Abstract
BackgroundPatients with adrenal metastasis from various primary tumours are regarded as cases of diffuse systemic spread and considered unsuitable for surgical resection. We herein report an operable case of heterochronic adrenal metastasis from colorectal carcinoma in a 63-year-old woman.Case presentationSixteen months after low anterior resection for the primary tumour, left lower pneumonectomy was performed for a solitary lung metastasis. Four months later a right adrenal metastasis was detected by magnetic resonance imaging (MRI), as sole evidence of metastatic disease. A right adrenalectomy was performed. The histopathological examination revealed adenocarcinoma compatible with the colorectal carcinoma resected 19 months earlier. The patient received adjuvant chemotherapy after each operation and is alive and free of disease 21 months after the adrenalectomy.ConclusionThe possibility of adrenal metastasis should be considered in the follow-up of patients after primary surgery for colorectal cancer, even though other sites are the main metastatic sites. Although the prognosis of adrenal metastasis from colorectal cancer is poor, we suggest that patients with solitary adrenal metastasis may benefit from complete removal of it.
Highlights
Patients with adrenal metastasis from various primary tumours are regarded as cases of diffuse systemic spread and considered unsuitable for surgical resection
Since there were no other signs of local recurrence or distant metastasis on radiological, endoscopic and laboratory examinations, with CEA level still within the normal range, the right adrenal mass was regarded as an isolated heterochronic metastasis from colorectal cancer (CRC) and resection was considered
Resection of solitary adrenal metastasis from CRC should be offered to patients with significant (> 6 months) disease free interval, since it may improve chances of survival [1,3]
Summary
Adrenal metastasis from CRC via the lung to the adrenal gland is considered to be relatively rare. It is generally accepted that a solitary adrenal metastasis from adenocarcinoma of the colon and rectum should be resected to achieve good prognosis. To detect adrenal metastasis early, radiological modalities such as US, CT and MRI as well as the measurement of serum CEA, should be done regularly. 3. Katayama A, Mafune K, Makuuchi M: Adrenalectomy for solitary adrenal metastasis from colorectal carcinoma. 5. Nagakura S, Shirai Y, Nomura T, Hatakeyama K: Long-term survival after resection of colonic adenocarcinoma with synchronous metastases to the liver, adrenal gland and aorticcaval lymph nodes: report of a case. 8. Kato T, Tsujie M, Handa R, Oshima S, Iijima S, Yamamoto H, Kurokawa E, Kikawa N: A case of rectal cancer with solitary adrenal metastasis. A copy of the written consent is available for review by the Editor-in-Chief of the
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