Definition/General

Introduction:
-Adrenal metastases represent secondary malignancies from distant primary sites
-They are more common than primary adrenal malignancies
-Account for 50-75% of adrenal masses in patients with known cancer
-FNAC plays crucial role in staging and diagnosis.
Origin:
-Arise from hematogenous spread from primary tumors
-Bilateral involvement common (50-60%)
-Rich adrenal vascularity facilitates metastatic seeding
-Common primary sites include lung, breast, kidney, melanoma
-May be synchronous or metachronous.
Classification:
-Classified by primary site of origin
-Carcinomas most common (lung, breast, GI tract)
-Melanoma (high propensity for adrenal spread)
-Sarcomas (rare)
-Hematologic malignancies (lymphoma, leukemia).
Epidemiology:
-More common in patients with known cancer
-Bilateral disease more common than primary tumors
-Advanced cancer patients at highest risk
-Autopsy studies show 25% incidence in cancer patients.

Clinical Features

Presentation:
-Known primary malignancy (majority of cases)
-Staging workup finding
-Adrenal insufficiency (bilateral destruction)
-Abdominal pain (large masses)
-Constitutional symptoms from primary cancer.
Symptoms:
-Usually asymptomatic (early stages)
-Fatigue and weakness (adrenal insufficiency)
-Weight loss (advanced cancer)
-Abdominal pain (mass effect)
-Nausea and vomiting (adrenal crisis)
-Hypotension (adrenal insufficiency).

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Gross Description

Appearance:
-Multiple bilateral nodules typical
-Variable size (few mm to several cm)
-Gray-white to tan cut surface
-May be hemorrhagic
-Replacement of normal adrenal
-Preservation of gland contour.
Characteristics:
-Bilateral involvement in 50-60%
-Multiple nodules characteristic
-Gray-white appearance most common
-Necrosis and hemorrhage possible
-Size variable depending on primary
-Normal adrenal tissue may be preserved.

Microscopic Description

Immunohistochemistry

Molecular/Genetic

Differential Diagnosis

Sample Pathology Report

Template Format

Sample Pathology Report

Complete Report: This is an example of how the final pathology report should be structured for this condition.

Clinical History

Patient with known [primary tumor type] diagnosed in [date]. Current imaging shows [bilateral adrenal masses/unilateral mass]

Specimen Information

FNAC from [adrenal mass], [side], performed under [guidance method]

Specimen Adequacy

[Adequate/Inadequate] for cytological interpretation

Cytological Findings

Cellular smears showing [morphological features consistent with known primary]. [Specific characteristics of primary tumor type]

Comparison with Primary

Morphological features [consistent/similar] to known [primary tumor type] from [date/location]

Immunocytochemistry

[Primary site marker panel] performed: [Results consistent with primary site origin]

Cytological Diagnosis

[Metastatic carcinoma] - Consistent with metastasis from [primary site]

Staging Implications

Findings indicate [M1 disease/distant metastasis]. [Bilateral involvement/Adrenal insufficiency risk] noted

Adrenal Function

[Assessment of adrenal function recommended] given [bilateral involvement/extent of disease]

Recommendations

Multidisciplinary oncology team discussion. [Systemic therapy/Supportive care/Adrenal function monitoring] as indicated

Note

Adrenal metastases indicate advanced stage disease. Treatment focuses on systemic therapy and supportive care