HER2-positive breast cancer with isolated adrenal metastasis: adrenalectomy with no recurrence at follow-up

What happened, in summary

A 64-year-old woman had previously been treated for right breast invasive ductal carcinoma with a modified radical mastectomy. The original breast tumor measured 5.0 cm, was grade II, and involved 1 of 16 axillary lymph nodes, placing the initial disease at Stage IIB. Biomarker testing showed estrogen receptor-negative, progesterone receptor-negative, and HER2/C-erbB-2-positive disease. After surgery, she accepted only 2 cycles of CEF chemotherapy, using cyclophosphamide, epirubicin, and fluorouracil, and declined further adjuvant treatment. Two years later, routine follow-up imaging found a 5.4 by 7.0 cm mass in the left adrenal gland. She had no symptoms, normal blood pressure, and normal CA 15-3, and additional imaging of the brain, chest, pelvis, and bones did not show other disease. Doctors suspected relapse, and she underwent left adrenalectomy in September 2006. Pathology confirmed that the adrenal tumor was metastatic breast invasive ductal carcinoma, again ER-negative, PR-negative, and HER2/C-erbB-2-positive. The metastasis also stained positive for GCDFP-15, mammaglobin, E-cadherin, and cytokeratin, supporting breast origin, while p53 staining was negative. She declined additional treatment after adrenal surgery. More than 3 years after adrenalectomy, and more than 5 years after the original breast surgery, she was alive, in good condition, and being followed without evidence of recurrence. The adrenal mass was treated as an isolated metastatic recurrence rather than widespread relapse, because staging scans found no other active sites. Her outcome therefore depended on both local control with adrenalectomy and continued surveillance after she declined more systemic therapy. Ongoing outpatient follow-up was therefore central to detecting any new recurrence early.