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. 2017 Dec;3(1):61.
doi: 10.1186/s40792-017-0337-8. Epub 2017 May 5.

A case of long-term survival after surgical resection for solitary adrenal recurrence of esophageal squamous carcinoma

Nobuhiko Kanaya  1 , Kazuhiro Noma  2 , Tsuyoshi Okada  1 , Naoaki Maeda  1 , Shunsuke Tanabe  1 , Kazufumi Sakurama  1   3 , Yasuhiro Shirakawa  1 , Toshiyoshi Fujiwara  1
Affiliations

A case of long-term survival after surgical resection for solitary adrenal recurrence of esophageal squamous carcinoma

Nobuhiko Kanaya et al. Surg Case Rep. 2017 Dec.

Abstract

Background: Esophageal carcinomas are highly malignant tumors with a high frequency of lymph node and distant organ metastasis. Treatment for recurrent tumors is generally decided on an individual basis. Although multidisciplinary treatments involving chemotherapy, surgical resection, and radiation are performed, the prognosis remains poor. Here, we report a case of prolonged recurrence-free survival (38 months) after esophageal carcinoma surgery and subsequent laparoscopic adrenalectomy for right adrenal metastasis.

Case presentation: An 83-year-old man was diagnosed with type 3 esophageal squamous cell carcinoma (T3N1M0, cStage IIIA, UICC-7), spreading from the lower thoracic esophagus to the abdominal esophagus. He underwent thoracoscopic esophagectomy with a two-field lymph node dissection followed by substernal gastric tube reconstruction. The final diagnosis was moderately differentiated squamous cell carcinoma (T3N2M0, fStage IIIB). Adjuvant chemotherapy was not administered because of the advanced age and postoperative condition of the patient. Computed tomography (CT) at 14 months postoperatively showed a mass with a 2-cm diameter at the right adrenal gland. Positron emission tomography (PET)/CT revealed a high fluorodeoxyglucose (FDG) uptake in the mass. It was suspected that the mass was a metastatic lesion secondary to the primary esophageal carcinoma. No metastases to lymph nodes or other distant organs were identified. The patient underwent laparoscopic right adrenalectomy. The histopathological examination revealed moderately differentiated squamous cell carcinoma, suggesting metastasis from the primary esophageal carcinoma. He has survived without recurrence for 38 months since laparoscopic adrenalectomy to remove the right adrenal metastastic mass after the esophageal carcinoma surgery.

Conclusions: We describe a very elderly male who survived laparoadrenalectomy for right adrenal metastasis following esophageal cancer surgery without recurrence for 38 months postoperatively. Therefore, surgical resection might be an option for solitary adrenal recurrence.

Keywords: Adrenal metastasis; Esophageal squamous cell carcinoma; Esophagectomy.

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Figures

Fig. 1
Fig. 1
Resected specimen of esophageal carcinoma. a Gross appearance shows type 3 tumor, approximately 4.5-cm long in LtAe. b Hematoxylin and eosin staining shows moderately differentiated squamous cell carcinoma
Fig. 2
Fig. 2
Images from CT and FDG-PET/CT. a A mass with a 2-cm diameter in the right adrenal gland. b PET/CT shows high accumulation of FDG (standardized uptake value max, 7.67) in the right adrenal mass. Abbreviations: CT computed tomography, PET positron emission tomography, FDG 8F-fluorodeoxyglucose
Fig. 3
Fig. 3
Clinical changes in concentrations of tumor markers, carcinoembryonic antigen (blue line) and squamous cell carcinoma (red line). Ope operation
Fig. 4
Fig. 4
Resected specimen of the right adrenal mass. a Gross appearance shows a hard, solid mass approximately 2.0 cm in diameter. b Hematoxylin eosin staining shows moderately differentiated squamous cell carcinoma
See this image and copyright information in PMC

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