Metastatic brain tumors from gastric cancer are extremely rare. A 61-year-old Korean woman, initially presenting with polydipsia and polyuria, was found to have metastatic lesions in the brain by MRI. We performed several diagnostic procedures to determine the origin of the brain metastases. She was revealed to have a soft tissue mass of the right adrenal gland and fungating ulcers in the stomach. Histologic studies of both the adrenal gland mass and gastric tissues revealed malignant tumors composed of anaplastic cells. Based on the electron microscopy study, the malignant tumor of the right adrenal gland was a metastatic lesion from the anaplastic carcinoma of stomach. Therefore, the malignant tumors of the brain were assumed to have originated from the gastric cancer. This case report is presented to make clinicians aware of the possibility that diabetes insipidus (polydipsia) may present as an initial manifestation of brain metastases.
Adrenal Gland Neoplasms/diagnosis/*secondary ; Brain Neoplasms/diagnosis/*secondary ; Carcinoma/*diagnosis ; Diabetes Insipidus/*etiology ; Female ; Humans ; Middle Aged ; Stomach Neoplasms/*diagnosis

We present here a very rare case of metastatic relapse in the pancreas of a 4-year-old boy who had been treated for stage 4 neuroblastoma. Computed tomography showed multiple metastatic masses in the pancreas with secondary pancreatitis. To the best of our knowledge, this is the first case report of pancreatic metastasis in a child with neuroblastoma.
Adrenal Gland Neoplasms/diagnosis/*pathology ; Child, Preschool ; Contrast Media ; Diagnosis, Differential ; Diagnostic Imaging ; Humans ; Male ; Neuroblastoma/diagnosis/*secondary ; Pancreatic Neoplasms/diagnosis/*secondary

Paraganglioma is a rare neuroendocrine tumor arising from the neural crest, which includes tissues such as the adrenal medulla, carotid and aortic body, organs of Zuckerkandl, and other unnamed paraganglia. The head, neck, and retroperitoneum are the most common sites for paraganglioma. However, paraganglioma of the pancreas is extremely rare. We report our experience of this rare disease. A 70-year old female patient admitted for a pancreas tail mass detected by computed tomography (CT) scan checked for vague left flank pain. CT with contrast enhancement showed a 4.2-cm heterogeneously enhanced lesion in the tail of the pancreas. A well defined ovoid shape mass in left adrenal gland was suggested adenoma. Distal pancreatectomy with left adrenalectomy was performed. Any lymph node enlargement was not found. Pancreas mass did not invade adjacent organ. Microscopic examination with pancreas and adrenal gland revealed that the cells were arranged in a characteristic Zellballen pattern. Immunohistochemical staining revealed positivity for neuron-specific enolase, chromogranin A, synaptophysin, and S-100 protein. On the basis of these findings, we diagnosed the tumor as a paraganglioma of the pancreas and adrenal gland. We report the first case of pancreas paraganglioma in Korea.
Adenoma/diagnosis/surgery ; Adrenal Gland Neoplasms/*diagnosis/secondary/surgery ; Aged ; Chromogranin A/metabolism ; Female ; Humans ; Pancreatic Neoplasms/*diagnosis/pathology/surgery ; Paraganglioma/*diagnosis/secondary/surgery ; Phosphopyruvate Hydratase/metabolism ; S100 Proteins/metabolism ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

Although the adrenal gland is a common site of metastasis from hepatocellular carcinoma (HCC), adrenal metastases are rarely seen in clinical practice because of its lower metastatic potential compared to the other malignancies. Adrenal metastases usually were detected at the time of diagnosis of primary HCC or simultaneously with intrahepatic recurrence after curative management of HCC. It is very rare that only metastatic HCC is detected without evidence of intrahepatic recurrence. Hereby, we report two cases of adrenal metastasis from HCC without intrahepatic recurrence after hepatic resection.
Adrenal Gland Neoplasms/*diagnosis/radionuclide imaging/secondary ; Aged, 80 and over ; Carcinoma, Hepatocellular/*pathology/surgery ; Humans ; Liver Neoplasms/*pathology/surgery ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

OBJECTIVETo analyze the clinical features of adrenal metastasis.

