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Case Reports
. 2022 Jul 29;5(6):446-450.
doi: 10.1002/iju5.12511. eCollection 2022 Nov.

Metastatic neuroendocrine carcinoma of right adrenal gland successfully treated with laparoscopic adrenalectomy after multimodal therapy

Yusuke Yamagata  1 , Takashige Abe  1 , Naoya Iwahara  1 , Kohichi Takada  2 , Yasuhiro Hida  3 , Emi Takakuwa  4 , Hiroshi Kikuchi  1 , Ryuji Matsumoto  1 , Takahiro Osawa  1 , Nobuo Shinohara  1
Affiliations
Case Reports

Metastatic neuroendocrine carcinoma of right adrenal gland successfully treated with laparoscopic adrenalectomy after multimodal therapy

Yusuke Yamagata et al. IJU Case Rep. .

Abstract

Introduction: We report a case of laparoscopic adrenalectomy in a salvage setting after multiple chemotherapies for neuroendocrine carcinoma.

Case presentation: A 49-year-old man was diagnosed with unknown primary carcinoma with single brain metastasis, and right supraclavicular and mediastinal lymph node metastases. After stereotactic radiotherapy of the brain metastasis and systemic chemotherapy, lymphadanectomy was performed. The pathologic diagnosis was neuroendocrine carcinoma. At 11 months after surgery, computed tomography revealed right adrenal metastasis. Local radiotherapy initially resulted in complete remission. However, adrenal recurrence was noted 10 months later. Laparoscopic adrenalectomy was performed with curative intent. The patient is currently alive without recurrence at 20 months after the operation.

Conclusion: Adrenalectomy can become a treatment option if other metastases are well-controlled with systemic therapy. Surgical elimination of oligometastases can offer long-term disease control in selected patients as part of a multimodal approach.

Keywords: adrenal gland neoplasms; adrenalectomy; combined modality therapy; laparoscopic surgery; metastasectomy; salvage therapy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
(a)‐(d) Pathologic findings of the right supraclavicular lymph node biopsy specimen (a) Hematoxylin and eosin staining (b) TTF‐1 is positive. (c) ALK is negative. (d) PD‐L1 is weak positive. (e)‐(h) Pathologic findings of the right adrenal tumor (e) A well‐circumscribed white lesion is found in the right adrenal gland. (red circle). (f) Low‐magnification view of the right adrenal gland. (g) Hematoxylin and eosin staining (h) Chromogranin A, which is specific for neuroendocrine tumors, is partially positive.
Fig. 2
Fig. 2
FDG PET‐CT findings. Fluorodeoxyglucose uptake is shown in the right adrenal gland at 11 months after right supraclavicular and mediastinal lymph node dissection.
Fig. 3
Fig. 3
Transition of ProGRP during the treatment (normal range: 0–80.9 pg/mL).
Fig. 4
Fig. 4
Enhanced computed tomography before adrenalectomy. Right adrenal metastasis remains after local radiotherapy and multiple chemotherapies.
See this image and copyright information in PMC

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