A rare case of long‐term survival from metachronous bilateral adrenal metastasis of lung adenocarcinoma after combined surgical removal and immunochemotherapy

Fig. 1. Contrast‐enhanced CT (a) revealed a 15 × 12‐mm–sized substantial mass in the left adrenal cortex with positive accumulation on FDG–PET/CT (b) (white arrowheads). CT showed a 60 × 24‐mm–sized mass in the right adrenal cortex (c) with positive accumulation on FDG‐PET/CT (d) (Black arrowheads).

Fig. 2. Pathological findings of surgical resection of left upper lobe of the lung. HE staining (a) revealed a poorly differentiated adenocarcinoma; immunohistochemical staining was positive for AE1/3 (b), TTF‐1 (c), and negative for vimentin (d). Pathological findings of surgical resection of left adrenal gland (e). HE staining (f) revealed metastasis of a poorly differentiated adenocarcinoma that originated from the lung; immunohistochemical staining was weakly positive for TTF‐1 (g), and negative for vimentin (h). Pathological findings of surgical resection of right adrenalectomy (i). HE staining (j) revealed metastasis of a poorly differentiated adenocarcinoma that originated from the lung; immunohistochemical staining was negative for TTF‐1 (k) and vimentin (l).

Fig. 3. Clinical course and transition of serum CEA level in this case.

Fig. 4. The pathological analysis by immunochemical staining of AE1/3 of a left adrenal tumor specimen. The dissemination of multiple tumor cells (black arrowheads) with positive staining of AE1/3 (c, d) was recognized, apart from the mass, that could not be detected by HE staining (a, b).