1
|
Oshiro H, Shimizu Y, Nakayasu R, Miyazaki Y, Utsunomiya N, Asai S, Kanamaru S. Bilateral adrenal metastases from renal cell carcinoma after robot-assisted partial nephrectomy. Int Cancer Conf J 2024; 13:49-53. [PMID: 38187184 PMCID: PMC10764699 DOI: 10.1007/s13691-023-00635-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/26/2023] [Indexed: 01/09/2024] Open
Abstract
Renal cell carcinoma often metastasizes to the adrenals; however, bilateral adrenal metastases are rare. We here report a patient with bilateral adrenal metastases from renal cell carcinoma after robot-assisted partial nephrectomy and review relevant published reports. A 64-year-old man underwent robot-assisted partial nephrectomy for a left renal tumor. During follow-up, he was diagnosed with bilateral adrenal metastases. He underwent left adrenalectomy followed by right partial adrenalectomy to preserve adrenal function. The renal tumor later metastasized to other parts of the body. He continues to receive systemic treatment and remains in partial remission. Patients with pT1aN0M0 renal cell carcinoma generally have a favorable prognosis. However, occasional such patients develop multiple metastases. To the best of our knowledge, this is the first reported case of bilateral adrenal metastases after partial nephrectomy. Clinicians should keep this rare scenario in mind.
Collapse
Affiliation(s)
- Hiroki Oshiro
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Yousuke Shimizu
- Department of Urology, Osaka Red Cross Hospital, Osaka, Japan
| | - Ryota Nakayasu
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Yu Miyazaki
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Noriaki Utsunomiya
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| | - Satsuki Asai
- Department of Pathology, Kobe City Nishi-Kobe Medical Center, Kobe, Hyogo Japan
| | - Sojun Kanamaru
- Department of Urology, Kobe City Nishi-Kobe Medical Center, 7-1 Kojidai, 5-Chome Nishi-ku, Kobe, Hyogo 651-2273 Japan
| |
Collapse
|
2
|
Kim ES, Kim SY, Moon A. C-Reactive Protein Signaling Pathways in Tumor Progression. Biomol Ther (Seoul) 2023; 31:473-483. [PMID: 37562952 PMCID: PMC10468419 DOI: 10.4062/biomolther.2023.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
Many cancers arise from sites of chronic inflammation, which creates an inflammatory microenvironment surrounding the tumor. Inflammatory substances secreted by cells in the inflammatory environment can induce the proliferation and survival of cancer cells, thereby promoting cancer metastasis and angiogenesis. Therefore, it is important to identify the role of inflammatory factors in cancer progression. This review summarizes the signaling pathways and roles of C-reactive protein (CRP) in various cancer types, including breast, liver, renal, and pancreatic cancer, and the tumor microenvironment. Mounting evidence suggests the role of CRP in breast cancer, particularly in triple-negative breast cancer (TNBC), which is typically associated with a worse prognosis. Increased CRP in the inflammatory environment contributes to enhanced invasiveness and tumor formation in TNBC cells. CRP promotes endothelial cell formation and angiogenesis and contributes to the initiation and progression of atherosclerosis. In pancreatic and kidney cancers, CRP contributes to tumor progression. In liver cancer, CRP regulates inflammatory responses and lipid metabolism. CRP modulates the activity of various signaling molecules in macrophages and monocytes present in the tumor microenvironment, contributing to tumor development, the immune response, and inflammation. In the present review, we overviewed the role of CRP signaling pathways and the association between inflammation and cancer in various types of cancer. Identifying the interactions between CRP signaling pathways and other inflammatory mediators in cancer progression is crucial for understanding the complex relationship between inflammation and cancer.
