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Adrenal gland & paraganglia

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Metastases

Author: Lan L. Gellert, M.D., Ph.D.

Last author update: 1 July 2016

Last staff update: 12 November 2020

Copyright: 2002-2024, PathologyOutlines.com, Inc.

PubMed Search: Metastases [title] adrenal

Table of Contents

Cite this page: Gellert LL. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalmetastases.html. Accessed December 22nd, 2024.

Definition / general

Metastatic tumors more common than primary tumors in adrenal gland
Common at autopsy, usually bilateral
Most common primary sites are breast, lung, kidney, stomach, pancreas, ovary and colon
Usually does not affect adrenal function
- May cause adrenal insufficiency if extensive (replacing 80%+ of adrenal gland)

Essential features

Metastatic tumors more common than primary tumors in adrenal gland
Morphologic mimickers of adrenal cortical carcinoma include metastatic renal cell carcinoma, lung large cell neuroendocrine carcinoma, hepatocellular carcinoma and sometimes melanoma
Immunohistochemical markers could be helpful to separate metastatic tumors from primary adrenal cortical tumors

Etiology

Hematogenous spread is considered the major route of tumor metastasis to the adrenal gland

Clinical features

Typically asymptomatic
Present with adrenal cortical insufficiency when extensive metastasis

Radiology description

CT scan is recommended to be the first imaging approach
MRI and nuclear imaging are advisable if CT studies are not diagnostic

Radiology images

Images hosted on other servers:

Unilateral adrenal metastasis from breast cancer

Right renal mass and the left adrenal metastatic mass on CT

Adrenal metastasis from
colon adenocarcinoma
before and after
chemotherapy

Prognostic factors

Surgical resection of isolated adrenal metastases improves overall survival (Endocrine 2015;50:187)
In recent series, median survival after resection was within 1 year

Case reports

35 year old woman with unilateral adrenal gland metastasis from breast invasive ductal carcinoma (Mol Clin Oncol 2016;4:859)
41 year old man with metachronous solitary bilateral adrenal metastasis from colorectal adenocarcinoma (World J Gastroenterol 2016;22:3879)
45 year old man with surgical resection of adrenal metastases from gastric cancer (Korean J Intern Med 2007;22:18)
47 year old woman with solitary adrenal metastasis from breast cancer successfully resected by laparoscopy (Gan To Kagaku Ryoho 2013;40:2351)
50 year old man with bilateral synchronous adrenal metastases of renal cell carcinoma (Oncol Lett 2015;9:1897)
52 year old woman with unusual metastasis of uterine leiomyosarcoma to the adrenal gland with intravenous extension to the heart (J Obstet Gynaecol 2014;34:206)
60 year old woman with synchronous adrenal metastasis and an inferior vena cava tumor thrombus from an ovarian carcinoma (J Ovarian Res 2014;7:5)
64 year old woman with contralateral adrenal metastasis from renal cell carcinoma (J Ultrason 2015;15:438)
66 year old man with adrenal metastasis and hemorrhage secondary to hepatocellular carcinoma (Intern Med 2015;54:1513)
69 year old man with abdominal pain and adrenal insufficiency from metastasis of large cell lung cancer (BMJ Case Rep 2015;2015)

Treatment

Surgical resection
Chemotherapy
Radiotherapy

Gross description

Single or multiple firm masses replacing some or all of adrenal gland
Hemorrhage and necrosis in larger metastases
Tumors are grey white, tan-brown or black

Gross images

Images hosted on other servers:

Adrenal metastasis from ovarian carcinoma

Microscopic (histologic) description

Metastatic carcinoma is morphologically similar to the primary tumor
Morphologic mimickers of adrenal cortical carcinoma include renal cell carcinoma, large cell lung carcinoma, hepatocellular carcinoma and sometimes melanoma
Immunohistochemical markers could be helpful to separate metastatic tumors from primary adrenal cortical tumors

Microscopic (histologic) images

Contributed by Lan L. Gellert, M.D., Ph.D.