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 Yang^{1, 2}, Wun-Rong Lin^{1, 2}, Allen W. Chiu^{1, 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.