Collapse
Affiliation(s)
- Eun-Sook Kim
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University, Seoul 01369, Republic of Korea
| | - Sun Young Kim
- Department of Chemistry, College of Science and Technology, Duksung Women’s University, Seoul 01369, Republic of Korea
| | - Aree Moon
- Duksung Innovative Drug Center, College of Pharmacy, Duksung Women’s University, Seoul 01369, Republic of Korea
| |
Collapse
|
3
|
Brimo Alsaman MZ, Almerhej M, Qut A, Al Nahhas Z, Alia L, Nahas MA. A rare co-occurrence of renal cell carcinoma, bilateral adrenal metastasis and inferior vena cava thrombus: A case report. Int J Surg Case Rep 2023; 110:108675. [PMID: 37611394 PMCID: PMC10470296 DOI: 10.1016/j.ijscr.2023.108675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The incidence of ipsilateral adrenal metastasis from RCC varies between 1.1 and 10 %, on the other hand, the presence of bilateral adrenal metastasis from solitary RCC is extremely rare, with less than 20 reported cases in the literature. CASE PRESENTATION A 68-year-old man presented to the clinic with hematuria. Further investigations, contrast CT, showed mass at the right kidney and adrenal gland, a mass on the left adrenal gland and inferior cava thrombosis measuring 3*6 cm. The patient underwent, first, right nephrectomy and adrenalectomy with thrombectomy and IVC plasty. Microscopic examination showed clear cell renal cell carcinoma, while adrenal tissue showed metastatic renal cell carcinoma. The patient was followed up from the oncological, endocrinological and cardiac point of view. After 6 months he underwent left adrenalectomy. Subsequent follow-up showed body free of metastases. CLINICAL DISCUSSION The co-occurrence of renal cell carcinoma, bilateral adrenal metastasis, and inferior vena cava thrombus is a very rare phenomenon in the literature. Most patients with adrenal metastasis are asymptomatic, and the adrenal function is typically preserved even when malignancy affects bilateral adrenal glands. In addition, patients with adrenal ipsilateral metastases typically have primary renal tumors with poor prognosis. CONCLUSION The Diagnosis and management are a surgical challenge. Contrast-enhanced CT scan is the preferred imaging modality for renal cell carcinoma. The surgical intervention is mandatory if it can increase survival rate.
Collapse
Affiliation(s)
| | - Merhej Almerhej
- Vascular and Endovascular Surgery Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Alaa Qut
- Vascular and Endovascular Surgery Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | | | - Louei Alia
- Urology Department, Al-Assad University Hospital, Damascus University, Damascus, Syria
| | - Mohamad Ali Nahas
- Vascular and Endovascular Surgery Department, Al-Assad University Hospital, Damascus University, Damascus, Syria.
| |
Collapse
|
4
|
Ivanova NA, Burdennyi AM, Lukina SS, Filippova EA, Pronina IV, Karpukhin AV, Matveev VB, Kazubskaya TP, Loginov VI, Braga EA, Kushlinskii NE. The Role of Methylation of a Group of microRNA Genes in the Pathogenesis of Metastatic Renal Cell Carcinoma. Bull Exp Biol Med 2023:10.1007/s10517-023-05844-9. [PMID: 37466853 DOI: 10.1007/s10517-023-05844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 07/20/2023]
Abstract
The role of methylation of 9 miRNA genes in the pathogenesis of metastatic clear cell renal cell carcinoma was determined by quantitative methylation-specific PCR (MS-PCR). For 5 genes (MIR125B-1, MIR137, MIR193A, MIR34B/C, and MIR375), a significant correlation of high methylation level with late (III-IV) stages, large size (T3+T4) of the tumor, and metastasis to lymph nodes and/or distant organs was revealed. For another group of genes (MIR125B-1, MIR1258, MIR193A, MIR34B/C, and MIR375), a statistically significant correlation of high methylation level with loss of differentiation in the tumor (G3-G4) was found, and the opposite pattern was found for MIR203A. A total of 7 microRNA genes (MIR125B-1, MIR1258, MIR137, MIR193A, MIR203A, MIR34B/C, and MIR375) were identified, the methylation of which is associated with the progression of metastatic clear cell renal cell carcinoma. For 6 of them (except MIR34B/C) these data were obtained for the first time. Thus, new factors of the development and progression of clear cell renal cell carcinoma were identified as potential biomarkers for the early diagnosis and prognosis of metastatic clear cell renal cell carcinoma.
Collapse
Affiliation(s)
- N A Ivanova
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - A M Burdennyi
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia.
