Adrenal Gland Metastasis of Breast Invasive Mucinous Carcinoma: A Rare Case Report and Review of Literature

Abstract

The adrenal gland is a frequent site for metastasis, and the majority of the metastatic lesions of the adrenal gland normally originate from lung cancer, colon cancer, renal cell carcinoma, and melanoma. However, adrenal gland metastasis from breast invasive mucinous carcinoma is extremely rare. This report described a rare case of right adrenal gland metastasis in a 48-year-old female, who was diagnosed with breast invasive mucinous carcinoma and underwent right modified radical mastectomy with axillary lymph node dissection 5 years previously. A mass located on the right adrenal gland was detected during a routine examination 2 months ago. The patient was asymptomatic and adrenal gland MRI revealed a mass in the right adrenal gland. Definitive preoperative diagnosis failed to be established. Right adrenal gland laparoscopic adrenalectomy was performed and the diagnosis of adrenal gland metastasis of breast carcinoma was confirmed by pathological and immunohistochemical examination, especially ER, PR, GATA3, and HER-2. The patient remained in good condition by the time of writing.

Keywords: Adrenal gland metastasis; Breast invasive mucinous carcinoma; GATA3; Laparoscopic adrenalectomy.

Fig. 1

a, b Enhanced MRI scan showing a 3.5 × 2.1 cm, no obvious enhancement, long-bar shape mass in the right adrenal gland.

Fig. 2

a Laparoscopic screenshot. This image showed the laparoscopic retroperitoneal view of the right adrenal gland tumor. The adrenal gland tumor (yellow) with clear margin was located on the upside of the right kidney and the tumor exhibited mild adhesion with the surrounding tissue. The peritoneum (touching with ultrasonic cutter head) was labeled to the right of the adrenal gland tumor, and the right kidney was below the adrenal gland tumor in this view. The vessel in the middle center is IVC. b The gross specimen resected by surgery was shown, measuring approximately 3.5 × 2.0 cm.

Fig. 3

Results of pathological and IHC examination (magnification, ×400). a HE staining showed low differentiated adenocarcinoma in the adrenal metastatic lesion. b Ki-67 expression revealed positivity (20%) by IHC analysis in the adrenal metastatic disease. IHC staining of the tumor cells in the adrenal metastatic lesion demonstrated positive staining for GATA3 (+) (c), ER (+) (d), PR (+) (e), HER-2 (++) (f).