%0 Journal Article
%T Bilateral Adrenalectomy for Metastatic Esophageal Adenocarcinoma: A Case Report
%A Ciara S. McNevin
%A Darragh B. Herlihy
%A Elaine W. Kay
%A Jack P. Gleeson
%A John J. Aird
%A Liam Grogan
%A Oscar S. Breathnach
%A Patrick G. Morris
%A William B. Robb
%J General Information | Journal of Oncology Practice
%D 2018
%R https://doi.org/10.1200/JOP.2017.023713
%X Section: ChooseTop of page <<REFERENCES Introduction Adrenal metastases from esophageal carcinoma are uncommon, and the role of surgical resection has not been clearly defined. Management decisions with regard to the surgical or medical management of solitary adrenal metastases are challenging because they have generally been accepted as evidence of systemic disease. Surgical resection of oligometastatic disease or solitary sites of metastasis has been proven to be of benefit in certain cases. We present the case report of a patient who had two separate adrenal resections for metastatic esophageal carcinoma. Case Report A 42-year-old man presented to the emergency department in January 2012 with a history of painless progressive dysphagia, weight loss, fatigue, and epigastric discomfort. Computed tomography (CT) of his thorax, abdomen, and pelvis (TAP) revealed an epigastric mass and significant subcarinal, retrocrural, and gastrohepatic ligament lymphadenopathy. Esophageal and liver biopsies confirmed a poorly differentiated esophageal adenocarcinoma with liver metastases. The patient recieved six cycles of cisplatin and fluorouracil combination chemotherapy in 2012 and six cycles of paclitaxel and carboplatin in 2013. A follow-up CT TAP in October 2013 showed only an isolated left adrenal lesion, and a left adrenalectomy was performed (Fig 1). Histologic evaluation showed a poorly differentiated carcinoma similar in appearance to the esophageal primary cancer. The immunophenotype was also supportive of a metastasis from the esophagus (positive for AE1/AE3 and CAM5.2 and negative for inhibin, CD56, S100, synaptophysin, and melan-A). In March 2015, the patient¡¯s CT imaging showed left axillary lymphadenopathy suggestive of nodal metastasis. He underwent six additional cycles of paclitaxel and carboplatin chemotherapy. In January 2016, a restaging CT TAP revealed a solitary right adrenal lesion. A right-sided adrenalectomy was performed. Again, histology showed metastatic poorly differentiated adenocarcinoma consistent with an esophageal primary cancer. The patient received maintenance hormone replacement therapy. It is now 5 years since his primary diagnosis, and follow-up scans show no evidence of further metastatic disease. He remains on hormone replacement therapy, is working full time as a lecturer, and is married with a 2-year-old son. Fig 1. Gross appearance of resected left adrenal gland containing tumor. Discussion Metastasis to the adrenal glands is a relatively frequent observation at autopsy of patients with cancer,1 particularly among those
%U http://ascopubs.org/doi/full/10.1200/JOP.2017.023713