| | - S S Lukina
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - E A Filippova
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - I V Pronina
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - A V Karpukhin
- N. P. Bochkov Research Center for Medical Genetics, Moscow, Russia
| | - V B Matveev
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - T P Kazubskaya
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - V I Loginov
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - E A Braga
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
| | - N E Kushlinskii
- N. N. Blokhin National Medical Research Center of Oncology, Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
5
|
Politis D, Konstantakou P, Bramis K, Alexandraki KI, Spyroglou A, Mastorakos G, Anastasiou I, Papaconstantinou I, Dimopoulos MA. Surgical Treatment of Solitary Metachronous Adrenal Metastasis from Urothelial Carcinoma of the Urinary Bladder. TOUCHREVIEWS IN ENDOCRINOLOGY 2023; 19:94-97. [PMID: 37313235 PMCID: PMC10258614 DOI: 10.17925/ee.2023.19.1.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 06/15/2023]
Abstract
Urothelial cancer is a common neoplasm and metastatic disease correlates with a poor prognosis. Isolated adrenal gland metastases of urothelial carcinoma are quite rare, and management options can decide a patient's prognosis. Herein we report the case of a 76-year-old man with a metachronous solitary adrenal metastasis from a bladder carcinoma, who underwent adrenalectomy as part of his treatment. Furthermore, we discuss the cases of solitary adrenal metastases of urothelial carcinoma available in the literature, to identify key features to direct appropriate treatment of this rare metastatic site of urothelial cancer and improve prognosis and survival. Still, further prospective studies are needed to design effective therapeutic strategies.
Collapse
Affiliation(s)
- Dimitrios Politis
- Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Panagiota Konstantakou
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Bramis
- Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Krystallenia I Alexandraki
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ariadni Spyroglou
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - George Mastorakos
- Endocrinology Department, Aretaieion Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Ioannis Anastasiou
- First Department of Urology, National and Kapodistrian University of Athens, Laikon University Hospital, Athens, Greece
| | - Ioannis Papaconstantinou
- Second Department of Surgery, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Greece
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Alexandra Hospital, Athens, Greece
| |
Collapse
|
6
|
Schuppe K, Burke S, Cohoe B, Chang K, Lance RS, Mroch H. Atypical Nelson Syndrome Following Right Partial and Left Total Nephrectomy With Incidental Bilateral Total Adrenalectomy of Renal Cell Carcinoma: A Chat Generative Pre-Trained Transformer (ChatGPT)-Assisted Case Report and Literature Review. Cureus 2023; 15:e36042. [PMID: 37056551 PMCID: PMC10089233 DOI: 10.7759/cureus.36042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/14/2023] Open
Abstract
Nelson syndrome (NS) is a dangerous condition that can sometimes manifest after bilateral adrenalectomy (BA), typically in treating Cushing's disease. It is defined by the collection of systemic signs and symptoms that can arise in a state where there are chronically and massively elevated levels of adrenocorticotropic hormone (ACTH). Traditionally it may manifest from six months to 24 years following the loss of both adrenal glands, with the meantime of development being 15 years following BA. The diagnostic criteria are controversial, with historically many different methods being used, ranging from visual field defects and an enlarged pituitary corticotrophinoma to elevated plasma ACTH levels and skin hyperpigmentation. What remains consistent between criteria is that it is secondary to total BA, traditionally in treating refractory Cushing's disease. We describe here a rare case of a patient diagnosed with bilateral renal cell carcinoma (RCC) treated with right partial and left total nephrectomy, and incidental BA, presenting with the symptoms and signs of NS. Although NS classically presents following total BA for the treatment of Cushing disease, further research is required to look for etiologies of Nelson's-like pathology outside the context of Cushing's disease treatment, thereby necessitating a change to the traditional diagnostic criteria for the syndrome to identify cases that would otherwise go untreated. In addition, this case report's outlining, drafting, and conclusions were written in part by or with the support of Chat Generative Pre-Trained Transformer (ChatGPT), a large language transformer open-source artificial intelligence.
Collapse
|
7
|
Repp ML, Alvarez RA, Arevalo-Salazar DE, Kotagiri R. Metastatic Renal Cell Carcinoma and Unforeseen Adrenal Insufficiency: A Case Report and Literature Review. Cureus 2023; 15:e35265. [PMID: 36968872 PMCID: PMC10035604 DOI: 10.7759/cureus.35265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 02/23/2023] Open
Abstract
Renal cell carcinoma (RCC) can metastasize to nearly every organ, yet rarely metastasizes to the adrenal glands despite their anatomical proximity. Adrenal metastases are typically incidental findings on medical imaging and are vastly clinically asymptomatic. The adrenal glands can maintain hormonal homeostasis if a tenth of total adrenal gland function is preserved. We present a patient with synchronous bilateral adrenal metastases from RCC with rapid and unexpected development of adrenal insufficiency (AI).
