A 63-year-old male patient visited our hospital with a right incidental renal tumor, which was found by ultrasonography for the follow-up study of chronic hepatitis B virus infection and diabetes mellitus. Consecutive computed tomography revealed a right renal tumor and two left adrenal tumors. Further systemic imaging study and hormonal examination suggested one right renal cell carcinoma and left adrenal metastases. We performed right nephrectomy and left adrenalectomy. The pathological diagnoses of all resected tumors were renal cell carcinoma. The patient has been in good health without any recurrence for 12 months since the operation. In patients with renal cell carcinoma, contralateral adrenal metastasis is usually associated with multiple metastases to other organs. There are a few cases of solitary and synchronous contralateral adrenal metastasis in the English literature. To our knowledge, this is the first report of a case of renal cell carcinoma with double synchronous contralateral adrenal metastases.
Adrenal Glands ; Adrenalectomy ; Carcinoma, Renal Cell ; Diabetes Mellitus ; Follow-Up Studies ; Hepatitis B, Chronic ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasms, Multiple Primary ; Nephrectomy ; Recurrence ; Viruses

Severe pain from mucositis resulting from concomitant chemoradiotherapy (CCRT) is commonly treated with opioid analgesics. However, the period of use of opioid analgesics differs among individuals. We performed a retrospective cohort study of 46 patients who were treated with long-term opioid analgesics after CCRT for head and neck cancer. Among these patients, opioid analgesics were used for a median of 30 days. A comparative study was conducted between patients with long-term use of strong opioid analgesic drugs and those with short-term use. A significantly prolonged use of opioid analgesic agent was associated with cetuximab use (TPF vs. S-1 vs. Cmab, 35.0 vs. 44.1 vs. 180.7, p≤0.001). There were no psychiatric symptoms such as dependence and delirium. When patient background and chemotherapy selection are known, the possibility of severe oropharyngeal mucositis and the potential need for long-term opioid analgesics can be evaluated. Consideration of reduction or discontinuation according to pain after the end of treatment is important.