A Case Report of Isolated Contralateral Adrenal Metastasis after Treatment of Primary Renal Cell Carcinoma

Ing Soon Ngu, Roger Anthony Idi

Abstract


Introduction: Renal Cell Carcinoma (RCC) is the most common kidney-originated neoplasm, which can be aggressive with high metastatic potential. It is reported that RCC can recur or metastasize years after curative treatment. While ipsilateral adrenal metastasis is not uncommon, isolated contralateral adrenal metastasis (CAM) is extremely rare. 

Case Presentation: A 67-year-old Chinese man had history of Fuhrman Grade 2 right clear cell RCC (Stage T1bN0M0) with right radical nephrectomy done in 2014. Subsequently, he was diagnosed having prostatic carcinoma in 2016 with the Gleason score of 9 (4+5).  On staging CT for prostate cancer, left adrenal mass was noted, measuring 1.7cm x 3.0 cm x 2.5cm (AP x W x CC). He had further undergone Positron Emission Tomography (PET) scan which showed equivocal findings of a mildly hypermetabolic nodule in the left adrenal gland. In addition, there were 2 small hypermetabolic foci in the prostate gland compatible with prostate carcinoma and hypermetabolic mediastinal lymph nodes. Thus, strategy of surveillance for adrenal tumour was adopted. He was treated with radiotherapy and thereafter androgen deprivation therapy (ADT) with intramuscular Lucrin injection. However, the surveillance CT revealed that the left adrenal nodule increased in size. In view of progressive disease despite ADT, left adrenalectomy was done in 2017. Intra-operatively, there was a well-circumscribed, encapsulated left adrenal lesion with no invasion to surrounding tissue. Histopathological examination revealed metastatic clear cell RCC.

Conclusion: Solitary CAM from RCC is extremely rare which will possibly occur at a remote interval following primary radical nephrectomy. Aggressive surgery remains as the feasible treatment option improving prognosis in such patients.


Keywords


Renal cell carcinoma; contralateral adrenal metastasis; prostate cancer

References


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