Synchronous Bilateral Adrenal Metastases from Papillary Renal Cell Carcinoma

Abstract

ÖzetRenal hücreli karsinomun eş zamanlı bilateral adrenal metastazını saptadığımız olguyu sunuyoruz. Olguda renal kitle ve aynı taraftaki adrenal bez metastazı açık cerrahiyle en blok çıkartılırken kontrlateral adrenal metastazı için eş zamanlı olarak laparoskopik transperitoneal yaklaşım terci edilmiştir. Kliniğimize başvuran 54 yaşındaki erkek olguda preoperatif bilgisayarlı tomografide primer tümör böb-reğin üst ve orta polüne lokalize olduğu izlendi. Kontrlateral metastatik adrenal tümör 65x 45 mm ve ipsilateral adrenal metastaz 140x 65 mm idi. Tetkikler sonrasında başka bir metastaz saptanmaması üzerine laparoskopik kontrlateral adrenalektomi ve ipsilateral açık nefroadrenalektomi eş zamanlı olarak uygulandı.Primer renal kitlelere bağlı eş zamanlı adrenal tutulum oldukça nadir görünmek-te olup uygun cerrahi yaklaşım metastaz boyutlarına ve hastanın performans durumuna göre belirlenmelidir. Anahtar KelimelerLaparoskopi; Adrenalektomi; Metastaz ; Renal Hücreli Kanser AbstractWe report a case of synchronous bilateral adrenal metastasis of renal cell carcinoma. The contralateral metastatic adrenal mass was treated by the laparoscopic transperitoneal approach. The renal mass and its huge ipsilateral metastatic adrenal gland were removed en bloc with open procedure. A 54-year-old man presented to our clinic with left-sid renal cell carcinoma synchronously bilateral adrenal metastases. The primary tumor was localized in the upper-mid pole of the kidney. The diagnosis was established preoperatively by computed tomography. The size of the contralateral adrenal mass was 65 x 45 mm, but the ipsilateral metastatic adrenal mass was huge (140 x 65 mm). After all analysis and other scannings for any metastasis, a contralateral lapararoscopic transperitoneal adrenalectomy and a left open nephroadrenalectomy were performed simultaneously. Synchronous bilateral adrenal metastases from primary renal cell carcinoma without another metastasis is very rare. The optimal surgical procedure should be selected according to the metastatic adrenal masses size and the patient's status. Keywords IntroductionRenal cell carcinoma (RCC) is the most common malignancy within the kidney at the rate of approximately 90% of all renal tumors. RCC has different subtypes with specific histopathological characteristics. This malignancy is more common in males than females (1.5:1) and the highest incidence is observed between the 6th and 7th decades [1]. Nearly 25% of RCC patients already have multiple distant metastases at the time of presentation. RCC can metastasize to every organ, but especially to the lungs, bones, and brain. The incidence of synchronous metastasis into the ipsilateral adrenal gland has been reported to be 2-10% [2]. Whereas metastasis of RCC to different sites is not uncommon, adrenal metastasis is synchronous in 2.7%, metachronous in 1.0%, ipsilateral in 1.9%, contralateral in 1.5%, and bilateral in 0.3% of patients [3].We reported a case of laparoscopic transperitoneal contralateral metastatic adrenalectomy and concomitant ...