Renal cell carcinoma with bilateral synchronous adrenal gland metastases: a case report

Abstract

IntroductionRenal cell carcinoma is characterized by its potential of metastasizing widely and to unusual sites, with the metastases occasionally preceding clinical recognition of the primary tumor. Synchronous bilateral adrenal metastases from renal cell carcinoma, without other metastases, are rare and, to our knowledge, only 17 cases have been published in the literature to date. In general, patients with synchronous bilateral adrenal metastases from renal cell carcinoma have a poor prognosis.Case presentationWe report a case of right-sided renal cell carcinoma with simultaneous bilateral adrenal metastases in a 58-year-old woman. The primary tumor was localized in the upper and mid pole of the kidney. The diagnosis was established preoperatively by abdominal ultrasound and computed tomography. Surgical treatment consisted of a right radical nephrectomy and bilateral adrenalectomy. Postoperative cortisone acetate replacement was instituted. The pathological findings of the right renal tumor showed clear cell carcinoma and both adrenal tumors showed the same pathology as the right renal tumor. There was no evidence of recurrence after 6 months of follow-up.ConclusionPatients with bilateral synchronous adrenal metastases should be considered to have disseminated metastatic disease. However, good performance status, the presence of paraneoplastic syndrome and the alleviation of refractory pain are important reasons make an urologist to consider radical nephrectomy in renal cell carcinoma patient with metastases.

Bilateral synchronous adrenal metastases of renal cell carcinoma: A case report and review of the literature

“…RCCs can metastasize to almost every organ, including the lungs (50–60%), liver (30–40%), bones (30–40%) and brain (5%), and ~25% of RCC patients will already have multiple distant metastases at the time of presentation, such as lung, lymph node, liver or bone metastases ( 3 ). The rate of ipsilateral adrenal metastasis from RCC ranges from 1.1 to 10% in RCC patients and increases to 6–29% in autopsy series ( 4 , 5 ). By contrast, contralateral adrenal metastases rarely occur (metastasis rate, ~0.7%) and bilateral adrenal metastases are limited to ~20 cases reported in the literature ( 4 ).…”

A renal cell carcinoma case presenting with bilateral adrenal metastasis

“…İki taraflı sürrenal metastaz olan olgularda iki taraflı adrenalektomi dışında alternatif tedavi seçeneği olarak uygun olgularda parsiyel adrenalektomi yapılarak steroid replasman tedavisine ait gastrit, hipertansiyon, hipokalemi gibi yan etkilerden kaçınılabilir. [3,13] Bilgisayarlı tomografi (BT) ve MRG, RHK'nın lokal evrelemesinde benzer değere sahiptir. MRG'nin inferior vena kava trombüsünü saptamada sensitivitesi %90 iken BT'nin %79'dur.…”

“…[2] Günümüze kadar İngilizce literatürde iki taraflı sürrenal metastaz yapan 18 RHK olgusu bildirilmiştir. [3] Bu olgu sunumunda iki taraflı sürrenal metastazı RHK olgusunu literatür ışığında tartışmayı amaçladık.…”

Bilateral renal cell carcinoma with bilateral adrenal metastasis: a therapeutic challenge

“…Metastasis to the contralateral adrenal gland is very rare and is seen in <1% of cases. Only a few cases of bilateral adrenal metastasis are reported in literature 2. Management of such cases is challenging as bilateral adrenalectomy may lead to development of iatrogenic Addison’s disease.…”