Management of contralateral adrenal metastasis from renal cell carcinoma: Possibility of inferior vena cava tumour thrombus

Objective: The contralateral adrenal gland is a rare metastatic site in ren al cell carcinoma (RCC). We describe our experiences with this metastasis i n a cohort of 610 radical nephrectomy patients analysed. To our knowledge t his study is the first to demonstrate an inferior vena cava tumour thrombus from metachronous contralateral adrenal metastasis. Patients and methods: After radical nephrectomy for RCC, 610 patients treated at our institution from 1985-99 were retrospectively investigated for the incidence of contral ateral adrenal metastasis, additional clinical findings, treatment modaliti es and survival after treatment for contralateral adrenal gland metastasis. Results: The incidence of contralateral adrenal metastasis was 1.1% (7/610 patients), while the incidence of ipsilateral metastasis was 3.4% (21/610) . In 3 of 7 cases the contralateral adrenal metastasis occurred simultaneou sly with primary RCC in the kidney. The contralateral adrenal gland was aff ected by distant tumour spread metachronously in 4 of 7 cases (3/4 bilatera l adrenal involvement, 1/4 unilateral disease). In 1 case a metachronous co ntralateral adrenal metastasis caused vena cava tumour thrombus by propagat ion via the suprarenal venous route. After a mean follow-up of 20 months (r ange 1-54 months), 3 of 6 patients showed no evidence of disease after cont ralateral adrenalectomy. Conclusions: The probability of contralateral adre nal metastasis from RCC is 1.1%. Adrenalectomy in these cases offers a good chance of cure. In 71% of cases contralateral adrenal metastasis occurs in conjunction with ipsilateral disease, which provides a strong argument for routine ipsilateral adrenalectomy during radical nephrectomy. Care must be taken in preoperative diagnostics, as metachronous adrenal metastasis is c apable of causing vena cava tumour thrombus.