Solitary adrenal metastasis from advanced gastric cancer invading duodenal bulb with situs inversus totalis
| Autor: | Shuang Wang, Min Wang, Zhang Mingwei, Yongbo Li, Wangsheng Xue, Wei Li, Zeyun Zhao, Tongjun Liu |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty intrabeam Complete inversion Adrenal metastasis Adrenal Gland Neoplasms Adenocarcinoma situs inversus totalis 03 medical and health sciences 0302 clinical medicine Situs Duodenal Neoplasms Stomach Neoplasms Duodenal bulb medicine Humans Clinical Case Report 030212 general & internal medicine intraoperative radiotherapy business.industry gastric cancer Liver Neoplasms General Medicine Middle Aged Advanced gastric cancer Situs Inversus medicine.disease Situs inversus medicine.anatomical_structure 030220 oncology & carcinogenesis Radiology adrenal metastasis business Research Article |
| Zdroj: | Medicine |
| ISSN: | 1536-5964 0025-7974 |
| DOI: | 10.1097/md.0000000000015244 |
| Popis: | Rationale: Situs invsersus totalis (SIT) is a rare anomaly featured by complete inversion of abdominal and thoracic organs. Adrenal metastasis is often encountered as part of advanced systemic dissemination, which is usually unresectable. Few published cases reported the adrenal metastasis from gastric cancer with SIT and the treatment of gastrectomy combined with adrenalectomy, especially with intraoperative radiotherapy (IORT). Patient concerns: A 61-year-old SIT man found a mass on the right clavicle and the biopsy revealed a metastatic cancer. Around 14 years ago, he had a rectal cancer resection surgery and no sign of occurrence. Five months later, the patient had a pain in his right low abdomen and abdominal CT found a right adrenal mass. Diagnoses: Gastroscopy and the pathology revealed the gastric antrum cancer invading the duodenal bulb. Abdominal enhanced CT suspected the adrenal mass as a hematoma, but positron emission tomography computed tomography suspected it as the metastases of gastric cancer which is consistent with the pathology results. Finally, the SIT patient was diagnosed with primary gastric cancer invading duodenal bulb with solitary right adrenal metastasis. Interventions: The patient was treated with curative distal gastrectomy and Billroth-II anastomosis with D2 lymphadenectomy. A total 18 Gy intraoperative radiotherapy (IORT) using low energy x-rays by Intrabeam were given after resection. Outcomes: The patient had liver metastasis in the seventh month after surgery but there is no sign of local recurrence until now. Lessons: Gastric cancer with adrenal metastasis, especially with SIT is rare and intractable. The result suggested that active surgical treatment for resectable gastric cancer and solitary adrenal metastatic tumor, especially in combination with IORT may be an option in controlling local relapse and prolonging survival in selected patients. |
| Databáze: | OpenAIRE |
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