ABSTRACT
A 71-year-old woman with a right adrenal mass detected by computed tomography was referred to our institution. Before 33 months, she had undergone a radical heminephrectomy for an 11-cm renal cell carcinoma (RCC) in the left moiety of a horseshoe kidney. The adrenal tumor was diagnosed as the metastasis of RCC. The tumor was subsequently removed in a laparoscopic adrenalectomy by a retroperitoneal approach. Pathologic examination revealed the mass to be the adrenal metastasis of RCC. To our knowledge, this is the initial report of a laparoscopic adrenalectomy for the adrenal metastasis of renal cell carcinoma arising from a horseshoe kidney.
ABSTRACT
OBJECTIVES: The treatment of adrenal metastases using laparoscopic surgery still remains a matter of considerable controversy. The aim of this study is to present our experience of laparoscopic adrenalectomy for isolated adrenal metastasis. METHODS: From June 2004 to June 2011, 5 adults (4 males/1 female) with isolated metastases to the adrenal glands underwent laparoscopic adrenalectomy. These patients included 3 cases of lung carcinoma, a case of hepatocellular carcinoma, and a case of renal cell carcinoma. The median patient age was 69 (range 61 to 72), and the median tumor size was 3.5 cm (range 2.5 to 7.0). RESULTS: Laparoscopic adrenalectomies were performed without any complications using transperitoneal and retroperitoneal approaches. The median operative time was 142 minutes (range 126 to 174), and the estimated blood loss was 38 ml (range 25 to 158). The resection margins were free in all cases. A patient with lung cancer has been treated with adjuvant chemotherapy, otherwise, 4 patients have not. Regarding the oncological outcome, 3 of 5 patients were alive without any recurrence at a median follow-up of 14 months. About the rest two cases, one was alive with lung metastasis occurred at 15 months later, the other was died of the cancer at 14 months later. CONCLUSIONS: Laparoscopic adrenalectomy for isolated adrenal metastasis is thought to be feasible. However, the indication of the surgery must be determined depending on tumor size, cancer characteristics, risk factors and so on. Additionally, the operative procedures such as approaches must be discussed sufficiently.
Subject(s)
Adrenal Gland Neoplasms/secondary , Adrenal Gland Neoplasms/surgery , Adrenalectomy , Laparoscopy , Adrenalectomy/methods , Aged , Female , Humans , Male , Middle AgedABSTRACT
We report on 2 infants with acute renal failure caused by bilateral obstructive ureteral stones associated with rotavirus gastroenteritis. A 28-month boy and a 13-month boy with several days history of watery diarrhea and vomiting were referred to our hospital because of anuria. They were diagnosed acute post-renal failure due to obstructive bilateral ureteral stones based on the findings of ultrasound scan and computed tomography. Immediately, percutaneous nephrostomy tubes were inserted for urinary drainage, serum levels of creatinine and uric acid returned to normal within several days. Sandy stones were excreted through the nephrostomy tubes with urine after urinary alkalization, which were proved to be mainly ammonium acid urate. Ammonium acid urate is rare in developed countries, but some cases of bilateral urolithiasis causing acute renal failure in infants with rotavirus gastroenteritis were reported in recent years. It has been known that the cause of acute renal failure is renal azotemia resulting from sustained hypovolemia, but post-renal causes due to ammonium acid urate stones should be taken into consideration.