CONTRALATERAL ADRENAL METASTASIS IN RENAL CELL CARCINOMA

Approximately one third of patients discovered to have renal cell carcinoma already have distant metastasis at the time of tumor diagnosis. The commonest sites for metastasis are lungs, lymphnodes, and bones. Adrenal metastasis is a fairly common finding in autopsy series with a 7 to 19 per cent incidence reported. Nonetheless, the diagnosis of the metastasis to the adrenal is uncommon during life. In the literature, ipsilateral adrenal involvement has been previously reported to occur in 5.7% of all patients undergoing radical nephrectomy for renal cell carcinoma. In contrast, it seems suprising that metastatic renal cell carcinoma in the contralateral adrenal gland is not found more frequently. A case of a contralateral adrenal metastasis is here presented, and the literature is reviewed. A 77-year-old man was admitted to a local hospital on October 1977, with urinary retention and gross hematuria. The patient was referred to our department, where extensive roentogenographic studies were performed. Results of arteriography and vena cavography demonstrated a large hypervascular mass in the upper pole of the kidney and tumor thrombus in the renal vein and vena cava consistent with a renal cell carcinoma. The patient underwent transcather embolization because of massive bleeding, thereafter a right radical nephrectomy an adrenalectomy including inferior vena cava wall resection. One year after discharge a CT scan disclosed a left suprarenal mass in the contralateral adrenal, suggestive of metastatic renal cell carcinoma. A left adrenalectomy was performed for treatment of the solitary metastatic lesion. Histologically, the tumor of the left adrenal was identical to the right renal cell carcinoma. The patient required adrenal cortical steroid (Hydrocortisone) and remained well over a two year follow-up interval.