Collapse
Affiliation(s)
- Matthew L Repp
- Medical School, University of Arizona College of Medicine, Tucson, USA
| | - Rodrigo A Alvarez
- Internal Medicine, University of Arizona College of Medicine, Tucson, USA
| | | | - Rajesh Kotagiri
- Internal Medicine, University of Arizona College of Medicine, Tucson, USA
| |
Collapse
|
8
|
Initial presentation of renal cell carcinoma as a vaginal mass with excessive bleeding. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2022; 21:285-288. [PMID: 36704765 PMCID: PMC9871993 DOI: 10.5114/pm.2022.124020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/09/2022] [Indexed: 01/19/2023]
Abstract
Introduction Renal cancer is the seventh most common cancer in men and the tenth most common cancer in women. Renal cell carcinoma accounts for 3% of all adult malignancies and 85% of all primary renal tumours. It metastasizes most often to the lungs, liver, bones, and brain and very rarely to the vagina. Case report We present a case of a 60-year-old patient, in whom the renal cell carcinoma manifested for the first time as an intense bleeding, soft tumour formation with dimensions 4/6 cm originating in the vagina. Discussion Renal cell carcinoma metastasizes in about 30% of cases. Metastasizing can be lymphatic, hematogenous, transcoelomic, or by direct invasion. Most commonly it affects the lungs, bones, adrenal glands, liver, lymph nodes, and brain. Much less often, it metastasizes to the thyroid, orbit, nasal structures, vagina, gallbladder, pancreas, sublingual tissues, and soft tissues of distal extremities. Metastases can be synchronous and metachronous. The described cases in the literature of renal cell carcinoma manifested with vaginal metastases are isolated. Conclusions We present an extremely rare case of renal cell carcinoma manifested by profuse genital bleeding from a vaginal metastasis. In such cases, especially if the vaginal lesion does not appear as the primary vaginal carcinoma, we must consider the possibility of metastasis from renal carcinoma.
Collapse
|
9
|
Knight AS, Ha FL, de Riese WT. Diagnostic and therapeutic challenges of synchronous renal mass and pancreatic mass: a review. JOURNAL OF CLINICAL UROLOGY 2022. [DOI: 10.1177/2051415820979099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Synchronous renal cell carcinoma (RCC) and pancreatic tumors are rare clinical events and have been described scarcely in the literature. Our institution has recently encountered one case. This review aims to summarize and present the diagnostic and therapeutic approaches that have been presented in the literature for these synchronous solid malignancies. Methods: After reviewing the literature using PubMed, 16 papers were collected that showed a total of 21 patients with a synchronous solid renal and pancreatic mass. The diagnostic and treatment data were then evaluated and analyzed. Results: Overall, 13 patients (59%) had two independent primary malignancies consisting of RCC and a pancreatic tumor, seven (31%) were diagnosed with primary RCC with synchronous metastasis to pancreas, one (5%) was found to have a primary pancreatic adenocarcinoma with synchronous metastasis to the kidney, and one (5%) was diagnosed with primary RCC with a benign solid pancreatic lesion. Of the 22 patients that were treated, 18 (81%) underwent surgery, one (5%) had no treatment, and three (14%) underwent chemotherapy without surgery. In the cohort of patients with surgical treatment 12 (66%) had no adjuvant therapy, one (6%) had adjuvant chemotherapy, four (22%) had adjuvant immunotherapy, and one (6%) had adjuvant radiation treatment. Conclusions: The occurrence of synchronous malignancies of the kidney and pancreas is rare. No clear guidelines have evolved in the literature in regard to diagnostics and treatment of these patients. This review presents recommended diagnostic and treatment guidelines for these rare clinical cases. Level of evidence: Not applicable for this multicenter review.
