Immune landscape of renal cell carcinoma with metastasis to the pancreas

INTRODUCTION

Clear cell Renal Cell Carcinoma (ccRCC) has a poor prognosis once metastatic. However, certain metastatic sites have been reported to have a different impact on the patient prognosis. For example, patients with pancreatic metastases have a much more favorable prognosis than those with metastases to other organs. The biological basis for this observation remains poorly understood. The aim of this study was to characterize the immune landscape of pancreatic metastases and the corresponding primary tumors in order to identify possible immunological features that correlate with disease biology.

PATIENTS AND METHODS

A detailed assessment of immune cell populations was performed using a total of 1,700 microscopic images from ccRCCs from 11 patients, their corresponding pancreatic metastases and ccRCCs from 10 patients without pancreatic metastases. Tumor specimens were stained for CD45, CD8, CD163 and FOXP3 and the densities of the respective immune cells were assessed semiquantitatively in the intratumoral and extratumoral compartment. Multispectral imaging was performed in selected tumors.

RESULTS

We found that pancreatic metastases show the lowest intratumoral infiltration with CD8+ cytotoxic T lymphocytes of all tumor specimens analyzed. The frequency of CD8+ lymphocytes was on 1.9 fold lower in pancreatic metastases (median density 8.3 cells per field of view [FOV] = 1.23 mm2) when compared to the corresponding primary tumor (15.6 cells per FOV, P = 0.0002) and more than 3-fold lower when compared to ccRCCs without pancreatic metastases (27.2 cells per FOV, P = 0.0012). There was also a significantly reduced intratumoral infiltration with immunosuppressive FOXP3+ lymphocytes in pancreatic metastases (2.6 cells per FOV, P = 0.009) and corresponding primary tumors (2 cells per FOV, P = 0.028) when compared to ccRCCs without pancreatic metastases (5.6 cells per FOV).

CONCLUSIONS

In this proof-of-concept study, we show that pancreatic metastases of ccRCC present with unique immunological features including a low intratumoral density of CD8+ and FOXP3+ lymphocytes. The low counts of CD8+ and FOXP3+ lymphocytes may reflect less aggressive features of ccRCC with pancreatic metastasis that may result in a more favorable patient prognosis.

Metastasis of incidentally diagnosed renal cell carcinoma to the sacrum 7 years after partial nephrectomy: Case report and literature review

INTRODUCTION

After undergoing partial nephrectomy for renal cell carcinoma (RCC), approximately 20-40 % of patients may develop either distant metastatic disease or locally recurring disease. Delayed occurrence of metastasis is an important aspect to consider in the management and monitoring of patients with renal cell carcinoma.

CASE PRESENTATION

A 69-years-old male who had been followed up for liver hemangioma, an incidental enhancing right renal mass was discovered which then revealed to be renal cell carcinoma on computed tomography scan. The patient underwent a partial nephrectomy in 2016without any reported complications, complaints, adverse event and/or re-admissions. Seven years following the surgery, the patient began experiencing left hip pain, leading him to seek medical advice which is then confirmed to be a cancerous metastasis of the renal origin.

CLINICAL DISCUSSION

Advocating for extended surveillance protocols is important to ensure that patients receive optimal care and that any disease progression is identified promptly. Early detection and intervention may lead to better treatment outcomes and improved patient survival. Therefore, continued vigilance and close monitoring of patients with RCC, even after long periods of disease-free survival, are essential components of comprehensive cancer care.

CONCLUSION

This case highlights the challenges in predicting and detecting the occurrence of metastases in renal cell carcinoma despite regular surveillance and follow-up examinations. The delayed appearance of the metastatic lesion underscores the importance of continued vigilance and thorough monitoring even in cases where initial imaging and blood tests appear unremarkable in patients with renal cell carcinoma.

