Often bitter mouth, pain in the side, examination discovered rare large tumor

Rare cases

Seeing unusual symptoms, she went to several hospitals in Ho Chi Minh City for examination. Some of them diagnosed her with intestinal disease, but medication did not improve her condition. Then, she went to Tam Anh General Hospital in Ho Chi Minh City for examination.

On November 20, Dr. Nguyen Hoang Duc, Head of the Department of Urology, Center for Urology - Nephrology - Andrology, said that the results of the CT scan showed that in the core (medulla) of the patient's left adrenal gland there was a tumor with a diameter of 10 cm - equal to the size of a kidney. Adrenal medullary cancer accounts for only about 10% of cases of pheochromocytoma. Tumors measuring 4 cm or more tend to be more malignant.

"This is a rare case. Because pheochromocytoma will cause the endocrine substances of this gland to secrete abnormally, causing typical symptoms such as high blood pressure, obesity, hirsutism... However, in this patient, although the test results showed many endocrine disorders, there were no clinical manifestations, so it was difficult to detect the disease," said Dr. Duc.

Thường xuyên đắng miệng, tức hông đi khám bác sĩ phát hiện khối u lớn hiếm gặp - Ảnh 1. — Rare large tumor 10cm in size

Large tumors pose many challenges during endoscopic surgery.

Dr. Duc said that to avoid the risk of tumor hemorrhage or compression that could damage other organs, Ms. L. was indicated for laparoscopic surgery to remove the left adrenal gland. The challenge for the surgical team was that the tumor was too large. Laparoscopic surgery is applied to adrenal tumors, but only to tumors under 6 cm. World literature has also rarely recorded cases of adrenal medullary tumors over 10 cm being completely removed by laparoscopic surgery, often requiring open surgery. However, if the entire surgery can be performed laparoscopically, it will be better for the patient, with less pain, faster recovery, and fewer complications of intestinal paralysis than open surgery.

One risk of this surgery is that the process of removing the tumor can easily cause a sudden increase in blood pressure leading to a stroke. To control blood pressure and blood loss during the surgery, the doctor carefully calculates the appropriate amount of anesthesia and closely monitors the patient throughout the surgery.

According to Dr. Duc, the first option is to perform endoscopic surgery, trying to control the blood vessels and remove all the tumor, but if that fails, open surgery will be required.

With the guidance of a modern endoscopic surgical system, doctors actively control blood vessels. The separation of tumors from surrounding organs is more convenient, without damaging neighboring organs such as the kidneys, spleen and pancreas. After more than 3 hours of endoscopic surgery, the tumor was completely removed through a small incision on the abdominal wall.

Three days after surgery, Ms. L. was able to move around easily, with little pain, and was discharged from the hospital. The remaining right adrenal gland will increase the secretion of hormones to compensate for the removed left gland. Most patients will not suffer from adrenal insufficiency, but they need to be closely monitored by an endocrinologist so that they can be supplemented if hormones are deficient.

Doctor Duc said that the surgical results of the malignant tumor have not invaded or metastasized to other organs, but the possibility of local recurrence is high. Currently, the main treatment for adrenal cancer is surgery, there is no role for radiation or chemotherapy. Therefore, patients need to be actively monitored for early detection and re-surgery if the tumor recurs.

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