Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2014  |  Volume : 57  |  Issue : 1  |  Page : 150--151

Isolated adrenal metastasis: A case report


Sonal Bhandare1, Shailesh Shrikhande2, Ganesh Bakshi3, Kedar K Deodhar1,  
1 Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Surgical Oncology (Gastrointestinal and Hepato-Pancreaticobiliary Surgery), Tata Memorial Hospital, Mumbai, Maharashtra, India
3 Department of Urgical Oncology (Urology), Tata Memorial Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Kedar K Deodhar
Department of Pathology,Tata Memorial Hospital, Dr. E Borges Road, Parel,Mumbai - 400 012, Maharashtra
India




How to cite this article:
Bhandare S, Shrikhande S, Bakshi G, Deodhar KK. Isolated adrenal metastasis: A case report .Indian J Pathol Microbiol 2014;57:150-151


How to cite this URL:
Bhandare S, Shrikhande S, Bakshi G, Deodhar KK. Isolated adrenal metastasis: A case report . Indian J Pathol Microbiol [serial online] 2014 [cited 2022 Jan 23 ];57:150-151
Available from: https://www.ijpmonline.org/text.asp?2014/57/1/150/130932


Full Text

Sir,

Adrenal metastases are most commonly seen in patients with primary in the lung, breast and kidney. [1] Generally, adrenal metastasis indicates a widespread metastatic disease, but in rare cases isolated adrenal metastasis can be found. [2] Isolated adrenal metastasis from colorectal cancer is uncommon and surgical resection of such a case is a rarity.

A 65-year-old man underwent ultra-low anterior resection for low rectal cancer in March 2011 following neoadjuvant chemotherapy. Microscopic examination showed moderately differentiated adenocarcinoma infiltrating the muscularis propria and perirectal fat. Circumferential resection margin was free of tumor. Lymphovascular emboli were not seen and nine reactive lymph nodes were observed (Stage ypT 3 N 0 ). The post-operative course was uneventful and post-operative single agent chemotherapy with capecitabine was started. During follow-up after 6 months, rise in serum CEA - Carcino Embyonic Antigen levels was observed (up to 23.01 ng/mL). Fluoro deoxy glucose positron emission computerized tomography (FDG PET/CT) scan was performed that revealed a right adrenal nodule measuring 3.3 cm × 2 cm with heterogenous uptake (SUV max - 5.4). Also noted were two subcentimeter non-FDG avid nodules one each in the right and left lung, suspicious but not confirmatory for metastasis. A joint clinic decision of adrenalectomy was made and the patient underwent right adrenalectomy in December 2011. Histopathology showed metastatic adenocarcinoma [Figure 1]. On immunohistochemistry, the tumor cells were CK20 and CDX2 positive and were negative for CK7, confirming metastatic deposits from rectal adenocarcinoma [Figure 2].{Figure 1}{Figure 2}

The incidence of adrenal metastasis found at autopsy was 8.6-27% of all malignancies, which seems high. [3] The incidence of adrenal metastasis from colorectal carcinoma ranges from 1.9% to 17.4%. [1],[3],[4] However, reports of isolated adrenal gland metastasis from colorectal cancer are rare. Routes of adrenal metastasis include systemic venous, portal venous, arterial and lymphatic. [3] Katayama et al. also hypothesized the hematogenous spread of tumor to adrenal gland routes through the lung. [5] Indeed, Kosmidis et al. in their review of the literature had observed five out of 24 cases of adrenal metastasis from colorectal cancer with synchronous or metachronous lung metastases. [4] Two of these case reports [4],[5] describe solitary adrenal metastatectomy following lung metastatectomy. From the PUBMED search, we came across 27 cases of isolated adrenal metastasis from colorectal carcinoma till 2012, none from the Indian subcontinent.

PET-CT scan is a relatively recent addition to our pool of investigations, and with more use of PET-CT scan we estimate that the detection of smaller metastatic lesions may increase, which is likely to decrease the resection of isolated adrenal metastasis. In this case, initially, the PET scan showed two nodules in the lung that were suspicious for metastasis. However, despite that, the decision of adrenalectomy was taken that proved beneficial in this case. Follow-up showed no increase in the lung nodule size and serum CEA levels. The patient is well at 6 months of follow-up after the surgery.

Drawing the experience from liver or lung resections for localized metastatic colorectal cancer, it seems oncologically sound to offer surgery for localized adrenal metastasis.

References

1Kim SH, Brennan MF, Russo P, Burt ME, Coit DG. The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer 1998;82:389-94.
2Komuro Y, Watanabe T, Kanazawa T, Tada T, Fukatsu K, Hosaka A, et al. A case of adrenal metastasis from rectal carcinoma without lung metastasis: Evaluation for alteration of loss of heterozygosity and immunohistochemical expression. J Gastroenterol 2004;39:594-5.
3Murakami S, Terakado M, Hashimoto T, Tsuji Y, Okubo K, Hirayama R. Adrenal metastasis from rectal cancer: Report of case. Surg Today 2003;33:126-30.
4Kosmidis C, Efthimiadis C, Anthimidis G, Levva S, Ioannidou G, Zaramboukas T, et al. Adrenalectomy for solitary adrenal metastasis from colorectal cancer: A case report. Cases J 2008;1:49.
5Katayama A, Mafune K, Makuuchi M. Adrenalectomy for solitary adrenal metastasis from colorectal carcinoma. Jpn J Clin Oncol 2000;30:414-6.