METHODSFrom January 1993 to December 2004, 103 cases of adrenal metastasis were reviewed.

RESULTSLung and hepatocellular carcinoma were the most common primary tumor of adrenal metastatic tumor, which about 36.9% (38/103) and 42.7% (44/103) of all cases, followed by renal carcinoma 6.8% (7/103), colorectal carcinoma 4.9% (5/103), stomach carcinoma 3.9% (4/103), breast cancer 1.9% (2/103), unknown primary tumor 2.9% (3/103). Most of these were low differentiation. The mean diameter of adrenal metastasis was 3.9 cm. The mean interval from detection of primary tumor to adrenal metastasis was 9.5 months. And 79.6% (82/103) were detected as a part of multiorgan metastasis. Only 5 cases (4.9%) were presented with pain in the back. There was little characterization of ultrasonography, CT and MRI, color-Doppler and selective arterial imaging showed little blood supply. All of patients were treated with synthetic methods, 16 cases (15.5%) who had undergone adrenalectomy for metastasis disease had a improved survival compared with those non-adrenalectomy.

CONCLUSIONSThere is no particular presentation of clinic and imaging, diagnosis depending on history, follow-up and the pathological presentation of primary tumor. There are no standard treatment guidelines for this group of patients. When the primary tumor could be resected or be well controlled, and there is no other evidence of metastasis, adrenalectomy is recommended. Transarterial chemoembolization (TACE) could not actually be performed.

Adrenal Gland Neoplasms ; diagnosis ; secondary ; therapy ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; pathology ; Combined Modality Therapy ; Female ; Humans ; Liver Neoplasms ; pathology ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Retrospective Studies ; Survival Analysis ; Treatment Outcome

OBJECTIVE: The aim of this study was to assess the diagnostic efficacy of integrated PET/CT using fluorodeoxyglucose (FDG) for the differentiation of benign and metastatic adrenal gland lesions in patients with lung cancer and to compare the diagnostic efficacy with the use of PET alone. MATERIALS AND METHODS: Sixty-one adrenal lesions (size range, 5-104 mm; mean size, 16 mm) were evaluated retrospectively in 42 lung cancer patients. Both PET images alone and integrated PET/CT images were assessed, respectively, at two-month intervals. PET findings were interpreted as positive if the FDG uptake of adrenal lesions was greater than or equal to that of the liver, and the PET/CT findings were interpreted as positive if an adrenal lesion show attenuation > 10 HU and showed increased FDG uptake. Final diagnoses of adrenal gland lesions were made at clinical follow-up (n = 52) or by a biopsy (n = 9) when available. The diagnostic accuracies of PET and PET/CT for the characterization of adrenal lesions were compared using the McNemar test. RESULTS: Thirty-five (57%) of the 61 adrenal lesions were metastatic and the remaining 26 lesions were benign. For the depiction of adrenal gland metastasis, the sensitivity, specificity, and accuracy of PET were 74%, 73%, and 74%, respectively, whereas those of integrated PET/CT were 80%, 89%, and 84%, respectively (p values; 0.5, 0.125, and 0.031, respectively). CONCLUSION: The use of integrated PET/CT is more accurate than the use of PET alone for differentiating benign and metastatic adrenal gland lesions in lung cancer patients.
Adrenal Gland Neoplasms/pathology/*radiography/*radionuclide imaging/secondary ; Adult ; Aged ; Biopsy ; Diagnosis, Differential ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Lung Neoplasms/pathology/*radiography/*radionuclide imaging ; Male ; Middle Aged ; Positron-Emission Tomography/*methods ; Radiopharmaceuticals/*diagnostic use ; Retrospective Studies ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods