Isolated recurrence of ovarian serous adenocarcinoma to adrenal gland

OBJECTIVES: The purpose of this report was to present the diagnosis and management of an unusual case of a woman with ovarian carcinoma who developed an isolated recurrence to the adrenal gland six years after initial diagnosis. CASE: A 79-year-old woman was diagnosed with stage IVa high-grade serous carcinoma of the ovary with malignant pleural effusion in January 2014. She received six cycles of carboplatin and paclitaxel and underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and optimal tumor debulking in May 2014. After developing new liver implants in August 2015 and peritoneal carcinomatosis in April 2016, she received 5 cycles of carboplatin and paclitaxel and 6 cycles of doxorubicin, respectively, after which she had no evidence of disease. In March 2020, a surveillance computed tomography (CT) scan showed a 1-cm interval thickening of the left adrenal gland suspicious for metastasis. Positron emission tomography (PET) scan revealed an adrenal mass that was intensely fluorodeoxyglucose (FDG) avid with subsequent fine-needle aspiration (FNA) consistent with metastatic serous carcinoma. She was treated with laparoscopic left adrenalectomy in October 2020 and underwent 4 cycles of adjuvant carboplatin and paclitaxel. Follow-up CT imaging revealed stable post-adrenalectomy status with no interval thickening of the gland and post-operative Ca-125 level of 11.2 from 26.1 pre-operatively. CONCLUSIONS: Interval adrenal thickening detected on surveillance CT was the most important initial indicator of adrenal metastasis in this case of ovarian carcinoma. The adrenal mass was further evaluated using PET CT and FNA for pathology diagnosis. As this new recurrence occurred in a patient with no evidence of disease, we suggested an aggressive management approach consisting of surgical excision in combination with chemotherapy to eliminate visible disease and optimize survival.