title: Primary adrenal gland carcinosarcoma associated  with metastatic rectal cancer: a hitherto unreported collision tumor.
abstract: In this report we describe the case of a young woman with familial adenomatous polyposis who developed metastatic rectal cancer during pregnancy. At diagnosis, we decided to perform a transabdominal laparoscopic adrenalectomy, because of the high risk of bowel obstruction, and to define the origin of the adrenal gland lesion, suspected to be primary on the basis of imaging results. The histological specimen showed a collision tumor between an adrenal metastasis of a rectal tumor and a primary adrenal gland carcinosarcoma. The peculiarity of the case is due not only to its clinical presentation during pregnancy, but also to the presence of this uncommon adrenal collision tumor. A particular challenge for the clinician is to define the priority between these two tumors: the presence of two distinct and colliding aggressive neoplasms poses a problem in the choice of the best therapeutic approach, also given the impossibility to biopsy all metastatic sites. However, we decided to treat the patient as having a metastatic rectal cancer, because we had a solid histological confirmation of metastases.
authors.affiliation: Department of Oncology, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy. bertolini.federica@policlinico.mo.it
authors.forename: Federica
authors.initials: F
authors.lastname: Bertolini
authors.forename: Giulio
authors.initials: G
authors.lastname: Rossi
authors.forename: Federica
authors.initials: F
authors.lastname: Fiocchi
authors.forename: Marco
authors.initials: M
authors.lastname: Giacometti
authors.forename: Annalisa
authors.initials: A
authors.lastname: Fontana
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Gibertini
authors.forename: Luca
authors.initials: L
authors.lastname: Roncucci
authors.forename: Gabriele
authors.initials: G
authors.lastname: Luppi
authors.forename: Pietro
authors.initials: P
authors.lastname: Torricelli
authors.forename: Aldo
authors.initials: A
authors.lastname: Rossi
authors.forename: Pier Franco
authors.initials: PF
authors.lastname: Conte
mesh_terms: D011125:Adenomatous Polyposis Coli / Q000150:complications / Q000601:surgery; D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D000315:Adrenalectomy / Q000379:methods; D018268:Adrenocortical Carcinoma / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood; D002296:Carcinosarcoma / Q000097:blood / Q000175:diagnosis* / Q000556:secondary / Q000628:therapy; D003082:Colectomy; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D010535:Laparoscopy; D008279:Magnetic Resonance Imaging; D009378:Neoplasms, Multiple Primary / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000097:blood / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D012004:Rectal Neoplasms / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor