Bilateral synchronous adrenal metastasis of invasive ductal carcinoma treated with multimodality therapy including adrenalectomy and oophorectomy

Abstract

A 38-year-old woman presented with a mass in the left breast. Biopsy of the lesion revealed invasive ductal carcinoma. Bilateral adrenal metastasis was detected in whole body positron emission tomography scanning. Needle biopsy of the left adrenal lesion proved infiltration of malignant cells from breast carcinoma. After eight cycles of neoadjuvant (preoperative) chemotherapy, mastectomy, bilateral adrenalectomy, and bilateral oopherectomy were performed. No further hormonal treatment was recommended due to the resection of both adrenal glands and ovaries. The patient is still followed without any sign of progression. To our knowledge, this is the first case representing multimodality approach to breast cancer with bilateral synchronous adrenal metastasis. Patients with oligometastatic disease may benefit from aggressive treatment including local therapies.

Left adrenal gland metastasis of breast invasive ductal carcinoma: A case report

“…Only 5 cases, to the best of our knowledge, have been reported previously in the literature (Table I) (2,5,6,8,9). The present case is the newest and the sixth in the literature.…”

“…The majority of patients with adrenal gland metastases are asymptomatic, while a small proportion of the patients may present adrenal gland disfunction if the malignant mass replaces or destroys the normal adrenal gland tissues (6). Although primary adrenal gland malignancies like adrenocortical carcinomas usually secrete hormone excessively and cause certain relative symptoms, or are followed with other symptoms, including hemorrhage, abdominal distension or discomfort (11), metastatic adrenal gland carcinomas are often difficult to identify from primary adrenal gland malignancies, which can lead to misdiagnosis (5).…”

“…A report revealed that ~80% of all breast cancer types are breast invasive ductal carcinomas (4), which normally metastasize to the lung, liver, bone and brain; however, metastasis to the adrenal gland is rare (5). Metastasis of breast carcinoma often leads to a poorer prognosis and a lower 5-year survival rate (6). Patients who have solitary adrenal gland metastasis normally have a long-term survival compared with those who exhibit synchronous metastasis (7).…”

Recurrent Invasive Ductal Breast Carcinoma Presenting as Primary Adrenal Insufficiency with Adrenal Crisis

“…In a study of metastatic patterns of breast cancer, Borst et al (8) reported that in a group of 2,246 patients with invasive ductal carcinoma, there were no observations of adrenal gland metastasis. This occurrence has only been demonstrated in prior case reports (3,6,(9)(10)(11)(12). Adrenal involvement usually occurs in the setting of widespread metastasis with solitary adrenal metastasis exceedingly rare (2).…”

Solitary Adrenal Metastases from Breast Invasive Ductal Carcinoma

“…From what we know, the first published case was in 2010 by Xiao-Jiao Liu et al in "Solitary adrenal metastasis from invasive ductal breast cancer: an uncommon finding" (5). We managed to find only six published cases of adrenal metastases from invasive carcinoma of no special type untill the time of writing (3,6,7,8,9).…”