Posted by CLDing on February 09, 1998 at 11:07:07:
In Reply to: Renal & adrenal mass posted by C S Loh on February 09, 1998 at 06:22:58:
The right renal mass sounds obviously a RCC. Question is what is the left adrenal mass.
A 4cm mass in the adrenal gland is always significant. It is highly possible that the left
adrenal mass represents metastatic tumour. If it is mets than this lady deserves
symptomatic treatment only. The case for nephrectomy in RCC for metastatic disease is very
tenuous even though still argued. I would suggest a needle biopsy of the left adrenal mass
(not my usual approach though since in general a 4 cm adrenal mass has to come out,
functional or not). If it shows metastatic disease then you need a really good reason to
operate, and if you do I suggest you leave behind the right adrenal, if possible. If it
turns up to be an adenoma or adenocarcinoma of the adrenal I will do a left adrenalectomy
and a right nephrectomy leaving behind the right adrenal, while still cautioning the
patient that she may need lifelong steroid support.