Adrenal gland & paraganglia

Other tumors

Metastases



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PubMed Search: Metastases [title] adrenal

Lan L. Gellert, M.D., Ph.D.
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Cite this page: Gellert LL. Metastases. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/adrenalmetastases.html. Accessed March 18th, 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
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.
Adrenal metastasis from lung adenocarcinoma Adrenal metastasis from lung adenocarcinoma Adrenal metastasis from lung adenocarcinoma

Adrenal metastasis from lung adenocarcinoma

Adrenal metastasis from lung small cell carcinoma Adrenal metastasis from lung small cell carcinoma

Adrenal metastasis from lung small cell carcinoma


Adrenal metastasis from clear cell renal cell carcinoma Adrenal metastasis from clear cell renal cell carcinoma Adrenal metastasis from clear cell renal cell carcinoma

Adrenal metastasis from clear cell renal cell carcinoma

Adrenal metastasis from melanoma Adrenal metastasis from melanoma Adrenal metastasis from melanoma

Adrenal metastasis from melanoma



Images hosted on other servers:

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
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