Metastatic Renal Cell Carcinoma to the Soft Tissue 27 Years after Radical Nephrectomy: A Case Report

Background and Objectives: Approximately 20-40% of patients affected with renal cell carcinoma (RCC) develop either distant metastatic or locally recurring disease following radical nephrectomy. Soft tissue, skin, and the central nervous system are less common metastatic sites. We present the case of a patient who has received a diagnosis of RCC; it was found that she had no metastases at the time of nephrectomy but had metastases in the soft tissue and subcutaneous tissue of the scalp 27 years later. As far as we can tell, this is the longest period elapsed between primary renal tumor and subcutaneous/soft tissue metastasis; moreover, this case is the first report of a combined soft tissue/subcutaneous metastasis from RCC. Case presentation: A 73-year-old woman underwent right radical nephrectomy 27 years earlier for clear cell renal cell carcinoma (CCRCC). She presented at our unit because she noticed swelling in the left temporal region; after radiological exams, a benign lesion was suspected. The patient underwent surgical eradication, but the massive bleeding did not allow the removal of the lesion. A biopsy of the mass was performed and the histological examination was consistent with RCC metastases. Conclusions: Metastases from renal cell carcinoma to the subcutaneous and soft tissues are rare. It is essential to take into account RCC metastases in the differential diagnostic of the new starting mass of the head and neck, and the necessity for close and continuous surveillance of patients diagnosed with renal cancer even after a long disease-free period should be emphasized.

Management of local recurrence after radical nephrectomy: surgical removal with or without systemic treatment is still the gold standard. Results from a multicenter international cohort

OBJECTIVE

To evaluate the survival outcomes of patients with local recurrence after radical nephrectomy (RN) and to test the effect of surgery, as monotherapy or in combination with systemic treatment, on cancer-specific mortality (CSM).

METHODS

Patients with local recurrence after RN were abstracted from an international dataset. The primary outcome was CSM. Cox's proportional hazard models tested the main predictors of CSM. Kaplan-Meier method estimates the 3-year survival rates.

RESULTS

Overall, 96 patients were included. Of these, 44 (45.8%) were metastatic at the time of recurrence. The median time to recurrence after RN was 14.5 months. The 3-year cancer-specific survival rates after local recurrence were 92.3% (± 7.4%) for those who were treated with surgery and systemic therapy, 63.2% (± 13.2%) for those who only underwent surgery, 22.7% (± 0.9%) for those who only received systemic therapy and 20.5% (± 10.4%) for those who received no treatment (p < 0.001). Receiving only medical treatment (HR: 5.40, 95% CI 2.06-14.15, p = 0.001) or no treatment (HR: 5.63, 95% CI 2.21-14.92, p = 0.001) were both independently associated with higher CSM rates, even after multivariable adjustment. Following surgical treatment of local recurrence 8 (16.0%) patients reported complications, and 2/8 were graded as Clavien-Dindo ≥ 3.

CONCLUSIONS

Surgical treatment of local recurrence after RN, when feasible, should be offered to patients. Moreover, its association with a systemic treatment seems to warrantee adjunctive advantages in terms of survival, even in the presence of metastases.

Atypical Locations of Renal Cell Carcinoma Metastases to the Pancreas and Duodenum

INTRODUCTION

Pancreatic tumors account for a small percentage of all malignancies. Most of them are primary and originate from cells of the exocrine pancreas. The remaining primary changes are neuroendocrine tumors. The pancreas may also be a target of metastatic lesions. The most common cancer that metastasizes to the pancreas is renal cell carcinoma.

CASE STUDIES

The paper presents two cases of rare metastases to organs of the abdominal cavity: the first patient treated surgically due to two metastatic lesions of renal cell carcinoma in the pancreas, diagnosed many years after radical nephrectomy. The second case of high gastrointestinal obstruction in the course of metastasis of renal cell carcinoma to the duodenum. The first patient underwent distal laparotomic resection of the pancreas. The second patient underwent resection of the duodenum and the first jejunal loop with side-to-side duodeno-jejunal anastomosis. Both patients remain under oncological supervision.

