Synchronous adrenal metastasis and an inferior vena cava tumor thrombus from an ovarian carcinoma
© Tokue et al.; licensee BioMed Central Ltd. 2014
Received: 8 December 2013
Accepted: 10 January 2014
Published: 13 January 2014
A 60-year-old woman presented with synchronous adrenal metastasis and an inferior vena cava tumor thrombus in the adrenal vein that developed from an ovarian carcinoma. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right adrenalectomy with caval tumor thrombectomy for treatment. Microscopic examination revealed a clear cell ovarian carcinoma and a metastatic adrenal tumor. The patient is clinically free of disease after 6 years of follow-up. There have been no reports of synchronous adrenal metastasis with an inferior vena cava thrombus that developed from an ovarian carcinoma. As several reports have described the long-term survival after adrenalectomy for the treatment of isolated adrenal metastasis, clinicians should be aware of this potential occurrence so that patients can be appropriately treated.
KeywordsAdrenal metastasis Ovarian carcinoma Tumor thrombus
Adrenal metastases from visceral carcinoma are uncommon; they most commonly arise from primary lung, breast, and kidney tumors . Adrenal metastases from ovarian carcinomas are extremely rare. Currently, there is only one report in the English literature of synchronous adrenal metastasis that developed from an ovarian carcinoma , and, to the best of our knowledge, there are no reports of synchronous adrenal metastasis with an inferior vena cava (IVC) thrombus that developed from an ovarian carcinoma. Several investigators have documented that aggressive surgical resection of an adrenal metastasis, when done in patients with solitary, excisable disease and after a long disease-free interval, can prolong patient survival . We present a rare case of synchronous adrenal metastasis with an IVC tumor thrombus in the adrenal vein that developed from an ovarian carcinoma. The patient is clinically free of disease after 6 years of follow-up.
Ovarian cancer can spread via peritoneal implantation, lymphatic invasion, or hematogenous dissemination. Although intraperitoneal implantation is the primary mode of ovarian cancer dissemination, hematogenous metastases are uncommon. However, autopsy and cross-sectional imaging studies have determined that the prevalence of metastases in advanced disease is higher than the prevalence that was previously recognized. The reported prevalence of adrenal and pancreatic metastases in patients with ovarian cancer at autopsy is 15% and 21%, respectively . Hematogenous metastases from ovarian carcinoma may be more commonly identified with the implementation of new treatments, which would result in improved survival rates.
Documented cases of adrenal metastasis that developed from ovarian cancer
Location of ovarian tumor
Location of adrenal tumor
Small cell neuroendocrine
Small cell neuroendocrine
Clear cell carcinoma
There are potentially a number of routes for the development of adrenal metastases from an ovarian carcinoma, including the systemic venous, arterial, and lymphatic routes of dissemination. Some reports suggested that the incidence of contralateral lymph node metastasis from the primary site of the ovarian cancer was 11–30% [12, 13]. Although the mode of dissemination for contralateral adrenal metastasis is unknown, contralateral lymph node metastasis might suggest a route via the lymphatic system from the primary tumor to the contralateral adrenal gland.
The management of patients with adrenal metastases poses a therapeutic challenge. Although adrenal metastases were considered incurable, surgery is now recommended for isolated adrenal metastasis. Adrenalectomy for metastatic cancer was rarely performed because the survival benefit for patients undergoing such resections was not clear; however, it is now advised in patients with a good performance status where there is unilateral adrenal metastasis with no residual primary or other distant metastases [7, 14].
In the case of this patient, the metastases were localized to the adrenal gland and tumor thrombus. Macroscopically complete resection with subsequent chemotherapy contributed to the improved prognosis.
To the best of our knowledge, we present the first case of synchronous adrenal metastasis with an IVC tumor thrombus through the adrenal vein from an ovarian carcinoma. This is an uncommon case; however, clinicians should be aware of this occurrence so that patients can be treated appropriately. We believe that patients with macroscopically complete tumor resection may benefit from surgical intervention.
Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
- Kim SH, Brennan MF, Russo P, Burt ME, Coit DG: The role of surgery in the treatment of clinically isolated adrenal metastasis. Cancer 1998, 82: 389–394. 10.1002/(SICI)1097-0142(19980115)82:2<395::AID-CNCR20>3.0.CO;2-TView ArticlePubMedGoogle Scholar
- Baron M, Hamou L, Laberge S, Callonnec F, Tielmans A, Dessogne P: Metastatic spread of gynaecological neoplasms to the adrenal gland: case reports with a review of the literature. Eur J Gynaecol Oncol 2008, 29: 523–526.PubMedGoogle Scholar
- Luketich JD, Burt ME: Does resection of adrenal metastases from non-small cell lung cancer improve survival? Ann Thorac Surg 1996, 62: 1614–1616. 10.1016/S0003-4975(96)00611-XView ArticlePubMedGoogle Scholar
- Dvoretsky PM, Richards KA, Angel C, Rabinowitz L, Stoler MH, Beecham JB, Bonfiglio TA: Distribution of disease at autopsy in 100 women with ovarian cancer. Hum Pathol 1988, 19: 57–63. 10.1016/S0046-8177(88)80316-2View ArticlePubMedGoogle Scholar
- Einat S, Amir S, Silvia M, Moshe I: Successful laparoscopic removal of a solitary adrenal metastasis from ovarian carcinoma: a case report. Gynecol Oncol 2002, 85: 201–203. 10.1006/gyno.2001.6547View ArticlePubMedGoogle Scholar
- Patlas M, O’Malley ME, Chapman W: Adrenal metastasis from ovarian carcinoma. Am J Roentgenol 2004, 183: 1711–1712. 10.2214/ajr.183.6.01831711View ArticleGoogle Scholar
- Sundersingh S, Rajasundaram S, Majhi U: Bilateral adrenal metastases from bilateral small cell neuroendocrine carcinoma of the ovary. Indian J Surg 2003, 65: 373–375.Google Scholar
- Ozpacaci T, Tamam MO, Mulazimoglu M, Kamali G, Ozcan D: Isolated adrenal metastasis of small cell neuroendocrine carcinoma of the ovary detected with FDG-PET/CT. Rev Esp Med Nucl Imagen Mol 2012, 31: 297–298.PubMedGoogle Scholar
- Redman BG, Pazdur R, Zingas AP, Loredo R: Prospective evaluation of adrenal insufficiency in patients with adrenal metastasis. Cancer 1987, 60: 103–107. 10.1002/1097-0142(19870701)60:1<103::AID-CNCR2820600119>3.0.CO;2-YView ArticlePubMedGoogle Scholar
- Castillo OA, Vitagliano G, Kerkebe M, Parma P, Pinto I, Diaz M: Laparoscopic adrenalectomy for suspected metastasis of adrenal glands: our experience. Urology 2007, 69: 637–641. 10.1016/j.urology.2006.12.025View ArticlePubMedGoogle Scholar
- Lam KY, Lo CY: Metastatic tumours of the adrenal glands: a 30-year experience in a teaching hospital. Clin Endocrinol 2002, 56: 95–101. 10.1046/j.0300-0664.2001.01435.xView ArticleGoogle Scholar
- Negishi H, Takeda M, Fujimoto T, Todo Y, Ebina Y, Watari H, Yamamoto R, Minakami H, Sakuragi N: Lymphatic mapping and sentinel node identification as related to the primary sites of lymph node metastasis in early stage ovarian cancer. Gynecol Oncol 2004, 94: 161–166. 10.1016/j.ygyno.2004.04.023View ArticlePubMedGoogle Scholar
- Cass I, Li AJ, Runowicz CD, Fields AL, Goldberg GL, Leuchter RS, Lagasse LD, Karlan BY: Pattern of lymph node metastases in clinically unilateral stage I invasive epithelial ovarian carcinomas. Gynecol Oncol 2001, 80: 56–61. 10.1006/gyno.2000.6027View ArticlePubMedGoogle Scholar
- Folli S, Zaccaroni A, Mengozzi M, Dell’Amore D, Vio A: Surgical treatment of adrenal metastases. Personal experience. Minerva Chir 1998, 53: 1035–1038.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.