Management of contralateral adrenal metastasis from renal cell carcinoma: possibility of inferior vena cava tumour thrombus.
OBJECTIVE
The contralateral adrenal gland is a rare metastatic site in renal cell carcinoma (RCC). We describe our experiences with this metastasis in a cohort of 610 radical nephrectomy patients analysed. To our knowledge this study is the first to demonstrate an inferior vena cava tumour thrombus from metachronous contralateral adrenal metastasis.


METHODS
After radical nephrectomy for RCC, 610 patients treated at our institution from 1985-99 were retrospectively investigated for the incidence of contralateral adrenal metastasis, additional clinical findings, treatment modalities and survival after treatment for contralateral adrenal gland metastasis.


RESULTS
The incidence of contralateral adrenal metastasis was 1.1% (7/610 patients), while the incidence of ipsilateral metastasis was 3.4% (21/610). In 3 of 7 cases the contralateral adrenal metastasis occurred simultaneously with primary RCC in the kidney. The contralateral adrenal gland was affected by distant tumour spread metachronously in 4 of 7 cases (3/4 bilateral adrenal involvement, 1/4 unilateral disease). In 1 case a metachronous contralateral adrenal metastasis caused vena cava tumour thrombus by propagation via the suprarenal venous route. After a mean follow-up of 20 months (range 1-54 months), 4 of 6 patients showed no evidence of disease after contralateral adrenalectomy.


CONCLUSIONS
The probability of contralateral adrenal metastasis from RCC is 1.1%. Adrenalectomy in these cases offers a good chance of cure. In 71% of cases contralateral adrenal metastasis occurs in conjunction with ipsilateral disease, which provides a strong argument for routine ipsilateral adrenalectomy during radical nephrectomy. Care must be taken in preoperative diagnostics, as metachronous adrenal metastasis is capable of causing vena cava tumour thrombus.
von Knobloch
R
R
Department of Urology, Philipps University, Marburg, Germany. vonknob@post.med.uni-marburg.de
Hegele
A
A
Kälble
T
T
Hofmann
R
R
D000310:Adrenal Gland Neoplasms / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000453:epidemiology / Q000556:secondary* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D012189:Retrospective Studies; D014682:Vena Cava, Inferior