Biological, diagnostic and therapeutic aspects of a case of renal cell carcinoma occurring with bladder and contralateral adrenal metastasis

Contralateral adrenal metastasis of renal cell carcinoma: treatment, outcome and a review

OBJECTIVE

To report the surgical treatment of patients with renal cell carcinoma (RCC) metastatic to the contralateral adrenal gland and compare our experience with previous reports, as such metastases are found in 2.5% of patients with metastatic RCC at autopsy, and the role of resecting metastatic RCC at this site is not well defined.

PATIENTS AND METHODS

We retrospectively identified 11 patients who had surgery for metastatic RCC to the contralateral adrenal gland between October 1978 and April 2001. The patients' medical records were reviewed for clinical, surgical and pathological features, and the patients' outcome.

RESULTS

The mean (median, range) age of the patients at primary nephrectomy was 60.9 (64, 43-79) years; all had clear cell (conventional) RCC. Synchronous contralateral adrenal metastasis occurred in two patients. The mean (median, range) time to contralateral adrenal metastasis after primary nephrectomy for the remaining nine patients was 5.2 (6.1, 0.8-9.2) years. All patients were treated with adrenalectomy; there were no perioperative complications or mortality. Seven patients died from RCC at a mean (median, range) of 3.9 (3.7, 0.2-10) years after adrenalectomy for contralateral adrenal metastasis; one died from other causes at 3.4 years, one from an unknown cause at 1.7 years and two were still alive at the last follow-up.

CONCLUSIONS

The surgical resection of contralateral adrenal metastasis from RCC is safe; although most patients died from RCC, survival may be prolonged in individual patients. Hence, in the era of cytoreductive surgery, the removal of solitary contralateral adrenal metastasis seems to be indicated.

A solitary and synchronous metastasis of renal cell carcinoma to the bladder

We report a case of renal cell carcinoma with solitary metastasis to the bladder which occurred and was treated synchronously. The mode of spread and possible treatment modalities are discussed with relevant information from the literature.

The management of isolated renal recurrence of renal cell carcinoma following complete response to interleukin-2 based immunotherapy

The role of interleukin-2 based immunotherapy in advanced renal cell carcinoma is gradually expanding. Among patients who achieve significant responses to these regimens the subsequent development of isolated recurrences raises difficult management questions. We report 2 unusual cases of isolated recurrence in the remaining kidney following a sustained, complete response to interleukin-2 based adoptive immunotherapy. Both patients were treated with interleukin-2 based therapy following surgical resection of the primary renal tumor. The disease course of each patient is described and the literature is reviewed. Both patients were free of disease after relatively short-term followup. Surgery for patients with limited recurrence of renal cell carcinoma following an objective response to immunotherapy may, in select cases, be a reasonable treatment alternative.

Multiple urothelial recurrences of renal cell carcinoma after initial diagnostic ureteroscopy

Urothelial recurrence of renal cell carcinoma after radical surgery is exceedingly rare. We report on a 48-year-old man who underwent upper urinary tract flexible endoscopy to define a filling defect, which was found to be a perforating renal cell carcinoma. After radical nephrectomy the patient had multiple recurrences on the urinary surfaces, ureter and urethra. Urothelial lesions were treated endoscopically. He remains free of tumor 42 months after the last treatment.