Adrenal gland metastasis - an unusual manifestation of cancer cervix

Abstract

Cancer Cervix is the most common women related cancer in India. It mainly affects middle aged female of 40-55 years age group, largely attributed to HPV infection. Advances in radiation therapy, surgical techniques and chemotherapy, have resulted in improved survival rates. Still 20-30% patients with cancer cervix would develop recurrent or persistent disease. Although the typical manifestations of recurrent cervical carcinoma are pelvic masses and lymphadenopathy, less typical manifestations like solid organ metastases and peritoneal carcinomatosis also can occur. The increasing prevalence of these less typical manifestations is partially related to the use of intensive pelvic radiation therapy, resulting in a shift away from pelvic recurrence toward distant metastasis, as well as related to improvements in cross-sectional imaging techniques. This article describes a clinical case of a 40-year-old patient with cancer cervix, who achieved complete remission with concurrent chemo radiotherapy and 3 years later, she relapsed with adrenal metastasis.

Hiccups as the first presentation of secondary adrenal insufficiency associated with advanced cervical cancer

“…AI is one of the main causes of hyponatremia in patients with advanced cancers. Adrenal metastases are found in 14–16% of patients with recurrent cervical cancer ( 10 ). Moreover, the metastasis to the hypothalamus and/or pituitary gland can also induce secondary AI, although there are no detailed reports on the prevalence of secondary AI in patients with advanced cancer.…”

Squamous Cell Carcinoma of Vaginal Vault with Liver, Adrenal and Brain Metastases: Report of an Uncommon Presentation

“…Metastatic involvement of adrenals by primary SqCC cervix is rare [4] and those reported are mainly from adenocarcinoma of cervix [16]. On the contrary, distant metastases due to recurrent SqCC are commonly seen in para-aortic nodes (62%), liver (33%), lung (33 to 38%), peritoneum (5% to 27%), adrenal gland (14% to 16%), intestines (12%) and skin (10%) [4]. Cancer that forms in squamous cells, the thin, flat cells lining the vagina constitutes the SqCC of vagina which spreads slowly and usually stays near the vagina, but may spread to the lungs, bone or liver.…”

“…The indications for metastasectomy or hepatectomy of solitary liver metastases from colorectal cancer and neuro-endocrine tumors have shown relatively good prognoses, whereas the same for NCNNLM remain controversial owing to the limited number of cases and the heterogeneity of the primary diseases [23]. Isolated adrenal metastasis from primary SqCC of cervix has been managed with adrenalectomy but may later develop primary adrenalin sufficiency or Addison's disease [4].Other treatment options for isolated adrenal metastasis is SBRT and image guided percutaneous ablation [24] In our case as the patient developed both liver and adrenal metastases from SqCC, no surgical intervention was contemplated and was treated with palliative systemic therapy to which she showed complete metabolic response. For brain metastasis management usually involves palliative EBRT in the form of WBRT, surgery, or both depending on the clinical scenario.…”

“…Adrenal metastases from primary SqCC cervix are rarely reported in literature [4] while brain metastases are extremely rare [1,5,6] with an incidence of 0.4%-1.2% [7][8][9][10]. Similarly, SqCC of vagina most commonly metastasizes to lung, bone and least commonly to liver while adrenal and brain metastases are rarely heard of [11].…”