A rare metastatic site of primary adrenal leiomyosarcoma

A 56-year-old man was found to have a mass in the liver-kidney space during abdominal ultrasonography. His physical examination showed no positive signs. Plasma renin, cortisol, and aldosterone levels were within normal limits, while neuron-specific enolase (NSE) was estimated to be 16.53 ng/ml (reference range, 0–16.5 ng/ml); he tested negative for HIV. An abdominal computed tomographic (CT) scan revealed a lobular mass shadow of approximately 7.4 cm × 5.8 cm × 7.4 cm in size in the right adrenal gland area (Fig. 1A and 1B). The lesions were unclearly separated from the adjacent liver parenchyma; the adjacent inferior vena cava and right renal vein were found to be compressed (Fig. 1B, arrow). The lesion was removed by surgery. Microscopic examination revealed that the tumor cells (Fig. 1D, arrow) of the right adrenal gland were in the shape of a spindle with significant mitotic activity. The tumor was positive for desmin (Fig. E), smooth muscle actin (SMA) (Fig. F), and negative for CD117, S-100, DOG1, and pan-cytokeratin (PAN CK). The Ki-67 proliferation index was 30%. Based on these findings, the diagnosis of adrenal leiomyosarcoma was confirmed. At six months post-operation, a CT scan revealed a solid nodule on the right side of the abdominal wall in the patient (Fig. C arrow). The nodule was confirmed as a metastatic adrenal leiomyosarcoma using needle biopsy. Currently, the patient is undergoing radiotherapy.