The oncologic outcomes of endometrial cancer metastasizing to the adrenal gland and kidney: from case to analysis

Abstract

Objective: To evaluate the oncologic outcomes of endometrial cancer metastasis to the adrenal gland and kidney, based on a case study and review of the literature.

Material and methods: A systematic review of the medical literature was performed to identify articles about metastatic endometrial cancer to the adrenal gland and kidney from 1975 until 2021.

Results: A 55-year-old female patient was admitted to our center. On pelvic examination, a mass protruding out of the cervix was observed, which was shown to be endometrioid carcinoma on biopsy. Disease stage was IVB, based on radiological and pathological results and the International Federation of Gynecology and Obstetrics 2018 staging. Neo-adjuvant chemotherapy was given. After therapy, the patient underwent type 2 hysterectomy, bilateral salpingo-oophorectomy, total omentectomy and lymph node dissection. Left nephrectomy, left adrenalectomy and left hemicolectomy were also performed because the conglomerate tumor invaded the left kidney, left adrenal gland, and left colon mesentery. Pathological findings were consistent with metastasis of endometrioid carcinoma in the left adrenal gland, left kidney parenchyma and hilum.

Conclusion: Metastasis of endometrial cancer to the adrenal gland and kidney is extremely rare and metastasis to the kidney has been reported in only two previous cases. When there is an intraperitoneal spread of endometrial cancer, as well as ovarian cancer, cytoreductive surgery without leaving a residual tumor should be undertaken andshould include adrenalectomy and nephrectomy, if necessary.

Keywords: Adrenal gland; case report; endometrial cancer; kidney; metastasis.

Figure 1

a) PET/CT scan of abdomen showing left adrenal mass in the left paraaortic region invaded the left adrenal gland, left renal pelvis and renal parenchyma; b) CT image of the same lesion PET/CT: Positron emission tomography/computed tomography

Figure 2

Surgical specimen of the left kidney, left adrenal gland, and left colon

Figure 3

a) Tumoral areas in the adrenal (hematoxylin-eosin, x400); b) CK8-18 positivity in adrenal tumoral areas (x400) (tumor areas are marked with arrows)

Figure 4

a) Tumoral areas in the kidney (hematoxylin & eosin, x400); b) Tumoral areas in the kidney with vascular tumor embolisms (hematoxylin & eosin, x100); c) CK8-18 positivity in renal tumoral areas (x400); d) Vimentin positivity in tumoral areas in the renal specimen (x400) (tumor areas are marked with arrows)