Collapse
Affiliation(s)
- Andrew S Knight
- Department of Urology, Texas Tech University Health Sciences Center, USA
| | - Freedom L Ha
- Department of Urology, Texas Tech University Health Sciences Center, USA
| | - Werner T de Riese
- Department of Urology, Texas Tech University Health Sciences Center, USA
| |
Collapse
|
10
|
Li Y, Ji Z, Wang D, Xie Y. Bilateral adrenal metastasis of renal cell carcinoma 4 years after radical nephrectomy: A case report and review of literature. Medicine (Baltimore) 2021; 100:e26838. [PMID: 34397852 PMCID: PMC8341217 DOI: 10.1097/md.0000000000026838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Renal cell carcinoma (RCC) almost metastasizes to every organ, the possibility of adrenal metastasis is relatively low in patients that have undergone radical nephrectomy, only a few cases of bilateral adrenal metastasis are reported on literature. Although surgical treatment of metastases from RCC is preferred and contributes to the rate of survival, it is considered challenging to manage such cases due to the rarity of bilateral metastasis to the adrenal glands. PATIENT CONCERNS A 64-year-old Manchus female presented with an incidental ultrasonic finding of a left adrenal mass 4 years after radical nephrectomy for left renal cell carcinoma. DIAGNOSIS Abdominal contrast enhanced CT scan revealed bilateral adrenal masses, suggesting metastatic lesion. Examinations indicated neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography/Computed Tomography (PET/CT) scan except high radioactive uptake in bilateral adrenal glands. INTERVENTIONS Metachronous bilateral adrenalectomy was taken and laparoscopic right adrenalectomy was first performed. She was discharged home on third postoperative day. Pathological examination revealed metastatic renal cell carcinoma. Two months later she was performed laparoscopic left adrenalectomy. OUTCOMES The patient healed without obvious complications and no tumor recurrence. LESSONS Bilateral metastatic adrenal recurrence from RCC is very rare. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally. Surgical intervention is a wise option for these patients that may improve survival, and metachronous bilateral adrenalectomy is proved to be safe and effective.
Collapse
|
11
|
Moradi A, Shakiba B, Maghsoudi R, Dehghaniathar R. Vaginal bleeding as primary presentation of renal cell carcinoma. CEN Case Rep 2020; 9:138-140. [PMID: 31916227 DOI: 10.1007/s13730-019-00442-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022] Open
Abstract
Vaginal metastases from renal cell carcinoma has been recorded as extremely rare. We present a patient with vaginal bleeding as primary manifestation of renal cell carcinoma. A 40-year-old woman presented to a local private clinic with intermittent vaginal bleeding for approximately one month. Gynecological examination revealed a mass on the vaginal wall at approximately 8 o'clock. She underwent dilation and curettage (D&C) and mass excision. Microscopic histopathology and immunohistochemical stains showed vaginal metastases of clear cell RCC. The patient was referred to our urology clinic. Magnetic Resonance Imaging (MRI) of abdomen and pelvic showed a well-defined solid mass lesion measuring 16 × 12 × 11 cm in left kidney. Patient underwent left side radical nephrectomy through a left subcostal intraperitoneal incision. Histopathological results and metastasis workup confirmed the diagnosis of RCC with solitary metastatic vaginal lesion. After radical nephrectomy, she was treated with Sunitinib. No local relapse or distant metastasis was recognized 5 months after radical nephrectomy. In conclusion, the incidence of RCC metastasis to the vagina is extremely rare; but, in cases of vaginal bleeding or lesions we have to keep in mind the possibility of metastatic RCC.
Collapse
Affiliation(s)
- Asaad Moradi
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran
| | - Behnam Shakiba
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran.
| | - Robab Maghsoudi
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran
| | - Reza Dehghaniathar
- Department of Urology, Firoozgar Hospital, Iran University of Medical Sciences, Valadi St., Valiasr Ave., 1593748711, Tehran, Iran
| |
Collapse
|
12
|
Lee MW, Lee HJ. Adrenal insufficiency due to recurrent renal cell carcinoma in the left adrenal gland 3 years after right radical nephrectomy for renal cell carcinoma. Postgrad Med 2019; 132:301-303. [PMID: 31752580 DOI: 10.1080/00325481.2019.1696581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Primary adrenal insufficiency due to tumor involvement is very rare. We herein report a case of adrenal insufficiency caused by cancer metastasis to a remaining single adrenal gland in a renal cell carcinoma patient who had undergone radical nephrectomy including removal of the right adrenal gland. The patient presented with abdominal discomfort, nausea, and vomiting which had begun about 3 months earlier. A rapid adrenocorticotropic hormone (ACTH) test showed no cortisol response with upper normal level of baseline ACTH. The patient was treated with prednisolone after diagnosis of primary adrenal insufficiency due to adrenal metastasis. The symptoms improved after prednisolone replacement. The case reminds clinicians the diagnosis of primary adrenal insufficiency due to tumor metastasis should be considered in patients with nonspecific gastrointestinal symptoms.
