CONTRALATERAL ADRENAL METASTASIS IN RENAL-CELL CANCER

A 60-year-old female patient presenting with anemia was found to have a left-sided renal tumor and a contralateral adrenal mass of 2 cm in d iameter. Imaging studies for metastases were negative. Nephrectomy alo ng with contralateral adrenalectomy was performed and histology disclo sed renal cell carcinoma stage pT3a pNO G2 with solitary contralateral adrenal metastasis. In a survey of the literature, 24 previous cases of renal cancer with solitary contralateral adrenal metastasis were id entified. The most probable biological pathway to explain this peculia r metastatic pattern is transpulmonal passage of circulating cancer ce lls and seeding in the adrenal gland on the basis of a particular susc eptibility of adrenal tissue to circulating renal cancer cells. The ca se illustrates that surgery of solitary metastases from renal cell car cinoma may be beneficial to the patient. The case further highlights t he caution that is required diagnostically in the interpretation of in cidentally found adrenal masses when other malignancies are present.