腎臟癌腎上腺轉移於中斷sunitinib後自發消退:病例報告及文獻回顧
楊迪媛1, 2、林文榮1, 2、邱文祥1, 2, 3
1馬偕紀念醫院泌尿科, 2馬偕醫學院, 3國立陽明大學醫學院
Spontaneous Regression of Adrenal Metastasis from Renal Cell Carcinoma after Sunitinib Withdrawal: Case Report and Literature Review
Ti-Yuan Yang1, 2, Wun-Rong Lin1, 2, Allen W. Chiu1, 2, 3
1Department of Urology, Mackay Memorial Hospital,
2Department of Medicine, Mackay Medical College,
3School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
 
Introduction: We report a case of renal cell carcinoma adrenal metastasis after nephrectomy and spontaneous regression of metastases after short-term treatment with sunitinib.
Case report: A 55-year-old man presented with chronic testicular pain and ultrasonography of the abdomen detected left renal tumor. Computerized tomography (CT) showed a heterogeneous left upper pole renal tumor (5.3 cm in diameter). Laparoscopic radical nephrectomy was carried out in May 2008. Histology disclosed clear cell type renal cell carcinoma and the surgical margin was free (pathological stage T2N0M0). No tumor recurrence (CT scan every 6 months) was found until 51 months later. Two nodules (1.8 and 0.9 cm) in the renal fossa were detected by CT scan. Retroperitoneal exploration confirmed recurrent clear cell carcinoma with microscopically positive surgical margins. Four months after excision, abdominal CT showed a nodule (1.6 cm) over right adrenal gland. A repeat CT evaluation 6 months later confirmed disease progression of adrenal metastasis (2.1cm). He was treated with sunitinib (37.5 mg/ day) for 4 weeks, but discontinued as a result of gastrointestinal upset and fatigue. Three months later, CT scan showed adrenal metastasis progression (3.8cm). The patient refused the suggestion of right adrenalectomy. Eleven months after sunitinib treatment, obvious disease progression of adrenal metastasis (5.7 cm) was demonstrated on CT scan. However, 16 months after sunitinib, delay regression of adrenal metastases (3.4cm) was detected. Twenty-two months after sunitinib, gradually diminishing of the adrenal metastasis (1.8 cm) was found by CT scan.
To our knowledge, this is the fourth case of spontaneous regression of metastatic renal cell carcinoma after sunitinib withdrawal.
 
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