CONCLUSION

Patients after radical nephrectomy due to renal cell carcinoma require long-term systematic monitoring. Due to the anatomical position of the pancreas and duodenum as well as the number, location and size of metastatic lesions, the course of the disease may be initially asymptomatic or oligosymptomatic. Aggressive surgical treatment of pancreatic metastases creates opportunities for long-term survival.

Transnasal Endoscopic Resection of the Intraconal Metastases From Renal Cell Carcinoma: a Case Report and Review of Literature

Renal cell carcinoma (RCC) is the most common malignancy to cause metastasis to sinonasal cavity. These metastases can occasional cause invasion into the orbit. Isolated intraconal intraorbital metastasis from RCC is very rare. We hereby describe a case of 72-year-old female, who underwent right nephrectomy for RCC, 8 years back, and now presenting with a space occupying lesion in the right intraorbital intraconal compartment with no involvement of the paranasal sinuses. En bloc resection of the tumor was achieved via transnasal endoscopic approach. This is a rare case where minimally invasive surgery was done for metastatic lesion, with minimal postoperative morbidity.

[Retrovesical recurrence of renal cell carcinoma 14 years after laparoscopic nephrectomy: a case report]

Local recurrence or metachronous distant metastasis of renal cell carcinoma mostly occurs in the first five years after radical or partial nephrectomy. Nevertheless, late local recurrences or metachronous metastases are regularly observed. The most common metastatic sites are lung and bones, although unusual metastatic sites are also possible. We present the case of a 70-year-old patient with a solitary recurrence of a clear renal cell carcinoma in retrovesical location after a relapse-free survival of 14 years. We performed cystoprostatectomy with an ileal conduit, resecting the tumour completely (in sano). The long-term prognosis of the patient cannot be estimated as yet.Despite the fact that a solitary and very late recurrence of a renal cell carcinoma in retrovesical location is extremely rare, late recurrence is a specific characteristic of renal cell carcinoma. Therefore, long-term follow-up for at least 15 years is required. Curative surgical resection is the treatment of choice for such late solitary recurrences.

Renal cell carcinoma metastatic to the sinonasal cavity: A review and report of 8 cases

Renal cell carcinoma (RCC) metastatic in the sinonasal cavity is rare. In many cases, it represents the initial presentation of RCC. We conducted a retrospective chart review to report the clinical presentation, imaging, and treatment of RCC metastases in the sinonasal cavity at two tertiary care referral centers. Our population was made up of 8 patients-6 men and 2 women, aged 55 to 86 years (mean: 66.9; median: 63.5)-who had been diagnosed with cancer in the sinonasal cavity. The most common complaints were epistaxis, nasal obstruction, and diplopia. Cancers were located in the ethmoid sinus (n = 3), nasal cavity (n = 2), sphenoid sinus (n = 2), and maxillary sinus (n = 1). Local treatment involved resection and adjuvant radiotherapy in 4 patients, surgery alone in 2 patients, and radiotherapy alone in the other 2. The lesion was embolized before surgery in 4 cases. We also performed a critical review of similar published cases. Our literature review covered 53 cases of RCC metastatic to the sinonasal cavity, including ours. Metastases were the first presentation of RCC in 24 of these cases (45.3%); in our series, the metastases led to the diagnosis of the primary RCC in 3 cases (37.5%). In the 53 reported cases, metastatic resection was performed on 35 patients (66.0%). Survival data were available for 22 of these operated patients, and 17 of them achieved a complete local response. Adjunctive radiotherapy was not associated with a better local response. Overall survival was significantly better in patients who had an isolated metastasis rather than multiple metastases (p = 0.013). There was no difference in overall survival between patients whose metastasis represented the initial presentation of RCC and those whose metastasis did not (p = 0.95). We recommend that sinonasal metastasis be suspected in the event of unilateral nasal bleeding or nasal obstruction in patients diagnosed with RCC. Embolization may prevent abundant bleeding during removal. Surgery may improve the quality of life of these patients while decreasing nasal obstruction and bleeding.

