RCC with Contralateral Adrenal Metastasis 881 FIG. 3. Resected sample of the left adrenal gland (arrows: tumors). The tumors were macroscopically yellowish-white. Later, pathological examination revealed that the tumors were metastases of renal cell carcinoma. adrenal metastasis occurred. Zornoza et al mentioned that the abundant blood flow and sinusoidal structure of the adrenal gland may affect this unique metastasis [10]. Concerning adrenal tumors, it is said that 50% to 75% of incidental adrenal tumors in oncology patients are meta- stases and 30% to 50% are nonfunctional adenomas. To dis- tinguish a benign adenoma from a malignant adrenal mass, it is necessary to first identify the presence of fat in the tumor by nonenhanced CT or magnetic resonance imaging (in/opposite phase). Second, a CT protocol to eval- uate the wash-out rate of contrast media in an adrenal mass may be useful. In about one-third of RCC patients with isolated adrenal metastasis, surgical resection of the adrenal metastasis leads to an apparently curative outcome. In general, RCC patients with a solitary metastasis survive significantly longer than do those with multiple metastases. Complete resection of the primary renal and metastatic adrenal tu- mors should be the most important clinical treatment in cases such as this case. To our knowledge, we are the first to report a case of RCC with double synchronous contralateral adrenal metas- tases. In cases of a unilateral renal tumor and contralateral adrenal tumor, this unique pathological state should be considered. Conflicts of Interest The authors have nothing to disclose. FIG. 4. Microscopic specimen of the right renal tumor. Patholo- gical examination revealed that the tumor form was alveolar growth and there were many atypical cells that were composed of swelling nuclei in the clear cytoplasm. The tumor was diag- nosed as clear cell-type renal cell carcinoma (H&E, x100). REFERENCES 1. Lau WK, Zinche H, Lohse CM, Cheville JC, Weaver AL, Blute ML. Contralateral adrenal metastasis of renal cell carcinoma: treat- ment, outcome and a review. BJU Int 2003;91:775-9. 2. Saitoh H, Nakayama M, Nakamura K, Satoh T. Distant meta- stasis of renal adenocarcinoma in nephrectomized cases. J Urol 1982;127:1092-5. 3. Sapienza P, Stipa F, Lucandri G, Baratti L, Delfino M, Mingazzini PL. Renal carcinoma with a solitary synchronous contralateral adrenal metastasis: a case report. Anticancer Res 1997;17:743-7. 4. Utsumi T, Suzuki H, Nakamura K, Kim W, Kamijima S, Awa Y, et al. Renal cell carcinoma with a huge solitary metastasis to the contralateral adrenal gland: a case report. Int J Urol 2008;15: 1077-9. 5. Abi-add AS, Belldegrum A, Dekernion JB. Renal cell carcinoma. Physiology, diagnosis, and therapy. World J Urol 1991;9:168-72. 6. Hellsten S, Berge T, Linell F. Clinically unrecognised renal cell carcinoma: aspects of tumor morphology, lymphatic and haema- togenous metastatic spread. Br J Urol 1983;55:166-70. 7. Dieckmann KP, Wullbrand A, Krolzig G. Contralateral adrenal metastasis in renal cell cancer. Scand J Urol Nephrol 1996;30: 139-43. 8. Robey EL, Schellhammer PF. The adrenal gland and renal cell carcinoma: Is ipsilateral adrenalectomy a necessary component of radical nephrectomy? J Urol 1986;135:453-5. 9. Angervall L, Wahlqvist L. Follow-up and prognosis of renal cell carcinoma in a series operated by perifascial nephrectomy com- bined with adrenalectomy and retroperitoneal lymphadenec- tomy. Eur Urol 1978;4:13-7. 10. Zornoza L, Bracken R, Wallace S. Radiologic features of adrenal metastases. Urology 1976;8:295-9. Korean J Urol 2010;51:879-881