Primary melanoma of the adrenal gland: a case report and review of the literature

Abstract

BackgroundPrimary melanoma of the adrenal gland is exceptionally rare as demonstrated by the few cases reported in the medical literature, and it has a high fatality rate. We present the case of a patient with two relapses and survival to date.Case reportWe describe the case of a 58-year-old Caucasian woman who consulted her doctor with symptoms of asthenia, anorexia and weight loss. A mass was palpated in her abdomen at the height of the left hypochondrium. A computed tomographic scan revealed a retroperitoneal mass measuring 10 cm × 15 cm originating in the left adrenal gland. A left nephroadrenalectomy and splenectomy were performed. Histopathologically, the retroperitoneal mass corresponded to a melanoma, and no primary melanoma was found in any other location. The patient was treated with interferon-α-2b. Three years after her diagnosis the patient presented with a retroperitoneal relapse of the mass measuring 7.2 cm, which was removed. Five years after the first relapse a new retroperitoneal relapse mass was diagnosed, which was also removed. Since then the patient has been healthy and free from illness.ConclusionHistological and immunohistochemical studies, together with the criteria described by Ainsworth et al. and Carstens et al., allowed us to diagnose primary melanoma of the adrenal gland.

Metabolic and anatomic characteristics of benign and malignant adrenal masses on positron emission tomography/computed tomography: a review of literature

“…Primary melanoma of the adrenal, first reported in 1946, is extremely rare with between 20 and 30 cases reported in the world literature [117][118][119][120][121][122][123]. Diagnosis is difficult due to frequent adrenal metastases from melanoma.…”

Primary malignant achromic melanoma of the lung

“…In our case, a postoperative FDG‐PET scan showed increased left adrenal gland uptake, without enlargement, which could be consistent with metastatic disease. However, the possibility of a primary adrenal melanoma with solitary lung metastasis cannot safely be ruled out, even though primary adrenal melanoma is even rarer than PLM . Other unusual primary visceral sites have been reported, including the meninges, the esophagus, the oral‐nasopharynx, anal canal, rectum, stomach, small bowel, gallbladder, and large bowel, the uterine cervix, the ovary and the kidney…”

“…However, the possibility of a primary adrenal melanoma with solitary lung metastasis cannot safely be ruled out, even though primary adrenal melanoma is even rarer than PLM. 5 Other unusual primary visceral sites have been reported, including the meninges, 6 the esophagus, 7,8 the oralnasopharynx, anal canal, rectum, stomach, small bowel, gallbladder, and large bowel, 9 the uterine cervix, 10 the ovary 11 and the kidney. 12 Histological differential diagnosis of PLM includes carcinoma (which is negative for melanoma markers and positive for epithelial markers), neuroendocrine tumors (positive for neuroendocrine markers), and neurogenic sarcoma (positive for S100, but negative for HMB45 and Melan-A).…”

Adrenal Gland and Gastric Malignant Melanoma without Evidence of Skin Lesion Treated with the Oncolytic Virus Rigvir

“…Primary melanoma of the adrenal gland is a clinically extremely rare malignancy and only a small number of cases has been reported [1,2].…”

“…Symptoms of adrenal gland melanoma are not specific; most commonly they include pain, asthenia, anorexia and weight loss, which are characteristic to any tumor process [2]. The diagnosis of primary adrenal gland melanoma is based on immunohistochemical and histopathological examination.…”