An Unusual Presentation of Endometrial Cancer with Bilateral Adrenal Metastases at the Time of Presentation and an Updated Descriptive Literature Review.

Maisie Ryan,Richard Hutson,Michael Weston,Darshana Pathak,Alexandros Laios

doi:10.1155/2019/3515869

Maisie Ryan, Richard Hutson + Show 3 more

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https://doi.org/10.1155/2019/3515869

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Abstract

In endometrial cancer (EC), adrenal metastases are rare indicating advanced disease. We report an unusual presentation of EC with solitary adrenal metastases at the time of diagnosis and provide with an updated literature review. A 68-year-old woman was referred with postmenopausal bleeding of several weeks' duration. Imaging revealed a heterogenous uterine mass and bilateral malignant adnexal masses. Hysteroscopy, endometrial biopsies, and radiological guided biopsies of the adrenal masses confirmed poorly differentiated EC. A PET-CT reported both adrenal metastases being hypermetabolic and suspicious for malignancy. The patient received six neoadjuvant chemotherapy cycles with Carboplatin and Paclitaxel. A repeated CT scan confirmed size reduction for both primary tumour and metastases. The adrenal metastases were no longer PET-avid on repeat PET-CT scan. The patient received a course of hormonal treatment and as per adrenal MDT, she underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy followed by bilateral retroperitoneal laparoscopic adrenalectomy two months later. The patient remains asymptomatic on maintenance hydrocortisone 18 months post diagnosis. This is the first report of solitary synchronous adrenal metastases in a patient with EC. Central MDT review is key in providing individualised treatment recommendations of such rare entity.

Highlights

Endometrial cancer (EC) is the most common gynaecological malignancy with an average of 9,000 new cases diagnosed in the UK each year [1]
A diagnosis of Stage 4b, Grade 3 EC with adrenal metastases was made, and the patient was referred to the medical oncologists for consideration of neoadjuvant chemotherapy
We identi ed nine cases within the literature, which describe recurrent metastatic spread to the adrenal glands. ese metastases were picked up months to years a er the original EC presentation and surgical management [6,7,8,9,10,11,12,13]

Summary

Case Report

In endometrial cancer (EC), adrenal metastases are rare indicating advanced disease. We report an unusual presentation of EC with solitary adrenal metastases at the time of diagnosis and provide with an updated literature review. A PET-CT reported both adrenal metastases being hypermetabolic and suspicious for malignancy. A repeated CT scan con rmed size reduction for both primary tumour and metastases. E adrenal metastases were no longer PET-avid on repeat PET-CT scan. E patient received a course of hormonal treatment and as per adrenal MDT, she underwent total laparoscopic hysterectomy and bilateral salpingooophorectomy followed by bilateral retroperitoneal laparoscopic adrenalectomy two months later. Is is the rst report of solitary synchronous adrenal metastases in a patient with EC. Central MDT review is key in providing individualised treatment recommendations of such rare entity

Introduction

Discussion

Findings

Post mortem