Abstract. Metastasis of the gallbladder due to renal cell tumors is rare. We present a case of gallbladder and metachronous left adrenal metastasis at six months follow-up, which demonstrates the importance of radiological tests and histology when making a definitive diagnosis. Clinical findings are not specific enough to arrive at a final diagnosis. However, immunohistochemistry is necessary to differentiate between primary and secondary metastatic tumors. Cholecystectomy should be performed to obtain a definitive diagnosis and to improve survival in cases of single lesions in the gallbladder. IntroductionClear cell renal carcinoma (RCC) is a rare tumor accounting for 3% of all malignancies in adults and 85% of primary renal tumors (1). Currently, its incidence is on the increase due to the increased number of incidental findings in imaging tests (2). RCC frequently metastasizes in the lungs, bones, lymph nodes and liver. Gallbladder metastasis is extremely rare, being found in approximately 0.6% of cases at autopsy (3). We report a case of gallbladder and metachronous contralateral adrenal metastasis. The study was approved by the ethics committee of La Fe University Hospital, and consent was obtained from the patient. Case reportA 75-year-old female was incidentally diagnosed with right RCC following radiological tests requested for benign anorectal disease in March 2010. Computed tomography (CT) revealed a right renal mass of 11.3x8.6x12.2 cm with areas of necrosis, calcification, increased neovascularization and exophytic growth towards the liver. In addition, lymph nodes were detected in the renal hilum and retroperitoneum, with uncertain infiltration of the renal vein and inferior vena cava without distant metastases. The tumor markers CEA and CA19.9 were within the normal range. A radical right nephrectomy was carried out through a right subcostal incision without demonstrable vascular invasion or metastases intraoperatively. Macroscopically, the renal lesion was yellowish in appearance, with undefined limits and a confluent nodular pattern with fibrous areas.The patient's postoperative course was uneventful and systemic adjuvant therapy was not administered. The pathological study revealed a typical RCC with a solid growth pattern without invasion of the renal pelvic wall and tumor thrombosis in the renal vein. Surgical margins were tumor-free and all lymph nodes dissected were free of tumor infiltration, with stage pT3N0M0.A CT scan was performed at 6 months which showed a nodular lesion of 3 cm in the left adrenal gland and a lobulated lesion in the gallbladder wall, with the suspected diagnosis of metastasis. Ultrasonography (US) revealed a heterogeneous solid nodular structure of 2 cm with poor delineation of the gallbladder wall. It was not possible to exclude infiltration of the liver parenchyma (Fig. 1). The extension study was completed with a thoracic CT, which revealed no pathological findings. Tumor markers were also within normal ranges.A midline laparotomy was carried out and the patient un...

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