An unusual presentation of endometrial cancer with bilateral adrenal metastases at the time of diagnosis

Introduction/BackgroundEndometrial Cancer (EC) is the most common gynaecological malignancy with an average of 9,000 new cases diagnosed in the UK each year. If at presentation, the tumour is not amenable to operative management, then the approach must be tailored, and chemotherapy or systemic hormonal therapy should be considered. We report an unusual presentation of EC with solitary adrenal metastases at the time of diagnosis Methodology/Case reportA 68 year old woman was referred with post-menopausal bleeding of several weeks’ duration. Imaging including urgent ultrasound, pelvic MRI and full body CT revealed a heterogenous uterine mass and bilateral adnexal masses., which were not in keeping with benign adrenal adenomas. Hysteroscopy and endometrial biopsies diagnosed grade 3 EC. Central multidisciplinary team (MDT) meeting recommended radiological guided biopsy of the adrenal mass. The histology was consistent with poorly differentiated adenocarcinoma. A PET-CT reported both adrenal metastases being hypermetabolic and suspicious for malignancy. A diagnosis of stage 4b, grade 3 EC with adrenal metastases was made. Results The patient received neoadjuvant chemotherapy with Carboplatin and Paclitaxel. Following six chemotherapy cycles, a CT scan confirmed size reduction for both primary tumour and metastases. The adrenal metastases were no longer PET-avid on repeat PET-CT scan. She received hormonal therapy alternating Megace with Tamoxifen three-weekly. As per adrenal MDT, she underwent total laparoscopic hysterectomy and bilateral salpingo-oophorectomy followed by bilateral retroperitoneal laparoscopic adrenalectomy two months later. The patient remains asymptomatic on maintenance hydrocortisone 18 months post diagnosis. ConclusionThis is the first report of solitary synchronous adrenal metastases in a patient with EC. Central MDT review is key in providing individualised treatment recommendations of such rare entity.