Authors: Shinsuke Hamada Keiichi Ito Musashi Tobe Hideo Otsuki Yukihiro Hama Yutaro Kato Yoshiaki Sugiura Tatsumi Kaji Tomohiko Asano Masamichi Hayakawa
Publish Date: 2009/08/25
Volume: 14, Issue: 4, Pages: 356-360
Abstract
A 62yearold 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
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