Korean J Urol.  2010 Dec;51(12):879-881.

Renal Cell Carcinoma with Double Synchronous Contralateral Adrenal Metastases

• Ishida M
• Kojima K
• Ohtomo K

Abstract

A 63-year-old male patient visited our hospital with a right incidental renal tumor, which was found by ultrasonography for the follow-up study of chronic hepatitis B virus infection and diabetes mellitus. Consecutive computed tomography revealed a right renal tumor and two left adrenal tumors. Further systemic imaging study and hormonal examination suggested one right renal cell carcinoma and left adrenal metastases. We performed right nephrectomy and left adrenalectomy. The pathological diagnoses of all resected tumors were renal cell carcinoma. The patient has been in good health without any recurrence for 12 months since the operation. In patients with renal cell carcinoma, contralateral adrenal metastasis is usually associated with multiple metastases to other organs. There are a few cases of solitary and synchronous contralateral adrenal metastasis in the English literature. To our knowledge, this is the first report of a case of renal cell carcinoma with double synchronous contralateral adrenal metastases.

Keyword

Adrenal glands; Neoplasm metastasis; Neoplasms; Renal cell carcinoma; Synchronous neoplasms

MeSH Terms

Adrenal Glands
Adrenalectomy
Carcinoma, Renal Cell
Diabetes Mellitus
Follow-Up Studies
Hepatitis B, Chronic
Humans
Male
Middle Aged
Neoplasm Metastasis
Neoplasms, Multiple Primary
Nephrectomy
Recurrence
Viruses

Figure

• 

  FIG. 1 Preoperative computed tomography (CT) images of left adrenal tumors (arrows). We did not identify the presence of fat in the tumors (A). The tumors showed the same dynamic contrast enhancement pattern as the right renal tumor (B, C).

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  FIG. 2 Preoperative contrast-enhanced CT images of the right renal tumor. The tumor was heterogeneously enhanced, and the degree of enhancement was weaker than the normal renal parenchyma in the early phase (A). The tumor showed mild wash-out in the delayed phase (B). We also found right renal venous invasion (A).

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  FIG. 3 Resected sample of the left adrenal gland (arrows: tumors). The tumors were macroscopically yellowish-white. Later, pathological examination revealed that the tumors were metastases of renal cell carcinoma.

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  FIG. 4 Microscopic specimen of the right renal tumor. Pathological examination revealed that the tumor form was alveolar growth and there were many atypical cells that were composed of swelling nuclei in the clear cytoplasm. The tumor was diagnosed as clear cell-type renal cell carcinoma (H&E, ×100).

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