A long surviving case of resected gastric cancer presenting with a synchronous adrenal metastasis

Abstract

Case reportThe patient, a 75-year-old man, consulted us because of epigastric discomfort in February 1993. Upper GI series and gastroscopy revealed a Borrmann 3 gastric tumor in the proximal stomach. Laboratory data showed slight anemia, 10.5 g/dl of hemoglobin, and elevation of tumor markers (174 ng/ml of CA 19-9 and 298 ng/ml of Sialyl Tn). Computed tomography (CT) indicated a giant gastric tumor that invaded the pancreatic tail; the left adrenal gland seemed normal (Fig. 1). He was subjected to a total gastrectomy and a distal pancreatosplenectomy. Although the left adrenal gland was within normal limits in size, it was intraoperatively palpated as a hard mass. Therefore it was also removed during an abdominal paraaortic lymph node dissection.The postoperative course was uneventful. Histopathological examinations revealed that the gastric tumor, which measured 8.7 ϫ 8.5 cm, was predominantly a poorly differentiated adenocarcinoma with scirrhous invasion with a partial component of tubular adenocarcinoma that invaded the pancreas and involved nine lymph nodes [perigastric: #1, #2, #3, #4s, and #4d; along splenic artery: #11(n2)]. The histopathological findings of the left adrenal tumor revealed that there were adenocarcinoma cells nested within the normal adrenal gland and that this was compatible with those of gastric cancer (Fig. 2). At present, 6 years after the operation, the patient is still alive with no evidence of recurrence of cancer. DiscussionAdrenal metastases occur most commonly in patients with kidney, lung, and colon carcinomas. Recently, there have been three articles on adrenalectomy for metastatic carcinomas. Lo et al.[1] performed adrenalectomy in 52 patients with metastatic adrenal carciAbstract: Clinically curable adrenal metastases are rare. We treated a patient with gastric cancer and a synchronous adrenal metastasis who underwent curative resection. Upper GI examinations of a 75-year-old man revealed a Borrmann 3 gastric tumor in the proximal stomach. CT indicated a giant gastric tumor that invaded the pancreatic tail, and the left adrenal gland seemed normal. He was subjected to a total gastrectomy and a distal pancreatosplenectomy. Because a mass was palpated intraoperatively in the left adrenal gland, it was also removed. The gastric tumor was histopathologically a poorly differentiated adenocarcinoma with scirrhous invasion that invaded the pancreas, and the histopathological findings of the left adrenal tumor were compatible with those of gastric cancer. At present, 6 years after the operation, there has been no clear sign of cancer recurrence. It may be rational to excise the left adrenal gland en bloc in patients with serosa-positive Borrmann 3-4 gastric cancer.

Synchronous gastric cancer and primary lymphoma of right adrenal gland: a case report

“…The adrenal gland is an organ with abundant blood flow and is prone to hematogenous metastasis from malignant tumors [ 28 ]. Adrenal metastasis is not rare in advanced gastric cancer, as there are also reports of adrenal metastasis in early gastric cancer [ 29 , 30 ]. Therefore, although the preoperative size of gastric cancer was not large in this study, adrenal metastasis from gastric cancer was considered a differential diagnosis of adrenal tumors on imaging.…”

“…Similar to adrenal lymphoma, metastatic adrenal tumors do not have characteristic CT findings [ 24 , 25 ]. Gastric cancers with distant metastasis are usually non-candidate for surgery, and chemotherapy is the standard of care for those cases if no tumor bleeding or gastrointestinal obstruction exists; however, for gastric cancers with simultaneous adrenal metastasis, gastrectomy, and adrenalectomy have been reported to provide long-term survival [ 30 ]. Therefore, we planned to perform gastrectomy and adrenalectomy for gastric cancer without tumor bleeding or gastrointestinal obstruction combined with a suspicious adrenal metastasis from gastric cancer.…”

Surgical treatment for late-appearing adrenal metastasis from gastric cancer: report of two cases

“…Only three case reports have been published regarding long-term survival following curative resection for solitary adrenal metastasis in gastric cancer [5,15,16]. In the absence of a randomized clinical trial or a large case–control series, any patients who achieve long-term, disease-free survival can be assumed to have derived a clinically significant benefit.…”

Adrenal metastases from adenocarcinoma of the esophagogastric junction: adrenalectomy and long-term survival

“…A recent study on patients with recurrent gastric cancer showed that \20% of them receive surgery, and that complete resection is possible in only a quarter of operated cases [5]; a similar clinical behavior characterizes esophageal neoplasm [6]. However, patients with adrenal metastases from these neoplasms may, in some cases, achieve long-term survival after adrenalectomy [1,[7][8][9][10][11].…”