We report the case of a 25-year-old man who consulted by the Department of Onwings Physician (presenting an image suggestive of adrenal metastasis in a control Axialized Tomography (ACT) performed to monitor his disease).
Personal History
- You have no known allergies.
- Bronchial asthma, currently asymptomatic without treatment.
Amigrésidentified,
- skull fracture on two occasions (at one year and at nine years of age).
- In 1991 he was diagnosed with Ewing's sarcoma in the right iliac palatine non-metastatic.
Complete remission in 1992 after treatment with pelvic radiochemotherapy.
- After being asymptomatic for 6 years, an anterosuperior mediastinal image suggestive of recurrence appears on a control CT scan (1998).
Video-assisted thoracoscopy and biopsy were performed, confirming mediastinal recurrence. A new chemotherapy treatment was started, with a favorable response (second complete remission).
- In 1999, bone marrow autotransplantation was decided as consolidation therapy.
- Two right upper lobe nodules appeared in a control chest X-ray in February 2001; metastasis and resection of Ewing's sarcoma were performed on the same upper lobe and lymphadenectomy was the result of the pathological study.
Current History
A patient with the above-mentioned antecedents, who arrived to our consultations because a control CT scan showed an image suggestive of metastasis of his disease in the left adrenal gland.
This image did not appear in a control performed four months earlier.
A cytological study confirmed the suspicion of metastasis after aspiration biopsy (NAFNA).
Establishment
A patient with marked thinness who has good objective general condition and good mucocutaneous coloration.
She is conscious, oriented, afflicted and hemodynamically stable.
Cardio respiratory arrest (CRA): rhythmic heart at 85 bpm without murmurs or extracts.
TA: 90/60 mmHg.
Good ventilation in both hemithorax.
Abdomen: blade, depressible, painless.
No masses or organomegaly.
Extremities: no peripheral edema, preserved musculature, no signs of venous insufficiency.
Complementary tests
Laboratory test: blood biochemistry, blood count and coagulation were normal.
P. Imaging:
1.
Chest X-ray: loss of volume in the right upper lobe (RUL), existence of fibrous tracts, and urethral atelectasis associated with adjacent pleural thickening, suggesting the existence of a specific healing process.
2.
TAC-abdominal: highlights a loss of right hemithorax due to the presence of linear hyperdense tracts extending towards the apex and impressing as a manifestation of hyperdense
Projecting on the upper pole of the left kidney, we visualized a well-defined, low density nodular image of the kidney.
4 cm in diameter, with density slightly higher than the liquid, so it could correspond to a complicated cyst, without ruling out the possibility of metastatic lesion.
1.
Treatment
After completing the preanesthetic evaluation, adrenalectomy was performed using a lumbotomy.
1.
Ev
She was discharged one week after surgery and was asymptomatic.
Reviewed in our outpatient clinics, he presents surgical wound with good appearance, confirming with the pathological anatomy of the surgical specimen the presence of metastasis of his neoplasic process.
Currently the patient is being reviewed by the Medical Ongoing Service, being discharged by Urology.
