Solitary contralateral adrenal metastasis of renal cell carcinoma 15 years following radical nephrectomy: A case report and review of literature

Hthayyim Khalid Ahmed; Rawa Bapir; Goran Fryad Abdula; Karzan Mohammed Salih Hassan; Rawa Muhsin Ali; Mahabad Abdalaziz Salih

doi:10.1016/j.ijscr.2019.03.049

Solitary contralateral adrenal metastasis of renal cell carcinoma 15 years following radical nephrectomy: A case report and review of literature

Int J Surg Case Rep. 2019:58:33-36. doi: 10.1016/j.ijscr.2019.03.049. Epub 2019 Apr 5.

Authors

Hthayyim Khalid Ahmed¹, Rawa Bapir², Goran Fryad Abdula³, Karzan Mohammed Salih Hassan⁴, Rawa Muhsin Ali⁵, Mahabad Abdalaziz Salih⁶

Affiliations

¹ Sulaymaniyah Surgical Teaching Hospital, Urology Department, Sulaymaniyah, Iraq.
² Sulaymaniyah Surgical Teaching Hospital, Urology Department, Sulaymaniyah, Iraq; Shaheed Shawkat Haji Musheer Hospital, Urology Department, Said Sadiq/Sulaymaniyah, Iraq. Electronic address: dr.rawa@yahoo.com.
³ Shar Teaching Hospital, Urology Department, Iraq.
⁴ Sulaymaniyah Surgical Teaching Hospital, Department of Surgery, Iraq.
⁵ Shorsh General Teaching Hospital, Pathology Department, Iraq.
⁶ University of Sulaymaniyah, Faculty of Medical Sciences, School of Medicine, Department of Radiology, Iraq.

Abstract

Introduction: Renal cell carcinoma (RCC) is known to metastasize to almost every organ. A well-recognized phenomenon in RCC is late metastatic recurrence after nephrectomy which is arbitrarily defined as more than 10 years. The incidence of solitary ipsilateral and contralateral adrenal metastasis is 3% and 0.7% respectively in patients who have underwent radical nephrectomy.

Case report: A57-year-old female presented with an incidental ultrasonic finding of a right adrenal mass 15 years after radical nephrectomy for left side renal cell carcinoma. Further evaluation with abdominal contrast enhanced CT scan revealed a right adrenal mass suggestive of metastatic lesion. The results of laboratory examinations showed the mass to be nonfunctional. Open right adrenalectomy was performed. She was discharged home on 4^th postoperative day. Pathological examination revealed morphological and immunohistochemical findings in line with metastatic renal cell carcinoma of the left kidney. During the last 2 years she has being on regular follow up, neither local recurrence nor distant metastasis anywhere have been detected by whole body Positron Emission Tomography(PET) scan.

Discussion: Late metastatic contralateral adrenal recurrence from RCC is very rare and to the best of our knowledge, 5 similar cases have been reported 10 years after radical nephrectomy. Early diagnosis of adrenal metastasis is challenging because they are usually silent both anatomically and functionally.

Conclusion: Solitary contralateral adrenal metastatic recurrence of RCC is extremely rare event. Surgical removal is a wise option in these cases that may improve survival.

Keywords: Adrenal gland; Adrenal metastasis; Adrenalectomy; Case report; Renal cell carcinoma.