The malignant tumor was as large as a kidney.

Ho Chi Minh City – Ms. Lien, 45 years old, experienced abdominal pain in her left hip. Doctors discovered a 10 cm malignant tumor in her left adrenal gland, the size of a kidney.

Ms. Lien, a Vietnamese-American, has underlying conditions including high cholesterol, ankylosing spondylitis, and a history of gallbladder removal. She regularly returns to Vietnam for routine health checkups. For about six months now, she has been experiencing abdominal pain between 3 and 4 a.m., along with insomnia. Doctors have diagnosed her with an intestinal disorder, but medication hasn't helped.

Recently, she was diagnosed with a tumor in her left adrenal gland at another hospital, and then went to Tam Anh General Hospital in Ho Chi Minh City for a follow-up examination. A CT scan revealed a tumor in the core (medulla) of her left adrenal gland with a diameter of 10 cm, equivalent to the size of a kidney.

On November 20th, Dr. Nguyen Hoang Duc, Head of the Urology Department at the Center for Urology, Nephrology, and Andrology, stated that this is a rare case. The adrenal gland is a small, triangular endocrine gland located near the upper pole of the kidney. Adrenal medullary tumors often cause abnormal secretion of hormones from this gland, leading to characteristic symptoms such as hypertension, obesity, and hirsutism. In Ms. Lien's case, tests showed significant endocrine disorders, but there were no clinical manifestations, making the disease difficult to detect.

She and her family decided to seek treatment in Vietnam instead of returning to the US. "I trust the doctors' skills, partly because the cost of treatment in Vietnam is much lower than in the US," she said.

To prevent the risk of the tumor bleeding or compressing and damaging other organs, the surgeon removed the left adrenal gland using laparoscopic surgery. The challenge for the surgical team was that the tumor was too large. Laparoscopic surgery is usually only performed on tumors under 6 cm.

" World medical literature rarely reports cases of adrenal gland tumors larger than 10 cm being completely removed by endoscopy; open surgery is usually required in combination with endoscopy," Dr. Duc said, adding that performing the entire surgery endoscopically is better, resulting in less pain, faster recovery, and a lower risk of paralytic ileus compared to open surgery.

The tumor is visible on the CT scan (red circle). Photo: Provided by the hospital.

The tumor is densely covered with proliferating blood vessels. Laparoscopic surgery allows surgeons to clearly see each blood vessel in the tumor, proactively controlling bleeding from the outset and avoiding the risk of massive hemorrhage. Doctors decided to perform laparoscopic surgery; if that failed, open surgery would be necessary.

Another risk is that the tumor removal procedure can easily cause a sudden increase in blood pressure, leading to stroke. To control blood pressure and blood loss, the anesthesiologist carefully calculates the appropriate amount of anesthetic and closely monitors the patient throughout the surgery.

The 3D/4K laparoscopic surgical system assists doctors in separating the tumor from surrounding organs without damaging adjacent organs such as the kidneys, spleen, and pancreas. After more than three hours, the tumor was completely removed through a small incision in the abdominal wall.

Three days after the surgery, Ms. Lien was able to move gently, experienced little pain, and was discharged from the hospital. The doctor said that the right adrenal gland was secreting more hormones to compensate for the left gland that had been removed. Most patients do not suffer from adrenal insufficiency, but close monitoring with an endocrinologist is necessary so that hormone supplementation can be provided if needed.

Pathological examination revealed a malignant tumor that had not invaded or metastasized to other organs, but the likelihood of local recurrence was high. Currently, the primary treatment for adrenal cancer is surgery. Patients need close monitoring for early detection and re-surgery if the tumor recurs.

According to Dr. Duc, cancer accounts for only about 10% of adrenal gland tumors. Tumors measuring 4 cm or larger tend to be more malignant. Diagnosis is not difficult, but it needs to be done at a reputable medical facility with highly skilled medical staff, especially with thorough ultrasound examinations to avoid missing any abnormalities. The cause of adrenal gland cancer is currently unknown, making prevention very difficult. Treatment when the tumor is small offers a better prognosis, and surgery is simpler and safer for the patient.

Anh Thu

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