ADRENAL METASTASIS FROM ENDOMETRIAL CANCER AND PRIMARY COLON CANCER, A CONSTELLATION OF MULTIPLE PRIMARY AND AN EXTREMELY RARE SECONDARY MALIGNANCIES IN LYNCH SYNDROME

Background:
Adrenal metastasis of primary endometrial cancer is extremely rare (12 Cases Reported Thus Far), and is usually asymptomatic and adrenal hormonal profile is normal. Prognosis is dismal, especially in case of bilateral adrenal metastasis. Hereby, a case of primary endometrial and colon cancer with adrenal metastasis from endometrial cancer is presented, a constellation of malignancies which has not yet been reported in literature.
Case Discussion:
The patient was a 51-year-old postmenopausal woman presented with abnormal uterine bleeding and vaginal discharge from 6 months prior to admission. Her family history was positive for colon cancer in her brother (At the age of 40). Ultrasound exam revealed bulky necrotic endometrial thickening with myometrial and advanced parametrial invasion, regional and retroperitoneal lymphadenopathies, along with right adrenal heteroechoic mass. Same findings were confirmed in MRI, as well as a mass like heteroenhancing focal thickening in sigmoid colon wall. Patient underwent total hysterectomy with debulking of parametrial lesions, marginal excision of the sigmoid wall mass, and enucleation of encapsulated right sided adrenal mass. Histopathological and immunohistochemistry (IHC) analysis on specimen revealed high grade locally invasive endometroid cancer with adrenal metastasis and primary colon cancer in sigmoid wall. Lynch syndrome was also suggested according to IHC results. Patient developed with uremic encephalopathy 31 days post-surgery, and deceased on the same day.
Discussion:
This patient is the first-ever reported case of adrenal metastasis from endometrial cancer, along with primary colorectal cancer in a suspected context of lynch syndrome. Adrenocortical carcinoma has been reported in 3.2% of patients with lynch syndrome, but adrenal metastasis (As in this case) is another rare possibility which needs to be ruled out, as it profoundly affects the therapeutic approach. the prognosis of adrenal metastasis from endometrial cancer is poor, and other synchronous primary metastases in lynch syndrome may worsen the outcome.