Solitary adrenal metastatic adenocarcinoma one year after radical gastrectomy for gastric cancer: a case report

TL;DR

A rare case of adrenal metastasis from gastric cancer is reported, emphasizing the need for vigilance and the potential effectiveness of combined chemotherapy and immunotherapy.

Contribution

This case report highlights the rarity of solitary adrenal metastasis from gastric cancer and suggests a treatment strategy combining chemotherapy and immunotherapy.

Findings

Solitary adrenal metastasis from gastric cancer is rare and often overlooked during follow-up.

Combined chemotherapy and PD-1 inhibitor therapy improved the patient's condition.

Elevated tumor markers and imaging confirmed the metastasis despite prior negative follow-ups.

Abstract

Adrenal metastasis from gastric cancer is rare and usually occurs as part of widespread systemic dissemination. Solitary adrenal metastasis detected during postoperative follow-up is extremely uncommon and easily overlooked due to nonspecific clinical manifestations.

We report the case of a 69-year-old man who underwent radical gastrectomy for esophagogastric junction cancer one year earlier. Histopathology revealed diffuse infiltrative mucinous adenocarcinoma with components of signet-ring cell carcinoma and neuroendocrine carcinoma (pT4N3Mx). The patient completed six cycles of adjuvant chemotherapy with tegafur–gimeracil–oteracil (S-1) plus oxaliplatin, and routine follow-up examinations showed no evidence of recurrence. Twenty-one months postoperatively, he presented with left upper abdominal pain. Computed tomography revealed a solitary mass in the left adrenal gland. Tumor markers, including CA72-4, CA19-9, and carcinoembryonic antigen, were markedly elevated. Ultrasound-guided biopsy confirmed metastatic adenocarcinoma of gastric origin. The patient was treated with SOX chemotherapy combined with the PD-1 inhibitor tislelizumab. After the first treatment cycle, his general condition improved, and he remains under close follow-up.

This case highlights the importance of vigilance for rare metastatic sites, such as the adrenal gland, in patients with advanced gastric cancer even after standardized postoperative surveillance. Systemic chemotherapy combined with immunotherapy may represent an effective treatment strategy for selected patients with metastatic gastric cancer.

Figures