Renal cell carcinoma with metachronous metastasis to the contralateral adrenal gland and urinary bladder: A case report

Abstract

The adrenal gland and urinary bladder are rare localizations of metastases of renal cell carcinoma (RCC). In the present study, a case of metastasis to the contralateral adrenal gland and urinary bladder of clear cell-type RCC (ccRCC) in the left kidney is reported in a male who had undergone left radical nephrectomy at 55 years of age. Computed tomography (CT) revealed a mass in the right adrenal gland 5 years following surgery, and type-B ultrasound demonstrated a 1.0-cm solid space-occupying lesion in the right wall of the bladder. Consequently, laparoscopic right adrenalectomy and transurethral resection of the bladder tumor were performed. Furthermore, based on histopathological examination and immunohistochemical staining, the patient was pathologically diagnosed with contralateral adrenal gland and urinary bladder metastasis of ccRCC. CT performed at the 1-year follow-up detected multiple solid space-occupying lesions in the right kidney. Therefore, the patient was treated with sunitinib targeted therapy. To date, the patient is generally in good condition, without evident drug side effects or complaints of discomfort.

Cytology diagnosis of metastatic clear cell renal cell carcinoma, synchronous to pancreas, and metachronous to thyroid and contralateral adrenal: Report of a case and literature review

“…2,5,7,8,15 FNA biopsy diagnosed metastasis in a patient clinically suspected to have acute thyroiditis with subsequent detection of occult RCC. 3,17,20 FNA diagnosed bilateral adrenal metastasis 19year, 16 and CT-guided percutaneous fine needle biopsy confirmed metachronous solitary contralateral adrenal metastasis 5-year 17 post-nephrectomy respectively. 4 Smears from metastatic CCRCC are reported as moderately to highly cellular, containing clusters, sheets or nests of epithelial cells with distinct borders and atypia, containing moderate to abundant granular vacuolated/foamy/clear cytoplasm, with hyperchromatic, round, compact dark nuclei with conspicuous and more central nucleoli, and extensive vascularity, and occasional bland follicular clusters.…”

“…2 Multi-organ metastasis usually indicates poor prognosis, 2 and rarely occurs; for example metachronous RCC reported involving contralateral adrenal gland and urinary bladder, 3 and pancreas and thyroid. 1,4,15 Metastasis is either synchronous (25-30%) or metachronous (25-50%), or its initial manifestation.…”

“…4 Late metastasis many years following radical nephrectomy is well-documented and may cause diagnostic problems. [2][3][4][6][7][8]20 Pancreatic metastasis is uncommon in clinical studies 4.5%; nonetheless, 11% in autopsies. 19 Malignancies are now followed with PET-CT for detection and further evaluation of new lesions as primary versus metastatic.…”

“…2,4,7,15 Imaging does not reliably differentiates metastasis from primary thyroid neoplasms. 3,20 Latency period may range from 18 to 210 months. 2,5,7,8,15 FNA biopsy diagnosed metastasis in a patient clinically suspected to have acute thyroiditis with subsequent detection of occult RCC.…”

“…18 However, diagnostic challenges may ensue as normal thyroid cells were seen cytologically while thyroidectomy disclosed metastatic RCC. 1, 3,6,17,20 RCC immunoprofile on cytology supporting pancreatic and thyroid metastases includes positive CD10, vimentin, PAX-8, EMA, RCC and beta-catenin (cytoplasmic/membranous), and negative cytokeratin (CK)7, CK20, CK AE1/ AE3, CEA, synaptophysin, CD56, chromogranin, HMB45, thyroglobulin, TTF1, and calcitonin. 2 metastasis resection may provide survival benefit by hemithyroidectomy and isthmectomy.…”