Title:Transperitoneal Laparoscopic Adrenalectomy for Metachronous Contralateral
Adrenal Metastasis from Oligometastatic Renal Cell Cancer: Case Report and
Review of the Literature
Volume: 20
Author(s): Ercan Öğreden*, Ural Oguz, Erhan Demirelli, Doğan Sabri Tok, Safa Akyol, Hülya Öksüz and Serdar Aslan
Affiliation:
- Department of Urology, Giresun University, Faculty of Medicine, Giresun, Turkey
Keywords:
Oligometastatic kidney cancer, Metachronous adrenal metastasis, Laparoscopic metastasectomy, Contrast-enhanced CT, Contrastenhanced MRI, Renal cell cancer.
Abstract:
Background:
The definition of oligometastasis is still controversial. Cytoreductive nephrectomy and metastasectomy are important approaches in selected
patients with oligometastasis for improving survival. We aimed to present our laparoscopic metastasectomy experience in a rare case of
contralateral adrenal metastasis in an oligometastatic kidney tumor.
Case Report:
A 52-year-old male patient was admitted to our clinic with the diagnosis of an incidental right renal mass. On contrast-enhanced abdominal CT
revealed a mass reaching approximately 8 cm in diameter in the right kidney located in the middle pole. On contrast-enhanced thorax, CT showed
a metastatic lesion in the left main bronchus bifurcation. The patient underwent an open radical nephrectomy with the diagnosis of an
oligometastatic right renal mass. His pathology was reported as clear cell renal cell carcinoma (ccRCC). The patient was referred to the medical
oncology clinic for immunotherapy. The metastatic lesion in the lung completely regressed in the follow-up of the patient who was started on Chek
point inhibitors. However, he was referred to our clinic after an incidental metachronous mass was detected in the contralateral left adrenal in FDG
PET/CT (SUVmax: 6.7) in 1st year. Dynamic contrast-enhanced MRI was performed to reevaluate and for mass characterization, and a 4 cm mass
was observed in the left contralateral adrenal. Laparoscopic metastasectomy was performed for the left adrenal mass. No recurrence or adrenal
insufficiency developed in the 6-month follow-up after discharge.
Conclusion:
Transperitoneal adrenalectomy is a minimally invasive method that can be safely performed in metastatic adrenal masses. Although contralateral
adrenal metastasis is rare in ccRCC, it should be kept in mind that adrenal metastasis may develop in the late period in patients with a history of
renal cancer.