Collapse
Affiliation(s)
- Myung-Won Lee
- Department of Internal Medicine, College of Medicine Chungnam National University and Chungnam National University Hospital , Daejeon, Republic of Korea
| | - Hyo Jin Lee
- Department of Internal Medicine, College of Medicine Chungnam National University and Chungnam National University Hospital , Daejeon, Republic of Korea
| |
Collapse
|
13
|
Retroperitoneoscopic partial adrenalectomy for metachronous renal cell carcinoma metastasis to solitary adrenal gland. Int Cancer Conf J 2019; 9:1-4. [PMID: 31950008 DOI: 10.1007/s13691-019-00383-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 07/15/2019] [Indexed: 10/26/2022] Open
Abstract
Metastasectomy is a widely accepted treatment for renal cell carcinoma (RCC) metastasis, and is regarded as the most effective strategy for increasing the rate of cancer-specific survival. However, since bilateral synchronous or metachronous adrenal metastasis of RCC is extremely rare, a standard approach has yet to be established. Partial adrenalectomy may avoid lifelong hormonal supplementation and reduce the risk of Addisonian crisis. A 71-year-old man had a previous history of left nephrectomy and ipsilateral adrenalectomy for metachronous adrenal metastasis. Metachronous contralateral adrenal metastasis was detected 2 years after ipsilateral adrenalectomy, and he underwent retroperitoneoscopic partial adrenalectomy using a vessel sealing device. Although corticosteroid replacement therapy was not prophylactically performed, the patient did not exhibit any symptoms of hypocorticism. Nine months after the surgery, the patient remains well without steroid supplementation, and neither local recurrence nor metastasis has been detected. To the best of our knowledge, this is the first case report of laparoscopic partial adrenalectomy for RCC metastasis. The vessel sealing device was highly effective and suitable for laparoscopic partial adrenalectomy.
Collapse
|
14
|
Bourdeau I, El Ghorayeb N, Gagnon N, Lacroix A. MANAGEMENT OF ENDOCRINE DISEASE: Differential diagnosis, investigation and therapy of bilateral adrenal incidentalomas. Eur J Endocrinol 2018; 179:R57-R67. [PMID: 29748231 DOI: 10.1530/eje-18-0296] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 01/11/2023]
Abstract
The investigation and management of unilateral adrenal incidentalomas have been extensively considered in the last decades. While bilateral adrenal incidentalomas represent about 15% of adrenal incidentalomas (AIs), they have been less frequently discussed. The differential diagnosis of bilateral incidentalomas includes metastasis, primary bilateral macronodular adrenal hyperplasia and bilateral cortical adenomas. Less frequent etiologies are bilateral pheochromocytomas, congenital adrenal hyperplasia (CAH), Cushing's disease or ectopic ACTH secretion with secondary bilateral adrenal hyperplasia, primary malignancies, myelolipomas, infections or hemorrhage. The investigation of bilateral incidentalomas includes the same hormonal evaluation to exclude excess hormone secretion as recommended in unilateral AI, but diagnosis of CAH and adrenal insufficiency should also be excluded. This review is focused on the differential diagnosis, investigation and treatment of bilateral AIs.
Collapse
Affiliation(s)
- Isabelle Bourdeau
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
| | - Nada El Ghorayeb
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
| | - Nadia Gagnon
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
| | - André Lacroix
- Division of Endocrinology, Department of Medicine, Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Université de Montréal, Montréal, Canada
| |
Collapse
|
15
|
Ma Z, Qi Z, Shan Z, Li J, Yang J, Xu Z. The role of CRP and ATG9B expression in clear cell renal cell carcinoma. Biosci Rep 2017; 37:BSR20171082. [PMID: 28923830 PMCID: PMC5686392 DOI: 10.1042/bsr20171082] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/28/2022] Open
Abstract
The purpose of the study is to investigate the correlation between the expression of C-reactive protein (CRP) and autophagy-related 9B (ATG9B) and pathological features of clear cell renal cell carcinoma (CCRCC) patients. We also intended to explore the effects of manipulated expression of CRP and ATG9B on the apoptosis and cell cycle progression of CCRCC cell line. ATG9B expression in CCRCC tissues and adjacent renal tissues was analyzed by immunohistochemistry (IHC). Gene expression was determined at transcription and translational levels using real-time quantitative PCR (RT-qPCR) and Western blot. The association between CRP/ATG9B expression and clinical-pathological parameters including age, gender, pathological grades, TNM stage and distant metastasis of the patients was assessed by correlation analysis. siRNA and overexpression plasmids construction were used to manipulate the expression of CRP in human CCRCC cell line 786-O. Cell apoptosis and cell cycle progression were determined using flow cytometry (FCM) and Hoechst 33258 staining. CRP expression correlates with ATG9B expression. The expression of CRP and ATG9B are significantly correlated with TNM staging, distant metastasis, and survival time of CCRCC patients. A high-level of CRP indicates a poor overall survival (OS). In addition, CRP expression influences cell cycle and apoptosis of CCRCC cells. The study reveals that CRP might be a CCRCC development promoter. In addition, there is a close relationship between CRP and ATG9B in CCRCC carcinogenesis.
