Bilateral metachronous adrenal metastases of operated renal cell carcinoma

The adrenal glands are among the target metastatic organs due to the potential of systemic metastasis from renal cell carcinoma (RCC). The number of cases with bilateral metachronous metastases from RCC is about twenty.

A sixty-one-year-old man presented for routine checks due to an operated left renal tumor (clear cell carcinoma, PT2N0M0, Fuhrman grade III). The patient underwent 18FDG-PET/CT in order to re-stage the disease upon observation of bilateral adrenal masses on ultrasound and CT. A bilateral metachronous metastasis was found, whose SUVmax was 6.7 x 50 x 38 x 20 cm on the left adrenal gland, and another metastasis whose SUVmax was 5.5 40 x 29 x 20 on the right adrenal gland.

The patient underwent a CT-guided biopsy and diagnosis of adrenal metastasis was made by pathological and immunohistochemical examination. The laparoscopic treatment was performed.

There is no standard approach for the treatment of these patients in the literature. But metastasectomy is the most realistic part of the treatment. Making definitive diagnosis with biopsy, following hormonal examination and treatment with minimally invasive adrenal sparing surgical procedure containing frozen-section are strongly recommended. Cancer specific survival significantly increases with metastasectomy.