Department of Urology, Affiliated Hospital of Hebei University, Baoding city, Hebei Province, China
Received date: June 06, 2016; Accepted date: June 07, 2016; Published date: June 15, 2016
Citation: Guo J, Yang W, Zhang H, Zhang Y, Wei R, et al. (2016) Pleura Metastasis from Adrenal Neuroblastoma. Andrology (Los Angel) 5:162. doi:10.4172/2167-0250.1000162
Copyright: © 2016 Guo J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Adrenal neuroblastoma; Pleura metastasis; Adults patient
A 64-year-old man presented with a 15 day history of abdominal distention and anorexia. Physical examination disclosed a solid mass in the upper right abdomen. No fluctuation in blood pressure when pressing the tumor. Enhanced computerized tomographic scan of the upper abdomen showed a huge solid mass on the adrenal area, measuring 9.0 cm × 7.6 cm presumptive diagnosis was a neuroblastoma (Figure 1). The chest CT scan showed a soft tissue density of right pleura which was considered metastatic (Figure 2). No clear abdominal and retroperitoneal lymph nodes were found.
The renin, angiotensin, aldosterone and cortisol, catechol amines were all normal. The urinary VMA (3-methyl, 4-hydroxy mandelic acid) was 68.4 umol/24 h (normal value <85 umol/24 h).
The patient had undergone Laparoscopic adrenalectomy and pleura mass resection in general anesthesia. No intraoperative blood pressure fluctuated. Pathologic analysis confirmed the diagnosis of right adrenal neuroblastoma, also confirmed the pleura soft tissue was metastatic. Immunohistochemistry showed: syn (+), CgA (+), CD56 (+), Ki-67>20%, NF (-), GFAP (-), MB45 (-), CK (-) (Figure 3,4).
Adrenal neuroblastoma is a common tumor in children patients [1,2]. It is derived from the sympathetic nervous system of embryonic malignancies. But rarely occurs in adults . Only a few cases have been reported in adults [1,3,4].
The main adverse prognostic factors were age, more than one year old patients with poor prognosis, low pathological grade and highstage clinical also affect prognosis. At present, for treatment of adrenal neuroblastoma were drug therapy and surgery. Basic experiments have confirmed that the vascular endothelial growth factor played a very key role on tumor growth, metastasis and other biological activity .
Angiogenesis inhibitor is a good choice for the treatment of adult malignancies  and in NB animals such anti-tumor effect was confirmed , this experiment observed the antagonism of Sorafenib for NB’s vascular growth factor. Keir and other studies suggest that Sorafenib had a multi-inhibited of the adrenal neuroblastoma cell lines .
Since Gagner et al.  first reported in 1992, the laparoscopic adrenalectomy in treatment for benign adrenal lesions, laparoscopic surgery has become the gold standard of treatment of benign adrenal diseases. But for adrenal cancer is still controversial.
As technology continues to mature surgery for smaller adrenal malignancies, laparoscopic surgery are still had value. Haase  studied 7 cases of adrenal cancer patients, the mean tumor diameter was 2.8 ± 0.9 cm, mean operative time was 138.6 ± 65.5 m, mean hospital stay was 2.9 ± 1.6 d. Only one patient due to bleeding and giving blood transfusions, all patient follow-up was 18.8 ± 6.1 m. No recurrence and delayed surgical complications. He concluded: For adrenal cancer patients, only in smaller tumors (<6 cm), adrenal gland surrounding anatomical clear no significant adhesions circumstances was suitable for laparoscopy.
Because of the adrenal neuroblastoma’s characteristic is invasion growth, the majority of patients in need of open surgery. There are many authors believe that the intraperitoneal is the better surgical approach, and can simultaneously bilateral adrenal exploration areas, and major bleeding complications .
Adult adrenal neuroblastoma combined pleural metastasis rare, surgical removal of lesions and metastases acceptable short-term results, due to lack of large clinical data reported, its long-term effect needs further follow-up.