas
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, Athens, Greece
| | - Melpomeni Peppa
- Department of Endocrinology, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Dimitrios Schizas
- First Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Konstantinos Nastos
- Third Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Wang Y, Teng Y, Na S, Yuan Y. Pleomorphic Leiomyosarcoma of the Adrenal Gland in a Young Woman: A Case Report and Review of the Literature. Onco Targets Ther 2020; 13:4705-4713. [PMID: 32547099 PMCID: PMC7263850 DOI: 10.2147/ott.s254162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022] Open
Abstract
Leiomyosarcoma usually arises in the uterus, abdominal and urologic viscera, and walls of large and small blood vessels. However, primary adrenal leiomyosarcoma is extremely rare with only 39 cases previously reported in English-language literature. We report a case of a 29-year-old previously healthy woman with an incidentally found right adrenal-occupying lesion. CT scan revealed a right adrenal mass measuring 3.3×3.4 cm in size. The tumor was successfully removed by laparoscopic adrenalectomy. Postoperative histopathologic examination showed spindle cells arranged in interlacing fascicles with pleomorphism and a high mitotic rate. An immunohistochemical examination showed positive staining for SMA, desmin, vimentin and H-caldesmon, and the diagnosis of a well-differentiated adrenal leiomyosarcoma was established. The patient received no other oncological treatment after surgery and currently has no evidence of residual disease or tumor recurrence according to imaging follow-up.
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Affiliation(s)
- Yuanyuan Wang
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Yongliang Teng
- Department of Pathology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Shibo Na
- Department of Spinal Surgery, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
| | - Ye Yuan
- Department of Anesthesiology, The First Hospital of Jilin University, Changchun, Jilin, People's Republic of China
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Adrenal Leiomyosarcoma Presenting with Chest Wall Nodule: a Histological Insight in an Intriguing Case. Indian J Surg Oncol 2020; 11:118-120. [PMID: 33088145 DOI: 10.1007/s13193-020-01104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022] Open
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Jabarkhel F, Puttonen H, Hansson L, Muth A, Ragnarsson O. Primary Adrenal Leiomyosarcoma: Clinical, Radiological, and Histopathological Characteristics. J Endocr Soc 2020; 4:bvaa055. [PMID: 32537544 PMCID: PMC7278282 DOI: 10.1210/jendso/bvaa055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Indexed: 11/30/2022] Open
Abstract
Primary adrenal leiomyosarcoma (PAL) is a rare, high-grade proliferating mesenchymal tumor with a considerable risk of metastasis, deriving from the smooth muscle wall of a central adrenal vein, or its tributaries. Roughly 40 patients with PAL have been reported in the literature. Herein, we present 3 patients with incidentally discovered PAL, along with an overview of the current knowledge on the clinical, radiological, and histopathological characteristics of PAL.
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Affiliation(s)
- Fatema Jabarkhel
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Henri Puttonen
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lina Hansson
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Andreas Muth
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Oskar Ragnarsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and The Department of Endocrinology, Sahlgrenska University Hospital, Gothenburg, Sweden
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8
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Sakellariou M, Dellaportas D, Grapsa E, Tzikanoulas M, Dellis A, Theodosopoulos T, Nastos C. Primary adrenal leiomyosarcoma: A case report. Mol Clin Oncol 2020; 12:317-320. [PMID: 32190312 DOI: 10.3892/mco.2020.1987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/30/2019] [Indexed: 11/05/2022] Open
Abstract
Adrenal leiomyosarcomas are rare mesenchymal tumors of the suprarenal region that are usually diagnosed after they have reached a large size. We report the case of a 62-year-old male with an incidentally found left adrenal mass. Magnetic resonance imaging of the retroperitoneal space showed a heterogeneously enhanced mass, measuring 10x8.2 cm, with characteristics suspicious of malignancy. The patient underwent left radical adrenalectomy after the hormonal evaluation of the tumor due to the high probability of adrenocortical carcinoma. However, microscopic examination of the tumor showed a spindle cell sarcoma. Immunohistochemically the neoplastic cells were found positive for desmin and smooth muscle actin and the diagnosis of a well differentiated adrenal leiomyosarcoma was established. During follow-up the patient presented an aggressive course as he developed bone, liver and pulmonary metastases early postoperatively, which were treated with radiation therapy and chemotherapy. The patient has progressive metastatic disease while on chemotherapy 31 months after surgery.
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Affiliation(s)
- Maria Sakellariou
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
| | - Dionysios Dellaportas
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
| | - Eirini Grapsa
- Department of Nephrology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
| | - Menelaos Tzikanoulas
- Department of Biopathology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
| | - Athanasios Dellis
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
| | - Theodosios Theodosopoulos
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
| | - Constantinos Nastos
- Second Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, Aretaieion University Hospital, 11528 Athens, Greece
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Nerli RB, Ghagane S, Dixit NS, Hiremath MB, Deole S. Adrenal leiomyosarcoma in a young adult male. Int Cancer Conf J 2019; 9:14-17. [PMID: 31950011 DOI: 10.1007/s13691-019-00387-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022] Open
Abstract
Leiomyosarcomas are known to typically originate from smooth muscle cell. Primary adrenal leiomyosarcoma is an extremely rare mesenchymal tumor associated with delayed diagnosis and poor prognosis. We report a rare case of leiomyosarcoma arising from the left adrenal gland in a 27-year-old male who presented with left side back ache. It was a solid mass of 9 × 6.5 × 7 cms situated superior to the left kidney. Left adrenalectomy was done and microscopic examination revealed a primary adrenal leiomyosarcoma.
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Affiliation(s)
- R B Nerli
- 1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-To-Be-University), JNMC Campus, Belagavi, 590010 India.,KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, 590010 India
| | - Shridhar Ghagane
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru Nagar, Belagavi, 590010 India
| | - Neeraj S Dixit
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Nehru Nagar, Belagavi, 590010 India
| | - Murigendra B Hiremath
- 4Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka India
| | - Sushant Deole
- 1Department of Urology, JN Medical College, KLE Academy of Higher Education and Research (Deemed-To-Be-University), JNMC Campus, Belagavi, 590010 India
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Doppalapudi SK, Shah T, Fitzhugh VA, Bargman V. Primary adrenal leiomyosarcoma with inferior vena cava extension in a 70-year-old man. BMJ Case Rep 2019; 12:12/3/e227670. [PMID: 30936336 DOI: 10.1136/bcr-2018-227670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Primary adrenal leiomyosarcoma, a malignant soft tissue tumour originating from the smooth muscle of the inferior vena cava and adrenal vein, is rarely described in the literature. Cases are often diagnosed at an advanced stage as the tumour is not hormone-producing. We describe a 70-year-old man who presented with lower extremity swelling and abdominal varices and was subsequently found to have a large adrenal mass on imaging. Our case is among the few reported primary adrenal leiomyosarcomas in which a CT-guided biopsy was used to aid in diagnosis.
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Affiliation(s)
- Sai K Doppalapudi
- Department of Urology, Rutgers- New Jersey Medical School, Newark, New Jersey, USA
| | - Tejash Shah
- Department of Urology, Rutgers- New Jersey Medical School, Newark, New Jersey, USA
| | - Valerie A Fitzhugh
- Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Vladislav Bargman
- Department of Urology, Rutgers- New Jersey Medical School, Newark, New Jersey, USA
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