A 62-year-old woman presented with
right flank pain, and computed tomography (CT) showed bilateral adrenal
tumors (right, 8 cm; left, 4 cm). There were no abnormal findings on physical examination, and adrenal
hormone levels in serum and urine were within normal limits. Radiological studies showed a right adrenal
tumor with intratumoral
hemorrhage, a cystic
tumor in the left adrenal gland, and no sign of distant
metastasis. Because laboratory tests showed normal levels of adrenal
hormones, we considered the
tumors to be nonfunctioning adrenal
tumors. The right adrenal
tumor was surgically removed because it was thought to be malignant, and histological examination revealed that it was a
leiomyosarcoma. Postoperative CT showed a pleural
metastasis in the right chest wall. The patient received
combination chemotherapy with
cyclophosphamide,
vincristine,
adriamycin, and
dacarbazine. The
metastasis was also treated with
radiofrequency ablation (RFA). Because the left adrenal
tumor grew rapidly despite two courses of the
chemotherapy, it too was surgically removed. After the operation,
metastasis in the right iliac bone was treated with RFA and
radiotherapy. Positron emission tomography detected bilateral femoral
metastases, and these were treated with
radiotherapy in combination with a low dose of
cisplatin. A liver
metastasis and a small
metastasis in the left kidney were treated with RFA and a
metastasis in the pancreatic tail was removed surgically. Sixteen months after the right
adrenalectomy, the patient died due to systemic spread of the disease. Multiple local treatments including RFA,
radiotherapy, and resection were effective for the local control of metastatic lesions of adrenal
leiomyosarcoma.