Adrenal Metastasis from Ovarian Carcinoma

Abstract

1711 57-year-old woman with serous adenocarcinoma confined to the ovary was treated with transabdominal hysterectomy, bilateral salpingooophorectomy, and adjuvant chemotherapy. Two years later she developed recurrent disease involving the retroperitoneal lymph nodes. She was treated with second-line chemotherapy that resulted in complete remission. Surveillance CT performed 1 year later showed a new 1.0-cm nodule in the left adrenal gland (Fig. 1A). No further imaging or intervention was performed at that time. A CT scan obtained 1 year later showed that the adrenal nodule had increased in size to 2.0 cm and a 1.2-cm nodule had developed in the pancreatic tail (Fig. 1B). The remainder of the abdominal and pelvic CT was unremarkable, with no evidence of metastatic disease elsewhere. Because no other primary tumor was known and the left adrenal lesion was enlarging, a CT-guided core biopsy of the adrenal lesion was performed using an 18-gauge needle. Pathologic examination revealed the presence of high-grade serous adenocarcinoma of ovarian origin (Fig. 1C). The diagnosis was supported by immunochemical stains positive for cancer antigen 125 and cytokeratin 7 (CK-7). The patient declined further treatment. Follow-up CT performed 4 months after the biopsy showed further growth of the left adrenal and pancreatic lesions. Ovarian carcinoma can spread by peritoneal implantation, lymphatic invasion, and hematogenous dissemination. Intraperitoneal implantation is the primary mode of spread of ovarian cancer, although hematogenous metastases are considered uncommon. However, autopsy and cross-sectional imaging studies have proved that the prevalence of metastases in advanced disease is higher than previously recognized [1]. This may be related to improvements in therapy with the result that patients who have advanced disease are living longer and are more frequently imaged. The reported prevalence of adrenal and pancreatic metastases in patients with ovarian cancer at autopsy is 15% and 21%, respectively [1]. However, radiologic descriptions of adrenal metastases from an ovarian primary tumor are rare. To our knowledge, only one report of the imaging appearance of adrenal metastases from an ovarian primary tumor has been published in the Englishlanguage literature [2]. That case describes large bilateral adrenal metastases from smallcell neuroendocrine carcinoma that were removed surgically. Pancreatic metastases from ovarian carcinoma are uncommon [3, 4], and large lesions involving the pancreas also have been reported. To our knowledge, we report the first case of simultaneous adrenal and pancreatic metastases in a patient with serous carcinoma of the ovary. The adrenal glands and pancreas are uncommon sites of metastatic disease from ovarian cancer, especially in the absence of disease elsewhere. Clinicians and radioloAdrenal Metastasis from Ovarian Carcinoma