Definition
Secondary tumor involvement of the adrenal gland resulting from hematogenous spreading of cancer cells.
Clinical Features
Adrenal metastases are frequent in patients with advanced cancer, possibly on account of the rich sinusoidal blood supply of the glands. Patients rarely present with symptoms referable to the adrenal gland. Adrenal hypofunction (Addison disease) can only be observed when more than 90% of the adrenal parenchyma has been destroyed by the neoplasm. Furthermore, clinical features of Addison disease may be masked or overlooked in patients with advanced malignancies. Carcinomas comprise more than 90% of secondary tumors, 50% of which are adenocarcinomas (Lam 2017). The most common primary sites are lung and breast, accounting for 80% of cases, followed by the gastrointestinal tract, kidney, skin (melanoma), and ovary (Fig. 1). Secondary adrenal involvement by malignant lymphomas may occur in up to 25% of patients with disseminated disease (Lack 2007).
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References and Further Reading
Erickson, L. A. (2018). Challenges in surgical pathology of adrenocortical tumours. Histopathology, 72, 82–96.
Gryn, A., Peyronnet, B., Manunta, A., Beauval, J. B., Bounasr, E., Nouhaud, F. X., Rioux-Leclercq, N., Caron, P., Thoulouzan, M., Verhoest, G., Soulie, M., Bensalah, K., & Huyghe, E. (2015). Patient selection for laparoscopic excision of adrenal metastases: A multicenter cohort study. International Journal of Surgery, 24(Pt A), 75–80.
Higgins, S. E., & Barletta, J. A. (2018). Applications of immunohistochemistry to endocrine pathology. Advances in Anatomic Pathology, 25, 413–429.
Lack, E. E. (Ed.). (2007). Atlas of tumour pathology: tumors of the adrenal gland and extra-adrenal paraganglia (Fascicle 8, series 4). Washington, DC: Armed Forces Institute of Pathology.
Lam, A. K. (2017). Update on Adrenal Tumours in 2017 World Health Organization (WHO) of Endocrine Tumours. Endocrine Pathology, 28, 213–227.
Lam, K. Y., & Lo, C. Y. (2002). Metastatic tumours of the adrenal glands: A 30-year experience in a teaching hospital. Clinical Endocrinology, 56, 95–101.
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Santi, R., Nesi, G. (2020). Adrenal Metastases. In: van Krieken, J. (eds) Encyclopedia of Pathology. Encyclopedia of Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-28845-1_5233-1
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DOI: https://doi.org/10.1007/978-3-319-28845-1_5233-1
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