Ann Thorac Surg 1999;68:1084-1085
© 1999 The Society of Thoracic Surgeons
Case Reports
Long-term survival after surgical resections of bronchogenic carcinoma and adrenal metastasis
Marc de Perrot, MDa,
Marc Licker, MDb,
John H. Robert, MDa,
Anastase Spiliopoulos, MDa
a Unit of Thoracic Surgery, University Hospital of Geneva, Geneva, Switzerland
b Division of Anesthesiology, University Hospital of Geneva, Geneva, Switzerland
Address reprint requests to Dr Spiliopoulos, Unit of Thoracic Surgery, Department of Surgery, University Hospital of Geneva, Rue Micheli-du-Crest 24, 1211 Geneva 14, Switzerland
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Abstract
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There is some evidence that complete resection of both primary and metastatic sites of non-small cell lung carcinoma has more influence on survival than the locoregional stage of the lung cancer. We describe prolonged survival (> 5 years) after complete surgical resection of a bronchogenic carcinoma (T3N0M1) and solitary adrenal metastasis.
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Introduction
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The association of surgery and chemotherapy has been shown to prolong survival in patients with non-small cell lung carcinoma (NSCLC) and synchronous solitary adrenal metastasis [1]. Herein, we describe a patient who is still alive more than 5 years after resection of a bronchogenic carcinoma and solitary adrenal metastasis.
A 54-year-old man complained of nocturnal sweats, epigastric pain, and a 6-kg weight loss. A solid mass of 4.5 cm was visualized in the right adrenal gland by ultrasonography and confirmed by magnetic resonance imaging (Fig 1). Adenocarcinomatous cells were identified after percutaneous needle biopsy. Because an extensive workup including bronchoscopy, gastroscopy, coloscopy, and computed tomographic (CT) scans remained negative, the adrenal carcinoma was considered to be primitive, and a right adrenalectomy was performed through a posterior approach. Histological examination documented a poorly differentiated carcinoma without lymph node metastasis. Radiotherapy was administered on the adrenal site postoperatively.
Six months later, the patient complained of pain in his right shoulder. A thoracic CT scan documented a 4.5-cm tumor in upper part of the lung with partial lysis of the second rib (Fig 2). The patient underwent an enlarged right upper lobectomy with resection of the two first ribs and mediastinal lymph nodes dissection. The postoperative course was uneventful. Histologically, adrenal and lung carcinomas were found to be similar, and a definitive diagnosis of pulmonary large cell carcinoma with metastasis to the right adrenal gland was considered (T3N0M1). Postoperatively, radiotherapy was administered on the upper right hemithorax.
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Fig 2. Computed tomographic scan of upper chest showing lung tumor of the right upper lobe with invasion of the second rib.
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More than 5 years after lung resection, the patient is alive and has returned to his daily activities. A CT scan performed recently by his family physician does not show recurrence of disease.
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Comment
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The current case presented very unusually with an adrenal metastasis detected 6 months before the development of a bronchogenic carcinoma. Adrenal metastases from NSCLC are frequent, ranging from 25% to 45% in autopsy series [2]. With continuing progress in imaging techniques, the number of adrenal metastases detected before death or found incidentally at the time of diagnosis has been progressively increasing. Such findings usually preclude surgical intervention, since hematogenous spread of the disease to other sites is expected.
According to published series and case reports, a total of 27 patients with adrenal metastasis from NSCLC have undergone adrenalectomy with (n = 25) or without (n = 2) lung resection [1, 3–8]. In 24 cases, solitary metastasis were described, whereas in the remaining 3 cases, dissemination was extended in other organs. The decision to perform adrenalectomy was based on the presence of intractable pain (n = 8) or after excluding other remote metastasis (n = 19). Noteworthy, in 9 patients, adrenal metastasis occurred 6 to 15 months (median 11 months) after the diagnosis of lung cancer (metachronous presentation). In most cases, adrenalectomy was performed through an abdominal or a posterior approach, although transthoracic, transdiaphragmatic excision of simultaneous lung and adrenal lesions is an alternative approach associated with lower morbidity [3].
Fourteen patients (48%) are still alive 3 months to 14 years after surgery (median 4 years). Eight patients, including the current case, have survived at least 5 years after resection of adrenal metastases from bronchogenic carcinoma [1, 3–6]. Well-documented data of 6 patients alive 5 years after surgery are summarized in Table 1. Pulmonary resection and adrenalectomy was performed in all but 1 patient. In the latter case, a locoregional radiotherapy was the sole treatment, as the primary tumor was found to be irresectable (Patient 2).
The current case strongly suggests that complete resection of both the primary and metastatic sites of lung cancer have more influence on survival than the locoregional stage of the disease.
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References
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Accepted for publication March 3, 1999.
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Abstract
Introduction
