Adrenal gland and paraganglia
Other adrenal malignancies
Metastases

Author: Lan L. Gellert, M.D., Ph.D. (see Authors page)

Revised: 13 July 2016, last major update July 2016

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Metastases [title] adrenal
Cite this page: Metastases. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/adrenalmetastases.html. Accessed December 3rd, 2016.
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
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
Treatment
  • Surgical resection
  • Chemotherapy
  • Radiotherapy
Clinical Images

Images hosted on other servers:

Large adrenal metastasis from lung cancer

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

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 lung cancer

Adrenal metastasis from ovarian carcinoma

Micro 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
Micro Images

Images hosted on other servers:

Adrenal metastasis from lung adenocarcinoma

Adrenal metastasis from lung small cell carcinoma

Adrenal metastasis from clear cell renal cell carcinoma

Adrenal metastasis from melanoma

Adrenal metastasis from moderately
differentiated sigmoid colon
adenocarcinoma

Adrenal metastasis from ovarian clear cell carcinoma

Positive Stains
  • Metastatic tumor stains similar to the tumor of origin
Differential Diagnosis