Metastatic Invasive Ductal Carcinoma Presenting as Unilateral Adrenal Incidentaloma

The widespread use of cross-sectional imaging has led to increased detection of adrenal incidentalomas (AI), most of which are benign. However, a small fraction of AIs are malignant, with a significantly higher risk in patients with a history of cancer.

Sixty-nine-year-old woman with a remote history of invasive ductal breast carcinoma and thyroid carcinoma in remission presented with chronic abdominal pain. Imaging revealed 2 enlarging, right adrenal nodules with indeterminate features and no uptake on PET-CT. Hormonal tests indicated a nonfunctioning adrenal mass. Due to continued growth, she underwent laparoscopic adrenalectomy. Histopathology revealed metastatic breast carcinoma, and she subsequently initiated systemic chemotherapy.

This case highlights the diagnostic challenges posed by AIs in patients with known cancer and provides valuable insights into the detection and management of adrenal metastases.

Timely surgical intervention allowed for definitive diagnosis and appropriate oncologic management, highlighting the importance of individualized evaluation and multidisciplinary decision-making in cases of AIs.