International journal of surgery case reports · 2026
Laparoscopic resection of metachronous metastasis to the contralateral adrenal gland 5 years after radical nephrectomy.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Mohsen Sbh Kenan, Al-Bitar Ahmad, Alshalabi Abdul Ghani
Аннотация
INTRODUCTION: Renal cell carcinoma (RCC), especially clear cell RCC (ccRCC), frequently metastasizes to the lungs and bones after nephrectomy. However, isolated metachronous contralateral adrenal metastasis is exceptionally rare (≈0.7% of cases).
CASE PRESENTATION: A 57-year-old male, 5 years after a left radical nephrectomy for stage I ccRCC, presented with mild right upper quadrant discomfort. Ultrasound showed a 3.5-cm right adrenal mass with no significant internal vascularity on Doppler - an atypical hypovascular finding for ccRCC metastasis. Laboratory tests confirmed a non-functional lesion. A laparoscopic right adrenalectomy was performed. Histopathology and immunohistochemistry (IHC) (PAX-8+, CA-IX+, CD10+; Melan-A-, Inhibin-, Synaptophysin-) confirmed metastatic ccRCC. Recovery was uneventful, with no recurrence observed on 2-year surveillance imaging.
CLINICAL DISCUSSION: This case highlights the diagnostic challenge of contralateral adrenal metastases, especially when imaging is atypical for hypervascular ccRCC metastases. Definitive diagnosis requires histopathology and IHC to exclude primary adrenal neoplasms. Surgical resection is the preferred treatment for isolated metachronous metastases, offering potential cure or prolonged disease-free survival. The 5-year disease-free interval before metastasis underscores the delayed and variable recurrence patterns of RCC.
CONCLUSION: ccRCC can present with late, solitary metastases to unusual sites like the contralateral adrenal gland years after initial treatment. A high index of suspicion and thorough pathological evaluation are essential. Minimally invasive surgical resection is effective for isolated metachronous metastases. This case report reinforces the need for long-term, vigilant follow-up of RCC survivors.
CASE PRESENTATION: A 57-year-old male, 5 years after a left radical nephrectomy for stage I ccRCC, presented with mild right upper quadrant discomfort. Ultrasound showed a 3.5-cm right adrenal mass with no significant internal vascularity on Doppler - an atypical hypovascular finding for ccRCC metastasis. Laboratory tests confirmed a non-functional lesion. A laparoscopic right adrenalectomy was performed. Histopathology and immunohistochemistry (IHC) (PAX-8+, CA-IX+, CD10+; Melan-A-, Inhibin-, Synaptophysin-) confirmed metastatic ccRCC. Recovery was uneventful, with no recurrence observed on 2-year surveillance imaging.
CLINICAL DISCUSSION: This case highlights the diagnostic challenge of contralateral adrenal metastases, especially when imaging is atypical for hypervascular ccRCC metastases. Definitive diagnosis requires histopathology and IHC to exclude primary adrenal neoplasms. Surgical resection is the preferred treatment for isolated metachronous metastases, offering potential cure or prolonged disease-free survival. The 5-year disease-free interval before metastasis underscores the delayed and variable recurrence patterns of RCC.
CONCLUSION: ccRCC can present with late, solitary metastases to unusual sites like the contralateral adrenal gland years after initial treatment. A high index of suspicion and thorough pathological evaluation are essential. Minimally invasive surgical resection is effective for isolated metachronous metastases. This case report reinforces the need for long-term, vigilant follow-up of RCC survivors.