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Year : 2005  |  Volume : 15  |  Issue : 1  |  Page : 33-34
Adenocarcinoma oesophagus with solitary, unilateral calcified adrenal metastases


Departments Of Radiology And Imaging, University College Of Medical Sciences (Delhi University) & Guru Teg Bahadur Hospital, Delhi, India

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Keywords: CT, adrenal gland, metastatic tumour oesophagus, neoplasms

How to cite this article:
Bhargava N, Bhargava S K. Adenocarcinoma oesophagus with solitary, unilateral calcified adrenal metastases. Indian J Radiol Imaging 2005;15:33-4

How to cite this URL:
Bhargava N, Bhargava S K. Adenocarcinoma oesophagus with solitary, unilateral calcified adrenal metastases. Indian J Radiol Imaging [serial online] 2005 [cited 2019 Nov 12];15:33-4. Available from: http://www.ijri.org/text.asp?2005/15/1/33/28740

   Case Report Top


A 45 years old man presented to our hospital with symptoms of dysphagia and weight loss. He had undergone a upper g. i. barium study which raised a possibility of malignancy of middle third of the esophagus. Multislice CT examiantion confirmed the diagnosis of carcinoma of middle third of the thoracic esophagus[Figure - 1]. Upper abdominal examination revealed a calcified adrenal[Figure - 2]. No other abnormality was detected.

The patient was successfully operated, but he expired due to post anaesthesia complications. His autopsy showed adenocarcinoma oesophagus with solitary, unilateral, calcified right adrenal metastasis. Left adrenal and the other viscera were normal.


   Discussion Top


Most patients with diagnosed esophageal cancer already have spread of disease outside of the esophagus, and therapy is generally aimed at palliation rather than cure. Surgery is usually reserved for those patients who are thought to have disease localised either to the esophagus

or the regional lymph nodes,whereas patients with proven distant metastasis (M1) disease are better treated with other methods, such as radiotherapy and/or chemotherapy. The expected life span of a patient with M1 disease is so short that major surgery generally is not justifiable. Therefore, a reliable method of diagnosing M1 disease in these patients is needed, so that unwarranted surgery & its attendant complications are avoided [1].

Distant metastases were most commonly diagnosed in abdominal lymphnodes (45%) followed by liver (35%), lung (20%), cervical/supra clavicular lymph nodes (18%), bone (10%), adrenal (5%) brain & peritoneum (each 2%) [1]. Metastatic disease to the adrenal gland is common but often not considered. In Glomset's autopsy series, he found that about 25% of metastasizing tumors had involved the adrenals [2]. The autopsy cases in the Cranston [3] series indicated several findings that both glands were involved & enlarged in most cases (65%). While 25% of cases undergoing autopsy had bilateral microscopic disease. All autopsy cases had metastatic disease to other organs (90-100%). Solitary adrenal metastasis is rare (0-10%). The majority of patients with adrenal metastasis have bronchogenic carcinoma [3] as the primary.

Several autopsy series have been published detailing the distribution of tumor spread in patients who have died of esophageal cancer [4]. The reported frequency of metastatic spread to adrenal gland is 6% - 20% [4]. Cranston et al did not find calcification any of their patient of adrenal metastasis [3].

No characteristic CT finding has been attributed to adrenal metastases. Tumours could be large or small, most are sharply marginated, most are round and could have homogenous or inhomogeneous densities. CT scanning continues to be the modality of choice for diagnosing metastatic disease to the adrenal gland. CT cannot diagnose microscopic disease but has a high sensitivity for gross morphologic enlargement of the adrenals. The incidence of metastatic disease to the adrenal warrants the inclusion of adrenal area on chest CT performed for malignancy staging [3].

In our patient, we had suggested only a remote possibility of adrenal metastasis. But autopsy confirmed the presence of unilateral, solitary, calcified adrenal metastasis in a patient of adeno carcinoma lower third of oesophagus, making it an extremely rare entity. Therefore, we feel

justified in reporting this rare case of distant adrenal metastasis.

 
   References Top

1.Leslie E. Quint, Lisa M. Hepburn et al. Incidence and distribution of distant metastases from newly diagnosed Esophageal carcinoma. Cancer ,1995 ; 76 : 1120-1125.  Back to cited text no. 1    
2.Glomset, D.A. The incidence of metastasis of malignant tumor to the adrenals. Am. J. Cancer 1998 ; 32 : 57- 61.   Back to cited text no. 2    
3.Philip E. Cranston. Use of CT in metastatic adrenal gland tumor. Computerized Medical Imaging and Graphics, 1990s ;14 : 143-146.  Back to cited text no. 3    
4.Mandard AM et al. Autopsy findings in 111 cases of esophageal cancer. Cancer, 1981 ; 48 : 329-35.  Back to cited text no. 4    

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Correspondence Address:
N Bhargava
Department Of Radiology And Imaging, Ucms And Gtb Hospital,E - 3, Gtb Hospital Campus, Dilshad Garden, Delhi - 110095
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.28740

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    Figures

[Figure - 1], [Figure - 2]



 

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