During staging workup of colorectal cancer (CRC), adrenal incidentalomas (AIs) are frequently identified with an incidence of approximately 9-13%. Among AIs, adrenal adenomas are most commonly detected followed by adrenal myelolipomas (AMLs), presenting a diagnostic and management challenge in cancer staging. We present a case of well-differentiated carcinoma of the caecum in a male patient who presented with a right iliac fossa mass and severe anaemia without any comorbidities. Colonoscopic biopsy confirmed our diagnosis. During staging workup, CT imaging of abdomen revealed a coincidental left adrenal mass suggestive of myelolipoma. Endocrinal evaluation was performed to rule out functional status of the tumour. It was a normetanephrine secreting tumour though other parameters for pheochromocytoma were within normal limit creating diagnostic confusion. The patient underwent simultaneous right hemicolectomy and left adrenalectomy. Histopathological examination confirmed the diagnosis of adrenal myelolipoma concurrent with carcinoma caecum. The patient's postoperative course was uneventful. Patient received complete adjuvant treatment and under regular follow up. This case highlights the importance of detailed preoperative evaluation and management of adrenal incidentalomas discovered during staging workup of colon carcinoma. While most AIs are benign, appropriate radiological and functional assessment is crucial for optimal surgical planning. Our case demonstrates the need for simultaneous resection of colorectal cancer and adrenal myelolipoma when there the diagnosis is inconclusive.
Pal et al. (Tue,) studied this question.