Abstract
It might be difficult to make a precise diagnosis if the initial symptom is far from the primary lesion. We report a 61-year-old male with a primary lung cancer whose initial complaint was abdominal pain. He was admitted to our hospital because of loss of body weight and left abdominal pain. His laboratory data on admission showed abnormal high value of CEA. There was no abnormal lesions detected in routine chest X-ray. Abdominal CT scan and echogram showed a tumor of 5.0×6.5cm in the left adrenal gland, which could suggest metastatic tumor . Several tests were done for detecting primary lesion. Whole body Ga scintigram revealed abnormal accumulation in the upper part of left lung, Lung CT scan confirmed an abnormal tumor of 3.5×4.0cm in the upper part of left lung, which was compatible with the finding of Ga scintigram. The pathologic finding obtained through transbronchial lung biopsy (TBLB) was squamous cell carcinoma. This left adrenal tumor was resected and diagnosed as metastasis of the pulmonary squamous cell carcinoma in adrenal grand. After operation of the adrenal tumor, resection of upper part of left lung including thoracectomy and left pulmonary artery was done.
Previous studies showed that most primary origin of metastatic adrenal tumor was primary lung cancer. In our case, several radiologists could not detect any abnormal lesions in routine chest X-ray on admission. In case with the metastatic adrenal tumor, further examination in lung should be carried out, even if no abnormal findings in routine chest X-ray
