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.
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References
Linos D, Kiriakopoulos AC, Tsakayannis DE, et al. (2004) Laparoscopic excision of bilateral primary adrenal leiomyosarcomas in a 14-year-old girl with acquired immunodeficiency syndrome (AIDS). Surgery 136:1098–1100
Zetler PJ, Filipenko JD, Bilbey JH, et al. (1995) Primary adrenal leiomyosarcoma in a man with acquired immunodeficiency syndrome (AIDS). Further evidence for an increase in smooth muscle tumors related to Epstein-Barr infection in AIDS. Arch Pathol Lab Med 119:1164–1167
Boman F, Gultekin H, Dickman PS (1997) Latent Epstein-Barr virus infection demonstrated in low-grade leiomyosarcomas of adults with acquired immunodeficiency syndrome, but not in adjacent Kaposi’s lesion or smooth muscle tumors in immunocompetent patients. Arch Pathol Lab Med 121:834–838
Lack EE, Graham CW, Azumi N, et al. (1991) Primary leiomyosarcoma of adrenal gland. Case report with immunohistochemical and ultrastructural study. Am J Surg Pathol 15:899–905
Nakanishi M, Iseda T, Nishio S, et al. (1999) Spontaneous retroperitoneal hemorrhage from an adrenal leiomyosarcoma: a case report. Nishinihon J Urol 61:466–467
Choi SH, Liu K (1981) Leiomyosarcoma of the adrenal gland and its angiographic features: a case report. J Surg Oncol 16:145–148
Lujan MG, Hoang MP (2003) Pleomorphic leiomyosarcoma of the adrenal gland. Arch Pathol Lab Med 127:e32–e35
Lee CW, Tsang YM, Liu KL (2006) Primary adrenal leiomyosarcoma. Abdom Imaging 31:123–124
Goto J, Otsuka F, Kodera R, et al. (2008) A rare tumor in the adrenal region: neuron-specific enolase (NSE)-producing leiomyosarcoma in an elderly hypertensive patient. Endocr J 55:175–181
Mencoboni M, Bergaglio M, Truini M, et al. (2008) Primary adrenal leiomyosarcoma: a case report and literature review. Clinical Medicine: Oncology 2:353–356
Matsui Y, Fujikawa K, Oka H, et al. (2002) Adrenal leiomyosarcoma extending into the right atrium. Int J Urol 9:54–56
Candanedo-González FA, Vela Chávez T, Cérbulo-Vázquez A (2005) Pleomorphic leiomyosarcoma of the adrenal gland with osteoclast-like giant cells. Endocr Pathol 16:75–81
Wong C, Von Oppell UO, Scott-Coombes D (2005) Cold feet from adrenal leiomyosarcoma. J R Soc Med 98:418–420
Yap BS, Baker LH, Sinkovics JG, et al. (1980) Cyclophosphamide, vincristine, adriamycin, and DTIC (CYVADIC) combination chemotherapy for the treatment of advanced sarcomas. Cancer Treat Rev 64:93–98
Pinedo HM, Bramwell VH, Mouridsen HT, et al. (1984) Cyvadic in advanced soft tissue sarcoma: a randomized study comparing two schedules. Cancer 53:1825–1832
Bastide C, Garcia S, Anfossi E, et al. (2006) Histologic evaluation of radiofrequency ablation in renal cancer. Eur J Surg Oncol 32: 980–983
Raj GV, Reddan DJ, Hoey MB, et al. (2003) Management of small renal tumors with radiofrequency ablation. Urology 61:23–29
Dupuy DE, DiPetrillo T, Gandhi S, et al. (2006) Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer. Chest 129:738–745
Etten B, van Ijken MG, Mooi WJ, et al. (2001) Primary leiomyosarcoma of the adrenal gland. Sarcoma 5:95–99
Thamboo TP, Liew LC, Raju GC (2003) Adrenal leiomyosarcoma: a case report and literature review. Pathology 35:47–49
Kato T, Kato T, Sakamoto S, et al. (2004) Primary adrenal leiomyosarcoma with inferior vena cava thrombosis. Int J Clin Oncol 9:189–192
Mohanty SK, Balani JP, Parwani AV (2007) Pleomorphic leiomyosarcoma of the adrenal gland: case report and review of the literature. Urology 70:e5–7
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Hamada, S., Ito, K., Tobe, M. et al. Bilateral adrenal leiomyosarcoma treated with multiple local therapies. Int J Clin Oncol 14, 356–360 (2009). https://doi.org/10.1007/s10147-008-0844-5
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DOI: https://doi.org/10.1007/s10147-008-0844-5