Surgical Metastasectomy in Renal Cell Carcinoma: A Systematic Review

CONTEXT

The benefit of surgical metastasectomy (SM) for patients with metastatic renal cell carcinoma (mRCC) remains controversial because of the lack of high-level evidence on the role of SM in terms of survival benefit in the era of systemic therapy.

OBJECTIVE

To perform a systematic review of the literature on the role of SM in the treatment of mRCC and discuss key issues in the SM decision-making process.

EVIDENCE ACQUISITION

A systematic search of the Embase and Medline databases was carried out and a systematic review of the role of SM in mRCC was performed. A total of 56 studies were finally included in the evidence synthesis.

EVIDENCE SYNTHESIS

All the studies included were retrospective and mostly noncomparative. Median overall survival (OS) ranged from 36 to 142mo for those undergoing SM, compared to 8-27mo for no SM. SM was associated with a lower risk of all-cause mortality compared to no SM (pooled adjusted hazard ratio 2.37, 95% confidence interval 2.03-2.87; p<0.001). Morbidity and mortality were similar for SM and primary tumor surgery. The most important prognostic factor for OS was complete resection of metastases. Other prognostic factors included disease free-survival from nephrectomy, primary tumor features (T stage ≥3, high grade, sarcomatoid features, and pathological nodal status), the number of metastases, and performance status. Lung metastasectomy seemed to show the best survival benefit.

CONCLUSIONS

Although no randomized clinical data are available, published studies support the role of SM in selected patients in the modern era. Complete SM allows sustained survival free of systemic treatment. Integration of SM and systemic therapy in a multimodal approach remains a valid option for some patients.

PATIENT SUMMARY

Surgical resection of metastases originating from renal cell carcinoma may play a role in prolonging survival and avoiding systemic therapy when complete resection is achievable. This strategy is an option for selected patients with a limited number of metastases who still have good general health status.

[Is surgical treatment ever indicated in metastatic renal cell carcinoma and if so, based on which scientific rationale?]

BACKGROUND

Metastasis is a common event in renal cell carcinoma. Surgical resection of metastases may be feasible in two scenarios: aiming at palliation, which may be feasible due to reduced radiosensitivity of renal cell cancer, and aiming at prolonging survival, which may be feasible given the rather good prognosis of some patterns of metastasis.

OBJECTIVE

This review intends to reflect on current evidence for surgical resection of metastases in both scenarios. The literature was searched in PubMed and respective guidelines were reviewed.

RESULTS AND CONCLUSIONS

Palliative resection is mainly feasible to control symptoms like spinal compression; adjuvant radiation is advisable. Resection is markedly feasible, however, for improvement of cancer-specific survival in probably all resectable patterns of metastasis-solitary, multiple, syn- and metachronous, and in all organs-provided complete resection can be achieved. A fairly good prognosis is seen in solitary pulmonary metastasis without concomitant hilar or mediastinal lymph node metastasis and a metachronous appearance following long recurrence-free survival after tumor nephrectomy; complete resection may be considered curative in certain cases. Neo- or adjuvant medical therapy or radiation is not established. In cases lacking complete resectability, stereotactic radiation may be considered as an alternative.

Uncharacteristic metastasis of a renal clear-cell carcinoma to the muscles of the forearm-case report

Clear-cell renal carcinoma constitutes over 90% of all cases of renal cancers. One of the least common locations of metastases of this type of cancer are skeletal muscles. We believe that this is the first case ever presented of renal clear-cell cancer metastasis to the extensor digitorum muscle. Our case should sensitize clinicians and radiologists dealing with this type of carcinoma to the abundance of metastases, their uncommon locations and frequently asymptomatic nature, which all makes them easy to overlook on physical and imaging examinations.

