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.
Highlights
Introduction: Renal 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
Case presentation: We report a case of right-sided renal cell carcinoma with simultaneous bilateral adrenal metastases in a 58-year-old woman
We report a case of rightsided Renal cell carcinoma (RCC) with simultaneous bilateral adrenal metastases, the treatment and prognosis are discussed
Summary
It is well established that the incidence of adrenal metastases in certain types of malignancy, such as carcinomas of the breast, lung and melanoma is high [1]. The ultrasonography revealed a right upper pole renal mass and bilateral adrenal masses. Because of these findings she was admitted for further evaluation. A contrast-enhanced abdominal computed tomography (CT) confirmed the presence of a 6 cm × 5 cm × 4 cm solid mass at the upper and mid pole of the right kidney with heterogeneous and enhanced areas and bilateral involvement of the adrenal glands (Figure 1). The diagnosis of right renal cell carcinoma with bilateral adrenal metastases was established. Microscopic examination of the renal and both adrenal gland tumors revealed the diagnosis of Figure 2. Http://casesjournal.com/casesjournal/article/view/7298 cortisol and electrolytes were normal during the follow-up period She was discharged 10 days after the operation. The patient is alive with no evidence of disease recurrence or metastatic disease after six months postoperatively treated with adjuvant chemotherapy
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