EP553 An unusual presentation of endometrial cancer with bilateral adrenal metastases at the time of diagnosis. (1st November 2019) - Ryan, M
Abstract : Introduction/Background: Endometrial cancer (EC) is the most common gynaecological malignancy with an average of 9, 000 new cases diagnosed in the UK each year. If at presentation, the tumour is not amenable to operative management, then the approach must be individualised and chemotherapy or systemic hormonal therapy should be considered. We report an unusual presentation of EC with solitary adrenal metastases at the time of diagnosis. Methodology: A 68 year old Caucasian woman was referred with post-menopausal bleeding of several weeks' duration. Imaging including urgent ultrasound, pelvic MRI and full body CT revealed a heterogeneous uterine mass and bulky bilateral adrenal masses, which were not in keeping with benign adrenal adenomas. Hysteroscopy and endometrial biopsies diagnosed grade 3 endometrial adenocarcinoma. Central multidisciplinary team meeting (MDT) recommended radiological guided biopsy of the adrenal mass. The histology was consistent with poorly differentiated adenocarcinoma. A PET-CT scan reported the two adrenal metastases being hypermetabolic and suspicious for malignancy. A diagnosis of Stage 4b, Grade 3 EC with adrenal metastases was made. Results: The patient received neoadjuvant chemotherapy with carboplatin and Paclitaxel. Following six cycles of primary chemotherapy, a CT scan confirmed good response with size reduction of the primary tumour and metastases. The adrenal metastases were no longer PET-avid on repeat PET-CT scan. She received alternating hormonal therapy Megace/Tamoxifen three-weekly. As per adrenal MDT, she underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy followed by a bilateral retroperitoneal laparoscopic adrenalectomy two months later. The patient remains asymptomatic on maintenance hydrocortisone 18 months post diagnosis. Conclusion: This is the first report of solitary synchronous adrenal metastases in a patient with EC. Central MDT review is key in providing individualised treatment recommendations of such rare entity. Disclosure: Nothing to disclose.