[Complex radioisotopic diagnosis of primary and secondary adrenal lesions].
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We analysed the cases of renal carcinoma undergoing operation or autopsy from 1970 to 1978 in respect of their metastasizing to the adrenals. Of the 31 cases undergoing autopsy 10 adrenal metastases were found mostly as a result of a widespread metastasis. Of the operated 74 patients 37 underwent nephrectomy alone and 37 nephrectomy together with prophylactic adrenalectomy. The histologic evaluation of the 37 removed adrenals revealed metastases only in 4 cases. Only one of them proved to be a single metastasis, the other occurring together with other metastatic lesions. The value of the adrenalectomy will be discussed.
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The proto-oncogene c-kit encodes a transmembrane tyrosine kinase receptor that is thought to play an important role in hematopoiesis, spermatogenesis, and melanogenesis. We previously showed that the c-kit messenger RNA is preferentially expressed in small cell lung cancer and that its ligand, stem cell factor, is expressed in a broad spectrum of human cancers. Using anti-c-kit antisera raised against synthetic peptides, in situ localization of the c-kit protein in various human solid tumors as well as in corresponding fetal and adult normal tissues was studied by the ABC method. The results suggest that the c-kit gene products may be involved in the pathogenesis of a very restricted subset of human solid tumors such as small cell lung cancer. Interestingly, nuclear protein immunologically related to c-kit was found in both normal and neoplastic medullary cells of the adrenal gland.
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The nuclear medicine approach to the portrayal of endocrine organs is unique; the scintigraphic images provide not only anatomic and localization information, but in many instances allow a quantitative assessment of organ function. The ability to image endocrine glands is based upon the design of radionuclides and radiopharmaceuticals with characteristics to take advantage of many unique and specific biochemical and advantage of many unique and specific biochemical and metabolic functions of these tissues. The recent introduction of new radiopharmaceutical and tracers has provided the consulting endocrinologist with imaging procedures that allow localization and functional characterization not available by other single, noninvasive diagnostic modalities. This review will serve as an update of the available techniques to image and quantitate the function of the endocrine glands using the nuclear medicine approach.
Because renal cell carcinoma occasionally occurs in manifestations referable to a single metastatic lesion, there is a risk that a metastasis will be mistaken for the primary tumor. Histologic examination can compound the confusion, particularly when a clear cell carcinoma of the kidney metastasizes to an organ, such as lung, liver, adrenal, or skin, where clear cell tumors may occur as primary lesions. Although advanced renal cell carcinoma not infrequently involves the adrenal gland, the clinical and pathologic setting establishes the tumor in the adrenal as a metastasis. Two patients are described to illustrate what is to our knowledge the heretofore undescribed occurrence of renal cell carcinoma as a metastasis to the contralateral adrenal gland.
A continuous human cell line RN-GA was established from a stage-III primary neuroblastoma prior to therapy. Light and electron microscopic analysis of the biopsy showed morphological features typical of neuroectodermal origin. Relative cellular DNA content and N-myc oncogene copy number were also analyzed in the biopsy tissue: the tumor cells presented a near-diploid genome with N-myc amplification. The derived tumor cell line expressed distinctive ultrastructural, cytogenetic and immunological markers of neuroblastoma. Moreover, cells from the culture could be serially transplanted into splenectomized-irradiated nude mice, where they formed a progressively growing solid tumor. Surprisingly, the cells in culture did not show any N-myc amplification, while they retained a near-diploid DNA content. We propose that several techniques (electron microscopy, oncogene analysis, flow cytometry, cytogenetics, tissue culture, cell antigen immunodetection) should be used to establish a firm diagnosis and a correct clinical grading of this tumor. The establishment of this continuous cell line should be valuable as an experimental in vitro system for further studies of neuroblastoma biology and morphology.
We believe we report the first case of malignant juxtadrenal schwannoma. This rare tumor was discovered incidentally in a patient who presented with fever, mental confusion, weight loss, leukocytosis, and elevated erythrocyte sedimentation rate. Preoperative radiographic and endocrine evaluations were suggestive of a nonfunctioning adrenal tumor. Its suprarenal location was unequivocally demonstrated by CT scan, sonography, angiography, and magnetic resonance imaging studies. Angiography revealed that the tumor derived its blood supply from the adrenal and renal vessels. The final diagnosis and its juxtadrenal origin was confirmed by histologic and immunohistochemical studies. A review of the literature on retroperitoneal schwannoma is included.
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Multiple phaeochromocytomas represent a polytopic form of chromaffin tumours. The tumours may arise simultaneously or sequentially in chromaffin tissue, particularly in the retroperitoneal space. Malignancy can only be assumed if there are metastases to organs which do not contain chromaffin tissue. Their origin may be regarded as a dysontogenetic event. The clinical picture is dominated by the excretion of catecholamines. Laboratory tests are therefore used to determine the suspicion of the presence of a chromaffin tumour. A patient with an eight-year history is described, who had had four operations and in whom, by radiology or surgery, seven phaeochromocytomas had been found. The value of various radiological methods is discussed. The most informative method is arteriography; in view of the possibility of multiple tumours, aortography should be carried out in the first instance.
A 56-year old man was admitted with a tumour-like lesion located in the retroperitoneal space with adherence to the left adrenal gland. An extensive diagnostic procedure could neither establish the diagnosis nor differentiate the lesion from the adrenal gland. After tumour biopsy by ultrasound surgery was recommended and performed and the final diagnosis--mature teratoma--was established. In this article we discuss the genesis and therapeutic possibilities of mature teratoma in adults.
Gradient-echo pulse sequences with fast acquisition times permit examinations in short breath-holding intervals. In this way an improvement of MR imaging of upper abdominal organs can be expected. In 41 patients with space-occupying lesions of kidneys and adrenals, influence of external parameter variations on resulting contrasts was analyzed and results were compared to other imaging methods. Gradient-echo sequences demonstrated a high sensitivity in detection of tumorous lesions of kidneys and adrenals, the specificity being similar to that of CT. Further differentiation was only possible by performing dynamic perfusion studies using paramagnetic contrast agents.
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