Metachronous Adrenal Metastasectomy In Treated Rectal Cancer: Case Report and Literature Review

Abstract

Adrenal metastases are frequent in cancer patients. However, isolated adrenal lesions in colorectal disease are rare. In this report, we discuss the case of a young patient who was found to have an isolated adrenal lesion few months after primary diagnosis of rectal cancer. A rectal mass biopsy at presentation was consistent with moderately differentiated adenocarcinoma. Pre-operative staging was negative for distant metastases. The patient was treated with concurrent long course neoadjuvant chemoradiotherapy followed by laparoscopic abdomino-peritoneal resection. Final pathology was ypT3N1cM0. Patient refused any further chemotherapy in the adjuvant setting. Patient was kept on follow up and PET scan in September 2019 showed an FDG avid lesion in the left adrenal gland- suspicious for metastases. In January 2022, he underwent laparoscopic left adrenalectomy and histopathology came as metastatic moderate to poorly differentiated adenocarcinoma in keeping with colorectal primary. Post metastasectomy, he received 12 cycles of pseudo adjuvant FOLFOX till 6/09/2022. Since then, patient is on regular follow up and the last PET in October 2022 was negative for recurrence of disease.