Previous Next

ARCHIVE

№4' 2021

ONCOLOGY

International Medical Journal, Vol. 27., Iss. 4, 2021, P. 50−56.

DOI (https://doi.org/10.37436/2308-5274-2021-4-9)

CLINICAL AND MORPHOLOGICAL FEATURES OF ADRENAL METASTASES OF RENAL CELL CARCINOMA

Kharkiv National Medical University
Municipal Non−Profit Enterprise "V. I. Shapoval Regional Medical Clinical Center of Urology and Nephrology", Kharkiv, Ukraine

The problem of adrenal metastases and the need for ipsilateral adrenalectomy during nephrectomy in the patients with renal cell carcinoma has not yet been resolved. To study the clinical and morphological features of adrenal metastases of renal cell carcinoma and to identify a group of patients with a high probability of their development, pathological findings and case histories of 108 patients who underwent surgery included adrenalectomy or adrenal resection were retrospectively examined. Characteristics of patients and tumors in the groups of adrenal metastases and adrenal bulk formations not being cancer metastases were comparatively analyzed. When analyzing the tumors from the group of benign formations of the ipsilateral adrenal gland, it was found that in most cases they were represented by cortical adrenal adenomas without signs of hormonal activity. The histological structure of benign neoplasms was most often represented by clear cell and mixed−cell adenomas, dark−cell adenoma was observed in one case. The patients of this group complained mostly of common a persistent or intermittent rise of blood pressure. Patients with synchronous adrenal metastases of cancer are characterized by large kidney tumors, signs of local spread. According to the study results, it was concluded that the prognostic value in terms of differential diagnosis of adrenal metastases and adenomas in the patients with renal cell carcinoma there was demonstrated only by macroscopic intravenous cancer. The characteristics of the adrenal glands themselves were not objective prognostic parameters for the differential diagnosis between benign and malignant pathology. Ipsilateral adrenalectomy is indicated in the patients with intravenous renal cell carcinoma.

Key words: adrenal metastases, renal cell carcinoma, intravenous spread of renal cell carcinoma.

REFERENCES

1. Robson C. J., Churchill B. M., Anderson W. The results of radical nephrectomy for renal cell carcinoma // J. Urol. 1969. № 101 (3). R. 297−301. doi: 10.1016/s0022−5347(17)62331−0

2. Skinner D. G., Vermilion C. D., Colvin R. B. The surgical management of renal cell carcinoma // J. Urol. 1972. № 107. R. 705−710.

3. Adrenal metastases in 1635 patients with renal cell carcinoma: outcome and indication for adrenalectomy / S. Siemer et al. // J. Urol. 2004. Vol. 171. P. 2155−2159. doi: 10.1097/01.ju.0000125340.84492.a7

4. Routine adrenalectomy is unnecessary during surgery for large and/or upper pole renal tumors when the adrenal gland is radiographically normal / A. Kutikov et al. // J. Urol. 2011. Vol. 185 (4). P. 1198−1203. doi: 10.1016/j.juro.2010.11.090

5. Routine adrenalectomy in patients with locally advanced renal cell cancer does not offer oncologic benefit and places a significant portion of patients at risk for an asynchronous metastasis in a solitary adrenal gland / C. J. Weight et al. // Eur. Urol. 2011. Vol. 60 (3). P. 458−464. doi: 10.1016/j.eururo.2011.04.022

6. Comparative effectiveness of adrenal sparing radical nephrectomy and non−adrenal sparing radical nephrectomy in clear cell renal cell carcinoma: Observational study of survival outcomes / G. J. Nason et al. // Can. Urol. Assoc. J. 2015. Vol. 9 (9−10). P. 583−588. doi: 10.5489/cuaj.2842

7. Identifying tumor−related risk factors for simultaneous adrenalectomy in patients with cT1−cT2 kidney cancer during robotic assisted laparoscopic radical nephrectomy / J. Daza et al. // Minerva Urol. Nephrol. 2021. Vol. 73 (1). P. 72−77. doi: 10.23736/S0393−2249.19.03440−4

8. Factors influencing adrenal metastasis in renal cell carcinoma / S. M. Moudouni et al. // Int. Urol. Nephrol. 2003. Vol. 35 (2). P. 141−147. doi: 10.1023/b:urol.0000020299.36091.33

9. Should Ipsilateral Solitary Adrenal Involvement in Renal Cell Carcinoma be Staged as M1? / T. Takayama et al. // Jpn. J. Clin. Oncol. 2011. Vol. 41 (6). P. 792−796. doi: 10.1093/jjco/hyr031

10. The Role of Adrenalectomy in Renal Cancer / C. J. Weight, P. F. Mulders, A. J. Pantuck, R. H. Thompson // Eur. Urol. Focus. 2016. Vol. 1 (3). P. 251−257. doi: 10.1016/j.euf.2015.09.005

11. Management of locally advanced renal cell carcinoma / G. Samuel et al. // AME Med. J. 2021. Vol. 6. P. 5. doi: http://dx.doi.org/10.21037/amj−20−79