Renal cell carcinoma: Atypical metastasis to inguinal lymph nodes

Renal cell carcinoma (RCC) is a common tumor of the urinary tract. It is known to have variable presentations due to the extremely vascular nature of the organ. RCC are known to metastasize to lungs, bone, and brain commonly but atypical metastasis to various sites are reported in literature but as very rare pathology. We report a case of a 60-year-old female who presented with multiple inguinal and axillary lymph node enlargements which on excision biopsy showed metastatic RCC. RCC can present with synchronous metastatic deposits in the various organs. RCC can metastasize to some atypical sites as well such as thyroid, orbit, and neck as mentioned earlier in literature. The patient presenting with extra-regional lymph nodes like inguinal and axillary is extremely rare, and so far only one clinical case could be found from India in 2008. A 61-year-old female presented in the emergency department with left flank pain and hematuria. Imaging showed left swollen kidney but multiple lymph nodes in retroperitoneum, left inguinal and axillary region. Excisional biopsy confirmed metastatic renal clear cell carcinoma. The case was referred to an oncologist after left radical nephrectomy for further treatment. Renal cancer is quite common aggressive disease. Due to its vascular nature, it may present quite atypically as evident from literature. Although treatment of metastatic carcinoma is still controversial surgery is the mainstay of treatment and guidelines consider metastasectomy and cytoreductive nephrectomy as valid option followed by targeted systemic therapies. RCC has quite a high potential to metastasize in the versatile pattern, in our case, it is evident that valid management is still surgery but needs support from the multidisciplinary team.

A Rare Cause of Nasal Obstruction: Metastatic Renal Cell Carcinoma

Introduction. Renal cell carcinoma can present with several interesting symptoms, paraneoplastic syndromes, and unusual metastatic sites. Head and neck region is one of the rare locations for renal cell carcinoma metastasis. Case Report. A 50-year-old man was admitted to the hospital with nasal congestion and snoring. Physical examination revealed nasal serous secretion. First taken biopsy was misinterpreted. The symptoms of the patient were not revealed and he was readmitted to the hospital. On radiologic examination, a vascular rich mass in maxillary sinus extending to the nasal cavity was observed. Biopsy was diagnosed as renal cell carcinoma metastasis. Herein, we present a patient with renal cell carcinoma presenting nasal obstruction and snoring as first and recurrent symptom.

Metastases to nasal cavity and paranasal sinuses

The sinonasal cavities are rare locations for metastases. Metastases to these locations are usually solitary and produce similar symptoms to those of a primary sinonasal tumor. Nasal obstruction and epistaxis are the most frequent symptoms. The maxillary sinus is most frequently involved. The most common primary tumor sites to spread to this region originate in the kidney, breast, thyroid, and prostate, although any malignancy could potentially lead to a metastasis to the paranasal sinuses. The patient's prognosis is usually poor because of the fact that the sinonasal metastasis is usually associated with widespread disseminated disease. In the majority of patients, palliative therapy is the only possible treatment option. Nevertheless, whenever possible, surgical excision either alone or combined with radiotherapy may be useful for palliation of symptoms and, rarely, to achieve prolonged survival. This review considers the most interesting cases reported in the literature that presents metastases to the sinonasal cavities. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1847-1854, 2016.

Gallbladder's clear cell renal carcinoma metastasis: A case report

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Contribute to the comprehension of rare mestatic disease in clear cell renal carcinoma.

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Underline that non only primary tumors develop in the gallbladder.

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Increasing suspect of metastatic disease in patients with renal cell carcinoma will improve medical care of this patients.

Introduction

Clear cell renal cell carcinoma (ccRCC) is well known for its propensity to metastasize to unusual sites, even after 10 years. Gallbladder metastases are extremely rare, being found in approximately 0.6% of cases, at autopsy.

