The unilateral adrenal tumor in a patient with history of uterine cervix cancer: the radiological and endocrine profile related management

Abstract

The adrenal tumours represent a large area of pathological diagnosis. The radiological and endocrine features are the best tools in patients' management. The medical history of a cancer increases the metastasis suspicion. We present a 64-year-old hypertensive female with a previous diagnosis (20 years ago) of uterine cervix cancer that was remitted after surgery and local cobalt therapy. Four years before she was found with a non-secretor right adrenal tumor of 2 cm during a routine ultrasound for a kidney stone crisis. Currently she is admitted for an endocrine control: a mildly increased serum chromogranin A and neuron specific enolase with basal plasma metanephrines 4 times above the upper normal limit and normal plasma normetanephrines are found. The morning plasma cortisol after 2 days of dexamethasone 2 milligrams is 2.3 micrograms/decilitre. The contrast computed tomography of the pelvis, abdomen and thorax found no anomalies but the right adrenal mass with enlarged diameters of 2.55 cm × 4 cm × 4.54 cm. Laparoscopic right adrenalectomy was performed without adrenal insufficiency after surgery, neither remarkable changes in arterial blood pressure profile. The pathological report confirmed an adrenocortical adenoma. The macroscopic aspects showed a yellow tumor of 4 cm. The immunohistochemistry revealed weak positive reaction of melan A+, INHIBIN and SYN (in some tumor areas), negative CROMO (into the tumor cells and positive in normal adrenal medulla), with an index of proliferation (Ki67) of 2%. 6 months after surgery the patient was clinically stationary and endocrine follow-up is recommended. The radiologic and endocrine anomalies related to an adrenal mass in a patient with oncologic medical history may conclude to the idea of tumor removal for a certain diagnosis provided by pathological exam.