Elsevier

Gastrointestinal Endoscopy

Volume 66, Issue 6, December 2007, Pages 1201-1205
Gastrointestinal Endoscopy

New method
Clinical endoscopy
EUS-guided alcohol ablation of left adrenal metastasis from non-small-cell lung carcinoma

https://doi.org/10.1016/j.gie.2007.05.051Get rights and content

Background

EUS presents an alternative access to the left adrenal, making it possible to perform echo-guided needle biopsies.

Objectives

We present a case of EUS-guided therapy as alcohol ablation of left adrenal metastases.

Design and Patient

A 52-year-old man was admitted to the hospital complaining of abdominal pain. CT scan revealed an invasive process in the left upper lobe of the lung and a mass in the left adrenal area that was considered highly suspicious for left adrenal metastases from the patient's lung carcinoma. Cytopathologic examination of EUS-guided FNA confirmed the diagnosis of left adrenal metastasis. Because the patient's main clinical symptom was disabling abdominal pain, we considered the possibility of injection of alcohol into the left adrenal metastases under EUS guidance to ablate the metastatic lesion and potentially relieve the abdominal pain. EUS-guided alcohol ablation was performed successfully.

Results and Main Outcome Measurement

On follow-up 3 days after EUS-guided left adrenal ablation, the patient had no abdominal pain. He remained without abdominal pain after 30 and 60 days of follow-up.

Limitation

New technique with limited data.

Conclusion

EUS-guided alcohol ablation of left adrenal metastases in patients with non-small-cell lung cancer may provide palliation of cancer-related abdominal pain. There may be potential for combining this (minimally invasive and easily performed EUS-guided therapeutic) technique for ablation of solitary adrenal metastasis in patients with lung cancer with other modalities (e.g., surgery, radiation, or chemotherapy) directed toward the primary pulmonary malignancy and adjacent mediastinal disease.

Section snippets

Patient and method

A 52-year-old man had had abdominal pain for 45 days, fatigue, and weight loss. Chest x-ray examination revealed a consolidated area in the left upper lobe (LUL) of the lung. CT scan revealed a mass in the LUL (Fig. 1) and mediastinal lymphadenopathy. CT-guided needle biopsy of the lung mass confirmed the diagnosis of large cell carcinoma (Fig. 2). Abdominal CT scan revealed a mass in the LA area that was considered highly suspicious for LAM (Fig. 3). An EUS revealed a 5-cm heterogenous lesion

Discussion

The adrenal gland is not an uncommon site of metastasis from lung, breast, and liver cancers. We here present a new technique of ablating LAM. Although the value of such a technique may be considered only for palliation of pain, potentially this technique could have therapeutic/survival benefits in combination with other treatments in lung cancer. This concept as described below is supported by published data and reports of surgical and percutaneous techniques for resecting or ablating adrenal

References (13)

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