# I. Introduction lsewhere [1], the difficulties experienced generally during the diagnosis of lung cancer in the 19th century were presented. Therefore, the present report concerns a distinct group of as many as 3 cases [2][3][4] which were identifiable despite the peculiarity of the adrenal colonization. Moreover, it is shown that their recognition can stimulate interest in modern practice including treatment. c) "Medullary sarcoma of both suprarenal bodies; horseshoe kidney" [4]. # III. Discussion In my review of organ selectivity classes in cancer metastases, 12 classes were discernible [5]. Moreover, the adrenal gland featured in as many as 11 of the classes. This strengthens Bourne's suggestion [6], viz, that the anatomical position of the adrenal glands is probably not fortuitous but related to some evolutionary factor. Hence, I am persuaded that the existence of this inherent factor is supported by my researches on the significant role played by lymphangiogenesis in adrenal selectivity [7,8]. In this context, Internet search was undertaken as regards taking advantage of this unique topography. Firstly, there is the recent report thus: "surgical resection of isolated adrenal metastases from lung cancer appears to have a modest survival advantage over non operative therapy, and it occasionally results in longterm survival" [9]. Secondly, another group agreed that "surgical treatment might improve long-term survival" [10]. Next, in the field of radiotherapy, there are recent papers which convincingly demonstrated its palliative use in cases of symptomatic adrenal metastases [11,12]. # IV. Conclusion To promote such successes, there is need to include the upper abdomen so as to improve the detection of adrenal metastases during preoperative screening for metastases in lung cancer [13,14]. In sum, to facilitate current endeavors in the field of lung cancer treatment, extra attention should be paid to these two # II. Historical Misdiagnosis Cases The titles are quoted fully. However, the lung involvement is italicized for emphasis in the abridged reports which are as follows: Both suprarenal bodies are much enlarged, especially in thickness, presenting a rounded outline. On section they were seen to be infiltrated throughout by a soft medullary growth, by which all their proper structural features had been obliterated. The growth was associated with a mediastinal tumour of the same character, which had invaded the left lung from its root. Clearly, the above three cases were each misdiagnosed because the old masters did not recognize their status as secondary manifestations. Accordingly, in modern times, the emphasis should rightly be laid on the hopeful treatment of lung cancers spreading peculiarly to the adrenals. deceptively small upper abdominal organs. In other words, a cohort showing long-term survival can be identified. In sum, since adrenal glands could for long be the only extrathoracic sites of metastasis, this epidemiologically classifiable group of lung cancer patients should be carefully identified and followed up after treatment. In all probability, as Lam and Lo [15] concluded concerning lung cancer, "Long-term survival may be achieved in selected patients in whom an aggressive surgical approach may be adopted." ![](image-2.png "E") ## Conflict of interest The author wishes to express that he has no conflict of interest. * The diagnosis of lung cancer in the 19th century WibOnuigbo Br J Dis Chest 65 1971 * Primary cancer of the suprarenal capsule SWest Med Times Gaz ii 1878 721 * New growths in the mediastinum NMoore Trans Path Soc Lond 35 1884 * Medullary sarcoma of both suprarenal bodies; horseshoe kidney FCTurner Trans Path Soc Lond 36 1885 * Organ selectivity in human cancer metastasis. A review WibOnuigbo Oncology 30 1974 * The mammalian adrenal gland GHBourne 1949 Oxford University Press 213 London * Lymphangiogenesis may explain adrenal selectivity in lung cancer metastases WibOnuigbo 10.1016/j.mehy.201002.016 2010 Med Hypotheses * Lymphangiogenesis in cancer: A Review WibOnuigbo 10.4172/2168-9652.1000138 Biochem Phys 4 2014 * Surgical management of adrenal metastases from lung cancer AIBeitler JDUrschel SRVelagapudi HTakita J Surg Oncol 69 1998 * Surgical treatment of solitary adrenal metastasis from non-small cell lung cancer OMercier EFadel MDe Perrot J Thrax Cardiovasc Surg 130 2005 * Palliation of symptomatic adrenal gland metastases by radiotherapy SShort ACharturvedi MDLeslie Clin Oncol 8 1996 * Stereotactic body radiotherapy for adrenal metastases from lung cancer MGuiou NAMayr EYKim TWilliams SSLo 1007/s13566-012-0037-8 J Radio Oncol 10 2012 * Preoperative screening for metastases in lung cancer MFMuers Thorax 49 1994 * Stereotactic body radiotherapy for treatment of adrenal metastases SChawla YChen AWKatz AGMuhs APhilip POkunieff MTMilano 10.1016/j.ijrobp.2008.10.079.Epub Int J Radiat Oncol Biol Phys 1 1 2009. 2009 Feb 26