Solitary adrenal metastasis from invasive ductal breast cancer: an uncommon finding

Abstract

Background: Invasive ductal carcinoma (IDC) of the breast usually metastasizes to the lungs, liver, bones and brain. Solitary adrenal metastasis is extremely rare. Due to the rarity of this condition, the optimal treatment is unclear. We report the first case of IDC of the breast metastasizing solely to the adrenal gland after a modified radical mastectomy but having a long-term disease-free survival while treated merely by a left adrenalectomy.

Case presentation: A 64-year-old woman was found a left adrenal mass on a follow-up visit two years after taking a right modified radical mastectomy for the breast cancer. She was subsequently given a left adrenalectomy. Postoperative histopathology findings were compatible with invasive ductal carcinoma (IDC) of the breast. Due to the patient's refusal, no further treatments were offered after the adrenalectomy. The patient now is still alive and has no sign of relapse. Survival time after taking the right modified radical mastectomy and the left adrenalectomy is more than five years and three years, respectively.

Conclusion: This is the first case of a patient with solitary, metachronous adrenal metastasis from IDC of the breast to be reported. For patients in this condition, complete removal of metastasized organ may translate into survival benefit.

Figure 1

Unenhanced CT scan showing a 5.4 × 7.0 cm, homogenous, low-density (27 HU) mass of the left adrenal.

Figure 2

Histological section of the primary IDC of the right breast (2A) and the adrenal metastatic disease(2B, 2C). The tumor cells are arranged in solid nests or cords with infiltrative growth pattern in the primary IDC (2A; H & E 10 ×), which has also been shown in the adrenal metastatic lesion (2B; H & E 10 ×) with vaying size of oval cells showing eosinophilic cytoplasm and prominent small nucleoli (2C; H & E 40 ×).

Figure 3

Immuno - staining of the adrenal metastatic disease (IHC, 20 ×). The tumor cells show positivity for C-erbB2 (3A), GCDFP-15 (3B) and Mammaglobin (3C).