Adrenal metastasis from intrahepatic cholangiocarcinoma

Abstract

Intrahepatic cholangiocarcinoma is an uncommon disease with surgical resection as the only potentially curative modality of treatment. The pattern of failure in such tumours is recurrence in the remnant liver or metastases to lymph nodes, peritoneum and bones (1, 2). We report a case of intrahepatic cholangiocarcinoma with adrenal metastasis that was treated with simultaneous hepatic and adrenal resection. Adrenal metastasis from intrahepatic cholangiocarcinoma has not yet been reported in the published literature.A 68-year-old Indonesian gentleman was diagnosed with synchronous adrenal nodule with a large tumour in the left lateral segment of the liver. Left lateral segmentectomy with left adrenalectomy was performed on 6 November 2004. The histopathology report of the resected specimen revealed a tumour (9.0 Â 7.0 Â 6.8 cm size) in the liver with features of moderately differentiated intrahepatic cholangiocarcinoma. The nodule in the left adrenal gland was 1 cm in size and had histological features of metastatic cholangiocarcinoma ( Fig. 1).Following postoperative recovery, he was treated with four cycles of Gemcitabine and Cisplatin. In April 2006, he had recurrence of the disease in bone (right ilium), both lungs, and in the left adrenal bed. He received palliative radiotherapy for the painful lesion in the right ilium and was started on palliative chemotherapy with Gemcitabine and Xeloda. Two years following adrenalectomy, he is alive with recurrent disease.The options of treatment of a metastatic cholangiocarcinoma are limited. Such patients are generally treated with palliative chemotherapy or supportive care. Lessons from other solid malignancies like colorectal cancers and sarcomas have emphasized the value of surgical resection of metastatic disease when feasible (3,4). As our patient had a solitary adrenal metastasis, he was treated with simultaneous liver and adrenal resection. This is the first report of adrenal metastasis from intrahepatic cholangiocarcinoma. The patient developed recurrence in spite of an aggressive treatment with surgical resection and postoperative chemotherapy. The therapeutic options need to be further explored in order to provide hope to patients with metastatic cholangiocarcinoma.

Distal Cholangiocarcinoma with Gastric Metastasis Mimicking Early Gastric Cancer

“…Until now, unusual metastastic sites from cholangiocarcinoma were reported to be the colon, adrenal gland, skull bone, epididymis, corneal limbus, meninges, ovary, skeletal musle, and skin 2,8-15. Metastasis of a distal cholangiocarcinoma to the stomach has not been reported previously to our knowledge but, as in the above-mentioned sites, appears to be a rare site of metastasis of this tumor.…”

Adrenal metastasis in sequentially developed combined hepatocellular carcinoma-cholangiocarcinoma: A case report

“…Tsalis et al18 first reported the case of adrenal metastasis as the first presentation of HCC in a 76-year-old male with a marked increase in tumor markers but without initial liver masses. Pandey et al19 reported a case of adrenal metastasis from ICC, and the patient is still alive with recurrent disease 2 years after surgery.…”

Colon Mass as a Secondary Metastasis from Cholangiocarcinoma: A Diagnostic and Therapeutic Dilemma

“…Only a handful cases have been published to date to verify the spread of cholangiocarcinoma to unusual locations, such as adrenal glands, bones, brain, colon, and skin [3-5]. One patient, who was diagnosed with cholangiocarcinoma based upon the histopathology of an intrahepatic mass, was treated with GEMOX (gemcitabine and oxaliplatin) followed by 5-fluorouracil and mitomycin-C; however, nothing kept the tumor from spreading to the brain.…”

“…The most common sites of metastases are liver, peritoneum, and lungs but cases in unusual sites, such as skin and adrenal gland, have been reported previously [3-5]. Colon metastasis of cholangiocarcinoma is very rare, and only three cases have been reported thus far with metastases [6-8] and one case with infiltration [9].…”