Large bilateral adrenal metastases in non-small cell lung cancer

Abstract

Background: The adrenal gland is one of the common sites of metastasis from primary lung cancer. Adrenal metastases are usually unilateral however bilateral adrenal metastases are seen in 10% of all lung cancer patients; of these 2-3% occurs at the initial presentation of non-small cell lung cancer. Secondary tumors can disrupt the structure and function of the adrenal. This can lead to adrenal hemorrhage, which constitutes a life threatening hazard for the patient.

Case presentation: A 59-year-old male presented with persisting abdominal pain. His initial work-up revealed significant anemia, an invasive process in the right upper lobe of the lung and large masses of heterogeneous texture, with hemorrhagic and necrotic elements in both adrenal glands. A biopsy confirmed it to be a large-cell carcinoma of the lungs. The patient developed severe leukocytosis akin to the paraneoplastic syndrome and died suddenly five days after the administration of chemotherapy.

Conclusion: Intratumoral hemorrhage is a rare but life threatening complication of adrenal metastases and should be treated as soon as it has been diagnosed. If adrenalectomy is not feasible, combination chemotherapy should be applied as in metastatic disease. For choosing the appropriate chemotherapeutic regimen it is important to accurately achieve the diagnosis.

Figure 1

Abdomen ultrasound showing large masses with foci of hemorrhagic necrosis in both adrenal glands.

Figure 2

CT-scan of the chest showing a 60 × 53 mm invasive process in the right upper lobe of the lung.

Figure 3

CT-scan of the abdomen showing large masses (98 × 85 mm right and 90 × 65 mm left) of heterogeneous texture, with hemorrhagic and necrotic elements within both adrenal glands.

Figure 4

T₂ weighted MR image showing disseminated foci of high heterogeneous signal intensity.

Figure 5

T₁ weighted MR image showing enhancement after i.v. administration of contrast agent.