گزارش دو بيمار با متاستاز غير همزمان رنال سل كارسينوماي كليه به غده آدرنال طرف مقابل

Report of Two Cases of Renal Cell Carcinoma with Metachronous Contra Lateral Metastasis to the Adrenal Gland

ﮐﺎﺭﺳﻴﻨﻮﻣﺎﻱ ﺳﻠﻮﻝ ﻫﺎﯼ ﮐﻠﻴﻮﯼ ﮐﺸﻨﺪﻩ ﺗﺮﻳﻦ ﺗﻮﻣﻮﺭ ﺩﺳﺘﮕﺎﻩ ﺍﺩﺭﺍﺭﻱ ﺍﺳﺖ. ﺷﺎﻳﻊ ﺗﺮﻳﻦ ﻣﺤﻞ ﻣﺘﺎﺳﺘـﺎﺯﻫﺎ ﺩﺭ ﮐﺎﺭﺳﻴﻨﻮﻣﺎﻱ ﺳﻠﻮﻝ ﻫﺎﯼ ﮐﻠﻴـﻮﯼ ﻋﺒﺎﺭﺗﻨﺪ ﺍﺯ ﺭﻳﻪ، ﮐﺒﺪ، ﮐﻠﻴﻪ ﻣﻘﺎﺑﻞ، ﺍﺳﺘﺨـﻮﺍﻥ ﻭ ﻣﻐـﺰ ﻣﻲ ﺑﺎﺷﺪ. ﻣﺘﺎﺳﺘﺎﺯ ﺑﻪ ﺁﺩﺭﻧﺎﻝ ﻫﻤﺎﻥ ﻃﺮﻑ ﺩﺭ 40 ﺩﺭﺻﺪ ﻣـﻮﺍﺭﺩ ﺩﻳﺪﻩ ﻣﻲ ﺷﻮﺩ ﮐﻪ ﺩﺭ ﺍﮐﺜـﺮ ﻣﻮﺍﺭﺩ ﺟﺰﺋﻲ ﺍﺯ ﻳﮏ ﺑﻴﻤﺎﺭﻱ ﻣﺘﺎﺳـﺘﺎﺗﻴﮏ ﻣﻨﺘﺸـﺮ، ﺧﻮﺍﻫـﺪ ﺑﻮﺩ. ﻣﺘﺎﺳﺘﺎﺯ ﺑﻪ ﺁﺩﺭﻧﺎﻝ ﻣﻘﺎﺑﻞ ﻧﺎﺷﺎﻳﻊ ﻭ ﺩﺭ ﺩﺭﺻﺪ ﮐﻤﻲ ﺍﺯ ﻣـﻮﺍﺭﺩ ﺩﻳﺪﻩ ﻣﻲ ﺷﻮﺩ ﮐﻪ ﻣﻲ ﺗﻮﺍﻧﺪ ﻫﻤﺰﻣﺎﻥ ﻭ ﺩﺭ ﺩﺭﺻﺪ ﮐﻤﺘﺮﻱ ﺍﺯ ﻣﻮﺍﺭﺩ ﻏﻴﺮ ﻫﻤـﺰﻣﺎﻥ ﺑﺎﺷﺪ. ﺗﺸﺨﻴﺺ ﮔـﺮﻓﺘﺎﺭﻱ ﻫﻤﺰﻣﺎﻥ ﺁﺩﺭﻧﺎﻝ ﺣﻴﻦ ﺗﺸﺨﻴـﺺ ﺗﻮﻣـﻮﺭ ﺍﻭﻟﻴﻪ ﻭ ﺗﺸﺨﻴـﺺ ﮔـﺮﻓﺘﺎﺭﻱ ﻏﻴﺮ ﻫﻤـﺰﻣﺎﻥ ﺁﻥ ﻃﻲ ﭘﻴﮕﻴـﺮﻱ ﻫﺎﻱ ﺑﻌﺪﻱ ﺍﺳﺖ، ﺯﻳﺮﺍ ﻣﺘﺎﺳﺘﺎﺯﻫﺎﻱ ﺁﺩﺭﻧﺎﻝ ﺩﺭ ﺍﻏﻠﺐ ﻣـﻮﺍﺭﺩ ﺑﺪﻭﻥ ﻋﻼﺋﻢ ﺑﺎﻟﻴﻨﻲ ﺑﻮﺩﻩ ﻭ ﻇﻬـﻮﺭ ﻋﻼﺋﻢ ﮐﻢ ﮐﺎﺭﻱ ﺁﺩﺭﻧﺎﻝ ﺩﻳﺪﻩ ﻧﻤﻲ ﺷﻮﺩ. ﺭﻭﺵ ﺩﺭﻣﺎﻥ ﮐﺎﺭﺳﻴﻨﻮﻣﺎﻱ ﺳﻠﻮﻝ ﻫﺎﯼ ﮐﻠﻴﻮﯼ ﻭ ﻣﺘﺎﺳﺘﺎﺯﻫﺎﻱ ﺁﻥ ﺟﺮﺍﺣﻲ ﺍﺳﺖ.

Renal cell carcinoma is most fatal tumor in genitourinary system. The most prevalent metastatic sites in renal cell carcinoma are; lung, liver, contra lateral kidney, bone and brain. Metastasis to ipsilateral adrenal gland can be seen in more than 40% of the patients and in most of the cases is a part of diffused metastatic disease .Metastasis to contra lateral adrenal is far less common and can be synchronous or metachronous. Diagnosis of ipsilateral involvement of the adrenal is concomitant with diagnosis of the primary tumor, but the diagnosis of contra lateral adrenal involvement is usually done during routine follow ups. Because adrenal metastasis is asymptomatic and patients will not show the symptoms of adrenal insufficiency. The treatment of choice for RCC and it's adrenal metastasis is surgery.