www.kjurology.org DOI:10.4111/kju.2010.51.12.879 Case Report Renal Cell Carcinoma with Double Synchronous Contralateral Adrenal Metastases Masanori Ishida1,2, Kaoru Kojima2, Kuni Ohtomo1 Department of Radiology, 1University of Tokyo Hospital, 2Toshiba General Hospital, Tokyo, Japan A 63-year-old male patient visited our hospital with a right incidental renal tumor, which was found by ultrasonography for the follow-up study of chronic hepatitis B virus infection and diabetes mellitus. Consecutive computed tomography revealed a right renal tumor and two left adrenal tumors. Further systemic imaging study and hormo- nal examination suggested one right renal cell carcinoma and left adrenal metastases. We performed right nephrectomy and left adrenalectomy. The pathological diagnoses of all resected tumors were renal cell carcinoma. The patient has been in good health without any recurrence for 12 months since the operation. In patients with renal cell carcinoma, contralateral adrenal metastasis is usually associated with multiple meta- stases to other organs. There are a few cases of solitary and synchronous contralateral adrenal metastasis in the English literature. To our knowledge, this is the first report of a case of renal cell carcinoma with double synchronous contralateral adrenal metastases. Key Words: Adrenal glands; Neoplasm metastasis; Neoplasms; Renal cell carcinoma; Synchronous neoplasms This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Article History: received 23 June, 2010 accepted 1 September, 2010 Corresponding Author: Masanori Ishida Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan TEL: +81-3-5800-8666 FAX: +81-3-5800-8935 E-mail: masanoriishida@hotmail.com Renal cell carcinoma (RCC) can metastasize to almost ev- ery organ, including the lungs, liver, kidneys, bones, and brain [1]. Whereas metastasis of RCC to different sites is common, contralateral adrenal metastasis is remarkably rare [2]. There are a few cases of solitary and synchronous contralateral adrenal metastasis in the English literature [3,4], but there are no reports on double synchronous con- tralateral adrenal metastases with primary RCC. Herein, we report one such exceptional case along with a discussion of the literature. CASE REPORT A 63-year-old male patient was regularly followed up be- cause of chronic hepatitis B virus infection and diabetes mellitus. His history of present illness was a right in- cidental renal tumor that was found by ultrasonography (US). He had no other past history or family history. Abdominal and pelvic computed tomography (CT) revealed a 50x45 mm right renal tumor with an indistinct border. Korean Journal of Urology Ⓒ The Korean Urological Association, 2010 The right renal contour was smooth, and there was no ex- trusion by the tumor. The CT images also revealed two left adrenal tumors (20x15 mm and 15x10 mm) (Fig. 1A). By enhanced CT (dynamic study) with the use of contrast ma- terial, the right renal tumor was heterogeneously en- hanced and the degree of enhancement was weaker than the normal renal parenchyma in the early phase. The tu- mor showed mild wash-out in the delayed phase (Fig. 2B). We also found right renal venous invasion by the tumor (Fig. 2A). The two left adrenal tumors demonstrated the same enhanced pattern as the right renal tumor (Fig. 1B and 1C). In the present case, the differential diagnoses of the right renal tumor on the basis of the CT findings in- cluded RCC, transitional cell carcinoma, malignant lym- phoma, and metastasis. In addition, the left adrenal tu- mors were suspected to be metastases, adenomas, or pheochromocytomas. Including hormonal examination, laboratory data were normal except for an elevated HbA1c (8.5%) and positivity for HBs antigen. Chest CT and bone scintigraphy demonstrated no abnormal findings. No le- 879 Korean J Urol 2010;51:879-881