Case presentation

A 51-year-old man with a history of right ccRCC underwent total nephrectomy with extended lymphadenectomy, in another Hospital. Three years later, he was hospitalized at our Hospital, with gallbladder metastasis detected during a follow-up CT scan. At clinical examination, the patient did not present any symptoms or signs of gallbladder disease. Several imaging tests were performed to better characterize the lesion. A successful cholecystectomy and hepatic resection of 4b segment were performed, obtaining a R0 resection. The clinical course was uneventful, without any complications. After a 7-month follow-up, the patient is free from disease.

Discussion

A typical metastases are those located in a site other than thoracic, skeletal, hepatic, adrenal or encephalic tissue. Cholecystectomy with R0 resection has demonstrated to be the only factor increasing survival, mainly in isolated cases of metastasis, providing an overall 35–60% survival rate at 5 years.

Conclusion

In the follow-up of patients with a positive history of renal cell carcinoma specially clear cell subtype, all new finding should be taken into account as possible metastases. We ought to consider US and CT-scan behavior of gallbladder metastatic disease in order to orientate our diagnosis. Surgery for metastatic gallbladder disease of renal origin seems to be a feasible therapy which is capable of increasing patients’ overall survival.

A unique presentation of a renal clear cell carcinoma with atypical metastases

INTRODUCTION

Renal cancer is a relatively common neoplasia with renal clear cell carcinoma being the most frequent histological type. This tumor has a strong tendency to metastasize virtually to all organs. Today, new diagnostic tools allow physicians to distinguish between those patients with "incidental findings" and those with advanced metastatic disease.

PRESENTATION OF CASE

A 70-year-old male with multiple indolent subcutaneous masses underwent colonoscopy after a positive fecal screening test for colorectal carcinoma. A rectal lesion was discovered but biopsy was negative. CT scan revealed advanced renal cancer involving the peritoneal cavity, retroperitoneum and lung. Biopsy of subcutaneous masses confirmed the suspected metastases. The patient underwent surgery (an open left nephrectomy with rectosigmoid resection and metastases debulking) because of a high risk of bowel obstruction and increasing anemia. After three years of multi-targeted therapy and follow-up, the patient is still asymptomatic and in good general condition.

DISCUSSION

Treatment of metastatic renal cancer is still controversial even if more than 30% of patients have metastasis at the time of diagnosis. Recently introduced targeted therapies are encouraging but still present problems with side effects and an unlimited period of efficacy. Although there is no consensus, several studies and guidelines consider metastasectomy to be a valid option.

CONCLUSION

Recent series highlight surgery as a key-point in the management of advanced renal clear cell carcinoma. Our case demonstrates the validity of a surgical strategy supported by a multidisciplinary approach.

Pancreatic metastasis from clear cell renal cell carcinoma: outcome of an aggressive approach

OBJECTIVE

To evaluate the long-term results of patients surgically treated for metastatic clear cell renal cell carcinoma (CCRCC) with a unique pancreatic secondary localization to assess the importance of radical treatment in this rare group of patients.

PATIENTS AND METHODS

This is a retrospective monocentric study including 20 surgically treated patients between 1997 and 2012 for a unique pancreatic metastasis of a CCRCC. The main objective was to evaluate the outcome after surgical resection.

RESULTS

Twenty patients were followed up for a CCRCC. The M/F ratio was 1.2. The average age of onset of kidney cancer was 57.05 ± 7.78 years. Two patients who had synchronous pancreatic metastasis and 18 patients who had metachronous metastasis appeared after an average of 130 ± 59 months (24-240 months). The average size of the metastases was 20 ± 11.6 mm. Pancreatic metastasis was unique in all patients, with 35% of patients having multiple lesions of the pancreas. All patients underwent a pancreatic resection of metastasis. Histologic examination confirmed the location of a secondary CCRCC in all patients. Median follow-up after pancreatectomy was 69 months (1-150 months). Disease-free survival at 2 years was 60%. Overall survival rates at 2 and 4 years were 79% and 72%, respectively. There was no difference found between patients with multiple and unique pancreatic metastases in overall survival.

