Metastasis to the adrenal glands: An update

Figure 1 A 70-year-old male with 18cm pT1bN0M0 hepatocellular carcinoma post laparoscopic left lateral sectionectomy underwent Yttrium-90 radioembolisation for recurrence (blue arrow) at 12 months. A triphasic computerised tomography 2 months after Yttrium-90 (about 14 months after hepatectomy) demonstrated a new right adrenal nodule (yellow arrow) suspicious for metastasis and is being treated with systemic therapy.

Figure 2 A 66-year-old man underwent open extended right hemihepatectomy for pT3Nx hepatocellular carcinoma. At 11 months postoperatively, surveillance computerised tomography scan demonstrated an enlarging left adrenal mass (yellow arrow) suspicious for metastasis. Left adrenalectomy with splenectomy was done and he remains alive at 72 months.

Figure 3 A framework for management approach for adrenal metastatic lesions. CT: Computed tomography; MRI: Magnetic resonance imaging; FDG: Fluorodeoxyglucose; PET: Positron emission tomography; FNAC: Fine needle aspiration cytology; SBRT: Stereotactic body radiotherapy; RFA: Radiofrequency ablation; MWA: Microwave ablation; MDT: Multidisciplinary team.