A Resected Case of Gastric Cancer Memtmastasized to the Adrenal Gland

Toochika, Hironobu; Hirata, K; Nakao, Susumu; Ishii, Toshiyo; Eida, Kazuyuki; Takahara, Osamu

doi:10.3919/ringe1963.54.3147

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“…Such involvement is considered to occur in the manner of direct invasion or by lymphangitic routes. As for the metachronous metastases to the adrenal gland from gastric cancer, there have been a few resected cases [5,[7][8][9][10].…”

Section: Offprint Requests To: T Kosakamentioning

confidence: 99%

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

et al. 1999

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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.

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Section: Offprint Requests To: T Kosakamentioning

confidence: 99%