CONCLUSION

Unique pancreatic metastasis of CCRCC is rare. The literature on this subject is limited. Surgical resection might be an option and can be associated with long-term disease-free intervals in highly selected patients.

Bladder metastasis from renal cell carcinoma: retrospective analysis of 65 reported cases

This study was carried out to clarify the presentation, treatment options, and prognosis of renal cell carcinoma (RCC) metastasis to the bladder in which we do not yet have a comprehensive understanding. A systematic Medline, Web of Science, Embase, Google, and Ichushi Web search was performed to identify articles describing RCC metastasis to the bladder. The final cohort included 65 patients. The majority (75%) experienced gross hematuria at the point of diagnosis of RCC. RCC metastasis to the bladder occurred both synchronously (23%) and metachronously (77%), and the median time for metachronous bladder metastasis following the diagnosis of RCC was 33 months. Of the 58 patients whose metastatic data were available, 36 (62%) had metastasis to the bladder only, while 22 (38%) had additional sites of metastasis. On pathology, clear cell carcinoma was the most common histology (92%) and all bladder tumors were consistent with RCC metastasis; the median tumor size was 2.1 cm, and two-thirds of cases were superficial (non-muscle invasive) disease. The 2-year cancer-specific survival rate in patients with solitary bladder metastasis was 71.1%, which was significantly higher than in patients with additional distant metastasis (25.8%, p = 0.007). Regarding the interval after the diagnosis of primary RCC, the 2-year cancer-specific survival rate in patients who experienced bladder metastasis after more than a 1 year follow-up was 58.4%, compared to 34.6% in their counterparts (p = 0.063). A curative resection may provide a good possibility of long-term survival, particularly in those with a solitary bladder metastasis and/or a long interval after nephrectomy.

Bilateral synchronous adrenal metastases of renal cell carcinoma: A case report and review of the literature

Renal cell carcinomas (RCCs) metastasize to the adrenal glands via various mechanisms, including lymphatic vessel arterial embolism and retrograde venous embolism. The rate of ipsilateral metastasis is 3–5% and the rate of contralateral metastasis is ~0.7%, however, synchronous bilateral adrenal metastases are extremely rare. Therefore, the optimal diagnosis and treatment strategy for this condition is yet to be thoroughly defined. In the present study, a 50-year-old male patient presented with right flank pain. Ultrasonography (US) revealed a right renal mass and bilateral adrenal metastases, and a computerized tomography (CT) scan determined the size of the lesions: An 86×83×66-mm mass in the lower pole of the right kidney, an 18×12×10-mm mass in the right adrenal gland, and a 69×51×53-mm mass in the left adrenal gland with central necrosis and peripheral contrast uptake. A US-guided biopsy was performed which determined a diagnosis of right RCC and bilateral synchronous adrenal metastasis. Immunohistochemical examination of the biopsy revealed clear cell carcinoma (Fuhrman grade, III). Consequently, right radical nephrectomy, right partial adrenalectomy (with frozen section examination) and left adrenalectomy were planned. The bilateral synchronous adrenal metastases posed a challenge in the diagnosis and treatment of the disease, as there is no standard approach in the literature for the treatment of such patients. However, metastasectomy was selected, as it appears to be the most effective treatment strategy for increasing the rate of cancer-specific survival. As an adrenal mass was present in the current patient, a hormonal examination was recommended and an adrenal-preserving minimally invasive surgical procedure using frozen section examination during surgery was particularly important to prevent the patient from developing adrenal insufficiency.

Thyroid metastasectomy

Metastases to the thyroid gland are uncommon. Renal, lung, breast, and colon cancer and melanoma are the most common primary diseases implicated. Few retrospective series have been reported. Treatment decisions must be individualized, and will depend on the state of systemic disease. Selected patients could benefit from surgical treatment. Although most patients selected for surgery will not be cured, the aim of surgery is to avoid the complications of uncontrolled central neck disease.