We report a case of Paragonimus westermani infection simultaneously affecting two separate organs that presented as both a pulmonary cavity and adrenal mass in an immunocompromised host. A 65-year-old male with a previous kidney transplant visited our clinic because of hemoptysis. Chest computed tomography (CT) showed a pulmonary cavity and right adrenal gland mass. The Aspergillus antigen titer in bronchial lavage fluid was elevated and showed positive conversion. It was necessary to differentiate lung cancer with adrenal gland metastasis from a fungal infection with an adrenal gland adenoma. Positron emission tomography CT suggested benign disease, and it was misdiagnosed as pulmonary aspergillosis based on the elevated Aspergillus antigen titer in the bronchial lavage fluid. Owing to the adverse effects of anti-fungal treatment, the patient underwent wedge resection of the lung and P. westermani was confirmed. A careful history revealed that the patient had eaten raw freshwater crabs 3 years earlier, and a test for serum antibodies to P. westermani was positive. Despite treatment with praziquantel, the adrenal mass persisted on 3-month follow-up CT. A right adrenalectomy was performed and a P. westermani infection was confirmed.

Nivolumab, an anti-PD-1 antibody, inhibits binding between PD-1 and PD-1 ligand and activates antigen-specific T cells that have become unresponsive to cancer cells. Although it is recommended as a second-line therapy in gene mutation-negative non-small-cell lung cancer, interstitial pneumonia is a well-known side effect of the drug; however, granulomatous lesions have rarely been reported. We describe the case of an 81-year-old male with cT1aN2M1b stage IV pleomorphic carcinoma of the left upper lobe of the lung. After primary treatment with carboplatin and paclitaxel, recurrence was observed in the left supraclavicular lymph node and left adrenal gland. We initiated the administration of nivolumab as a secondary treatment. Reduction was observed in the swelling of the left supraclavicular lymph node and left adrenal gland, but the tumor shadow in the right upper lobe appeared to increase. Bronchoscopy was performed, and the biopsy result showed granulomas; the findings resembled a sarcoid-like granulomatous reaction. The shadows eventually disappeared with nivolumab discontinuation; thus, we concluded that the sarcoid-like granulomatous reaction had resulted from nivolumab administration. Based on our observations, we suggest that when invasive shadows are observed after nivolumab administration, it is necessary to differentiate between disease progression and interstitial pneumonia. Moreover, the decision to reinitiate nivolumab treatment requires careful judgment in future instances of cancer recurrence.

Distant metastases of pulmonary adenocarcinoma are regularly observed in the bones, brain, adrenal gland, and liver, but rarely in the breast or cervix. In this report, we describe a novel case of concurrent cervix and breast metastases from lung adenocarcinoma, with ALK rearrangements that were strongly consistent between the primary and metastatic cancers. A 44-year-old Chinese woman with a chief complaint of abdominal discomfort was referred to our hospital. Based on diagnostic imaging, pathology, immunohistochemistry, and next-generation sequencing, the patient was diagnosed with lung adenocarcinoma with breast and cervical metastases, and ALK rearrangements were found in all three lesions. The patient was prescribed crizotinib as first-line treatment, which showed a steady reduction of the lung lesion. To our knowledge, this is the first report of concurrent breast and cervical metastases from lung adenocarcinoma. We conclude that physicians should consider that metastases may invade the breast and cervix uteri when making a diagnosis.

Minimal invasive surgical methods are gold standard at the resection of adrenal tumors. Special medical care units provide laparoscopical and retroperitoneoscopical techniques. This review gives an overview about indication of minimal invasive adrenalectomy, technical implementation, perioperative management and generic surgery-associated complications.