Collapse
Affiliation(s)
- Zheng Ma
- Department of Urology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Zengguang Qi
- Department of Urology, Guanxian Center Hospital, Liaocheng 252500, Shandong, China
| | - Zhengfei Shan
- Department of Urology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong, China
- Department of Organ Transplantation, the affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong, China
| | - Jiangsong Li
- Department of Urology, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Jing Yang
- Department of Pediatrics, Liaocheng People's Hospital, Liaocheng 252000, Shandong, China
| | - Zhonghua Xu
- Department of Urology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
| |
Collapse
|
16
|
Nouralizadeh A, Afyouni A, Shakiba B, Radhi FK. Simultaneous Bilateral Laparoscopic Adrenalectomy for Adrenal Metastases of Renal Cell Carcinoma: A Case Report. J Endourol Case Rep 2017; 3:142-145. [PMID: 29098197 PMCID: PMC5655842 DOI: 10.1089/cren.2017.0062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The possibility of bilateral adrenal gland metastasis from renal cell carcinoma (RCC) has been extremely rarely reported. Surgery may be the preferred treatment strategy for adrenal metastasis from RCC. In this article, we present a patient with bilateral large adrenal metastases from the left RCC, which was managed with simultaneous bilateral laparoscopic excision. A 64-year-old woman had undergone left adrenal sparing radical nephrectomy for a left RCC 7 years ago. Her abdominal CT scan revealed bilateral large adrenal metastasis. She underwent bilateral laparoscopic adrenalectomy. The operation was uneventful and the patient was discharged after 4 days with no complications. Bilateral laparoscopic adrenalectomy for adrenal metastasis seems to be a feasible and safe procedure in such cases, but this needs to be confirmed by further studies with a larger sample size.
Collapse
Affiliation(s)
- Akbar Nouralizadeh
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Afyouni
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Shakiba
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahad Khalid Radhi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Urology, Aljomhori General Hospital, Basrah, Iraq
| |
Collapse
|
17
|
Paschou SA, Tzioras K, Nika C, Papatheodorou A, Samaras V, Vryonidou A. Visual Vignette. Endocr Pract 2017; 23:510. [PMID: 27631846 DOI: 10.4158/ep161489.vv] [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] [Indexed: 11/15/2022]
|
18
|
Bokhari A, Tiscornia-Wasserman PG. Cytology diagnosis of metastatic clear cell renal cell carcinoma, synchronous to pancreas, and metachronous to thyroid and contralateral adrenal: Report of a case and literature review. Diagn Cytopathol 2016; 45:161-167. [DOI: 10.1002/dc.23619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/31/2016] [Accepted: 09/19/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Aqiba Bokhari
- Division of Cytopathology; Department of Pathology and Cell Biology; New York Presbyterian-Columbia University Medical Center; New York New York
| | - Patricia G. Tiscornia-Wasserman
- Division of Cytopathology; Department of Pathology and Cell Biology; New York Presbyterian-Columbia University Medical Center; New York New York
| |
Collapse
|
19
|
Tumores renales bilaterales sincrónicos de células claras con trombo tumoral bilateral, reporte de caso. Rev Urol 2016. [DOI: 10.1016/j.uroco.2016.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Benetti MA, Nunes RAB, Benvenuti LA. Case 2/2016 - 76-Year-Old Male with Hypertensive Heart Disease, Renal Tumor and Shock. Arq Bras Cardiol 2016; 106:439-46. [PMID: 27305288 PMCID: PMC4914010 DOI: 10.5935/abc.20160067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
21
|
HE TAO, LIU JIAJU, LI YIFAN, JIN LU, SUN SHUOLEI, NI LIANGCHAO, MAO XIANGMING, YANG SHANGQI, LAI YONGQING. Left adrenal gland metastasis of breast invasive ductal carcinoma: A case report. Mol Clin Oncol 2016; 4:859-862. [PMID: 27123296 PMCID: PMC4840554 DOI: 10.3892/mco.2016.814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 02/25/2016] [Indexed: 02/05/2023] Open
Abstract
The majority of the metastatic lesions of the adrenal gland normally originate from lung cancer, colon malignant tumor, renal cell carcinoma and melanoma. However, adrenal gland metastasis that metastasize from breast invasive ductal carcinoma are extremely rare. The present study reported a rare case of left adrenal gland metastasis in a 35-year-old female who was diagnosed as breast carcinoma 5 years ago with a mass located on the left adrenal gland, which was detected during a routine examination. The patient was asymptomatic and adrenal gland computed tomography revealed a mass in the left adrenal gland. Definitive preoperative diagnosis failed to be established. Left adrenal gland laparoscopic adrenalectomy was performed and the diagnosis of adrenal gland metastasis of breast invasive ductal carcinoma was confirmed by pathological and immunohistochemical examination. The patient remained in good condition by the time of writing.
