title: Bilateral adrenal leiomyosarcoma treated with multiple local therapies.
abstract: A 62-year-old woman presented with right flank pain, and computed tomography (CT) showed bilateral adrenal tumors (right, 8 cm; left, 4 cm). There were no abnormal findings on physical examination, and adrenal hormone levels in serum and urine were within normal limits. Radiological studies showed a right adrenal tumor with intratumoral hemorrhage, a cystic tumor in the left adrenal gland, and no sign of distant metastasis. Because laboratory tests showed normal levels of adrenal hormones, we considered the tumors to be nonfunctioning adrenal tumors. The right adrenal tumor was surgically removed because it was thought to be malignant, and histological examination revealed that it was a leiomyosarcoma. Postoperative CT showed a pleural metastasis in the right chest wall. The patient received combination chemotherapy with cyclophosphamide, vincristine, adriamycin, and dacarbazine. The metastasis was also treated with radiofrequency ablation (RFA). Because the left adrenal tumor grew rapidly despite two courses of the chemotherapy, it too was surgically removed. After the operation, metastasis in the right iliac bone was treated with RFA and radiotherapy. Positron emission tomography detected bilateral femoral metastases, and these were treated with radiotherapy in combination with a low dose of cisplatin. A liver metastasis and a small metastasis in the left kidney were treated with RFA and a metastasis in the pancreatic tail was removed surgically. Sixteen months after the right adrenalectomy, the patient died due to systemic spread of the disease. Multiple local treatments including RFA, radiotherapy, and resection were effective for the local control of metastatic lesions of adrenal leiomyosarcoma.
authors.affiliation: Department of Urology, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Hamada
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ito
authors.forename: Musashi
authors.initials: M
authors.lastname: Tobe
authors.forename: Hideo
authors.initials: H
authors.lastname: Otsuki
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Hama
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Kato
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Sugiura
authors.forename: Tatsumi
authors.initials: T
authors.lastname: Kaji
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Asano
authors.forename: Masamichi
authors.initials: M
authors.lastname: Hayakawa
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000473:pathology / Q000628:therapy*; D000315:Adrenalectomy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary / Q000628:therapy; D017115:Catheter Ablation; D017024:Chemotherapy, Adjuvant; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000556:secondary / Q000628:therapy; D007890:Leiomyosarcoma / Q000556:secondary / Q000628:therapy*; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000556:secondary / Q000628:therapy; D010997:Pleural Neoplasms / Q000556:secondary / Q000628:therapy; D049268:Positron-Emission Tomography; D018714:Radiotherapy, Adjuvant; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
references.citation: Endocr Pathol. 2005 Spring;16(1):75-81
references.pmid: 16000850
references.citation: Clin Med Oncol. 2008;2:353-6
references.pmid: 21892297
references.citation: Am J Surg Pathol. 1991 Sep;15(9):899-905
references.pmid: 1951846
references.citation: Chest. 2006 Mar;129(3):738-45
references.pmid: 16537876
references.citation: Cancer. 1984 May 1;53(9):1825-32
references.pmid: 6367947
references.citation: Endocr J. 2008 Mar;55(1):175-81
references.pmid: 18250540
references.citation: Sarcoma. 2001;5(2):95-9
references.pmid: 18521310
references.citation: J Surg Oncol. 1981;16(2):145-8
references.pmid: 7464153
references.citation: Surgery. 2004 Nov;136(5):1098-100
references.pmid: 15523410
references.citation: Abdom Imaging. 2006 Jan-Feb;31(1):123-4
references.pmid: 16177871
references.citation: Arch Pathol Lab Med. 2003 Jan;127(1):e32-5
references.pmid: 12562292
references.citation: Arch Pathol Lab Med. 1997 Aug;121(8):834-8
references.pmid: 9278611
references.citation: J R Soc Med. 2005 Sep;98(9):418-20
references.pmid: 16140856
references.citation: Urology. 2007 Sep;70(3):591.e5-7
references.pmid: 17905130
references.citation: Int J Urol. 2002 Jan;9(1):54-6
references.pmid: 11972651
references.citation: Urology. 2003 Jan;61(1):23-9
references.pmid: 12559260
references.citation: Arch Pathol Lab Med. 1995 Dec;119(12):1164-7
references.pmid: 7503667
references.citation: Eur J Surg Oncol. 2006 Nov;32(9):980-3
references.pmid: 16952433
references.citation: Cancer Treat Rep. 1980 Jan;64(1):93-8
references.pmid: 7379060
references.citation: Int J Clin Oncol. 2004 Jun;9(3):189-92
references.pmid: 15221604
references.citation: Pathology. 2003 Feb;35(1):47-9
references.pmid: 12701684