AJR 2004; 183:1711-1712
© American Roentgen Ray Society
Adrenal Metastasis from Ovarian Carcinoma
Michael Patlas1,
Martin E. O'Malley2 and
William Chapman3
1 Department of Radiology, Hamilton General Hospital, Hamilton, ON, Canada L8L
2X2.
2 Department of Medical Imaging, University Health Network/Mount Sinai Hospital,
University of Toronto, 585 University Ave., Toronto, Canada M5G 1X5.
3 Department of Pathology, University Health Network/Mount Sinai Hospital,
University of Toronto, Toronto, Canada M5G 2M9.
Received January 23, 2004;
accepted after revision February 3, 2004.
Address correspondence to M. E. O'Malley
(martin.o'malley{at}uhn.on.ca.
A57-year-old woman with serous adenocarcinoma confined to the ovary was
treated with transabdominal hysterectomy, bilateral salpingooophorectomy, and
adjuvant chemotherapy. Two years later she developed recurrent disease
involving the retroperitoneal lymph nodes. She was treated with second-line
chemotherapy that resulted in complete remission. Surveillance CT performed 1
year later showed a new 1.0-cm nodule in the left adrenal gland
(Fig. 1A). No further imaging
or intervention was performed at that time. A CT scan obtained 1 year later
showed that the adrenal nodule had increased in size to 2.0 cm and a 1.2-cm
nodule had developed in the pancreatic tail
(Fig. 1B). The remainder of the
abdominal and pelvic CT was unremarkable, with no evidence of metastatic
disease elsewhere. Because no other primary tumor was known and the left
adrenal lesion was enlarging, a CT-guided core biopsy of the adrenal lesion
was performed using an 18-gauge needle. Pathologic examination revealed the
presence of high-grade serous adenocarcinoma of ovarian origin
(Fig. 1C).
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Fig. 1B. —57-year-old woman with serous adenocarcinoma of ovary.
Contrast-enhanced CT scan obtained 1 year later shows interval growth of left
adrenal nodule (arrowhead) and development of 1.2-cm hypoattenuating
lesion in pancreatic tail (arrow).
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Fig. 1C. —57-year-old woman with serous adenocarcinoma of ovary.
Photomicrograph from adrenal biopsy shows metastatic high-grade adenocarcinoma
consistent with ovarian serous carcinoma. (H and E, x100)
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The diagnosis was supported by immunochemical stains positive for cancer
antigen 125 and cytokeratin 7 (CK-7). The patient declined further treatment.
Follow-up CT performed 4 months after the biopsy showed further growth of the
left adrenal and pancreatic lesions.
Ovarian carcinoma can spread by peritoneal implantation, lymphatic
invasion, and hematogenous dissemination. Intraperitoneal implantation is the
primary mode of spread of ovarian cancer, although hematogenous metastases are
considered uncommon. However, autopsy and cross-sectional imaging studies have
proved that the prevalence of metastases in advanced disease is higher than
previously recognized [1]. This
may be related to improvements in therapy with the result that patients who
have advanced disease are living longer and are more frequently imaged.
The reported prevalence of adrenal and pancreatic metastases in patients
with ovarian cancer at autopsy is 15% and 21%, respectively
[1]. However, radiologic
descriptions of adrenal metastases from an ovarian primary tumor are rare. To
our knowledge, only one report of the imaging appearance of adrenal metastases
from an ovarian primary tumor has been published in the English-language
literature [2]. That case
describes large bilateral adrenal metastases from small-cell neuroendocrine
carcinoma that were removed surgically. Pancreatic metastases from ovarian
carcinoma are uncommon [3,
4], and large lesions involving
the pancreas also have been reported.
To our knowledge, we report the first case of simultaneous adrenal and
pancreatic metastases in a patient with serous carcinoma of the ovary. The
adrenal glands and pancreas are uncommon sites of metastatic disease from
ovarian cancer, especially in the absence of disease elsewhere. Clinicians and
radiologists should be aware of this potential occurrence so that patients can
be treated appropriately. Hematogenous metastases from ovarian cancer may
become more commonly recognized as novel treatments are implemented, resulting
in improved survival rates.
References
- Dvoretsky PM, Richards KA, Angel C, et al. Distribution of disease
at autopsy in 100 women with ovarian cancer. Hum
Pathol 1988;19:57
–63[Medline]
- Sundersingh S, Rajasundaram S, Majhi U. Bilateral adrenal
metastases from bilateral small cell neuroendocrine carcinoma of the ovary.
Indian J Surg2003; 65:373
–375
- Kawamoto S, Urban BA, Fishman EK. CT of epithelial ovarian tumors.
RadioGraphics1999; 19[spec no]:85
–102[Abstract/Free Full Text]
- Palazzo L, Borotto E, Cellier C, et al. Endosonographic features of
pancreatic metastases. Gastrointest Endosc1996; 44:433
–436[Medline]
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