Collapse
Affiliation(s)
- TAO HE
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
- Guangzhou Medical University, Guangzhou 511436, P.R. China
| | - JIAJU LIU
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
- Shantou University Medical College, Guangdong 515041, P.R. China
| | - YIFAN LI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
- Anhui Medical University, Anhui, Hefei 230032, P.R. China
| | - LU JIN
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
- Anhui Medical University, Anhui, Hefei 230032, P.R. China
| | - SHUOLEI SUN
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
| | - LIANGCHAO NI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
| | - XIANGMING MAO
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
| | - SHANGQI YANG
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
- Correspondence to: Professor Yongqing Lai or Professor Shangqi Yang, Department of Urology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen 518036, P.R. China, E-mail: , E-mail:
| | - YONGQING LAI
- Department of Urology, Peking University Shenzhen Hospital, Shenzhen 518036, P.R. China
- Correspondence to: Professor Yongqing Lai or Professor Shangqi Yang, Department of Urology, Peking University Shenzhen Hospital, 1120 Lianhua Road, Shenzhen 518036, P.R. China, E-mail: , E-mail:
| |
Collapse
|
22
|
Ficarra V, Crestani A. Case Discussion: A 63-year-old Man with Bilateral Adrenal Mass and Large Renal Cell Carcinoma-The Case for Surgery. Eur Urol Focus 2016; 1:294-296. [PMID: 28723404 DOI: 10.1016/j.euf.2015.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Abstract
The challenging case of an asymptomatic 63-yr-old man with a large renal cell carcinoma, bilateral adrenal mass, and small pancreatic and pulmonary nodules suspicious for metastases is presented. Treatment strategy is discussed by a surgeon recommending immediate cytoreductive nephrectomy and unilateral adrenalectomy as the first step and a medical oncologist favouring systemic targeted therapy at symptomatic disease progression.
Collapse
Affiliation(s)
- Vincenzo Ficarra
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia," Udine, Italy; Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
| | - Alessandro Crestani
- Urology Unit, Academic Medical Centre Hospital "Santa Maria della Misericordia," Udine, Italy
| |
Collapse
|
23
|
Metastatic renal cell carcinoma without evidence of a renal primary. Int Urol Nephrol 2015; 48:73-7. [PMID: 26527083 DOI: 10.1007/s11255-015-1145-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/22/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE Metastatic renal cell carcinoma (RCC), without an identified kidney primary, has been reported rarely. We report a patient with RCC metastatic to bilateral adrenal glands and liver, without an apparent renal primary. We detail the immunohistochemical and molecular studies employed to substantiate the diagnosis of RCC and direct therapy. METHODS Histopathologic findings were correlated with imaging data and supplemented by a panel of immunohistochemical stains, as well as tumor sequence analysis. RESULTS Despite the presence of bilateral adrenal masses and lack of tumor within kidney parenchyma, the diagnosis of RCC was substantiated by immunohistochemistry (RCC+/PAX2+/PAX8+/Melan-A-/SF-1- among others) and molecular genetic analysis, harboring mutations in VHL, TP53, KDM5C, and PBRM1. After debulking surgery, based on the diagnosis of RCC and the molecular profile, the patient was treated with a tyrosine kinase inhibitor (sunitinib), resulting in stablilization of disease. CONCLUSIONS This case illustrates the role of mutational analysis in carcinomas with rare or unusual presentations, such as metastatic RCC without a renal primary.
Collapse
|