Malignant tumor as large as a kidney

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

Ms. Lien, a Vietnamese American, has a history of high cholesterol, ankylosing spondylitis, and had her gallbladder removed. She often returns to Vietnam for regular health check-ups. For about half a year now, she has had stomachaches at 3-4am and insomnia. The doctor diagnosed her with intestinal problems, and medication did not help.

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

On November 20, Dr. Nguyen Hoang Duc, Head of the Department of Urology, Center for Urology - Nephrology - Andrology, said that this is a rare case. The adrenal gland is a small, triangular endocrine gland located close to the upper pole of the kidney. Adrenal medullary tumors often cause the endocrine substances of this gland to secrete abnormally, causing typical symptoms such as high blood pressure, obesity, hirsutism, etc. In Ms. Lien's case, tests showed many endocrine disorders but there were no clinical manifestations, so it was difficult to detect the disease.

She and her family decided to receive 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 tumor from bleeding or compressing other organs, the surgeons removed the left adrenal gland laparoscopically. 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 literature rarely has cases of adrenal tumors larger than 10 cm being completely removed by endoscopy. It is often necessary to combine them with open surgery," said Dr. Duc, adding that performing the entire surgery laparoscopically would be better, with less pain for the patient, faster recovery, and fewer complications of intestinal paralysis compared to open surgery.

Tumor on CT scan (red circle). Photo: Provided by the hospital — Tumor on CT scan (red circle). Photo: *Provided by the hospital*

The blood vessels that grow to feed the tumor are densely packed. Endoscopic surgery helps surgeons see each blood vessel of the tumor clearly, actively stop bleeding from the beginning, and avoid the risk of massive bleeding. The doctors decided to perform laparoscopic surgery; if it fails, they must perform open surgery.

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

The 3D/4K laparoscopic surgery system helps doctors separate the tumor from surrounding organs without damaging neighboring organs such as the kidney, spleen and pancreas. After more than three hours, the tumor is completely removed through a small incision on the abdominal wall.

Three days after surgery, Ms. Lien was able to move around lightly, with little pain, and was discharged from the hospital. The doctor said that the right adrenal gland increased its secretion of hormones to compensate for the left gland that had been removed. Most patients do not suffer from adrenal insufficiency, but they need to be closely monitored by an endocrinologist so that they can supplement if hormones are deficient.

The results of the surgery showed that the tumor was malignant, had not invaded or metastasized to other organs, but had a high chance of local recurrence. Currently, the main treatment for adrenal cancer is surgery. Patients need to be closely monitored for early detection and reoperation when the tumor recurs.

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

Anh Thu

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