ADRENAL METASTASIS IN RENAL CELL CARCINOMA

Abstract

To elucidate the significance of adrenalectomy in the radical nephrectomy, we studied the incidence of ipsilateral adrenal involvement in renal cell carcinoma, on 144 patients who underwent nephrectomy and 110 autopsy cases of renal cell carcinoma.
Of these patients 70 were treated with the standard radical nephrectomy including the removal of the ipsilateral adrenal glands and histopathological examination. Of these 70 patients undergoing radical nepurectomy, 5 had evidence of adrenal involvement for an overall incidence of 7.1%. All 5 had high stage of upper pole lesions involving the lymph nodes or additional distant metastasis. There was no significant difference in 5 year survival between 70 patients who underwent the standard radical nephrectomy and 22 patients in whom the ipsilateral adrenal gland was intact.
Of the 110 autopsy cases of renal cell carcinoma, 32 had evidence of ipsilateral adrenal involvement: 14 involving the upper pole (37.8%), 5 involving the mid pole (26.3%), 7 involving the lower pole (25.0%) and the remaining 6 involving the whole kidney (37.5%). Ipsilateral adrenal involvement was more common in the cases involving the upper pole, and also in the cases with high stage and high grade, and all 32 cases with adrenal involvement had additional distant metastasis.
The ipsilateral adrenal involvement in renal cell carcinoma was common in the cases of upper pole lesion with high stage and high grade, and in these cases the ipsilateral adrenalectomy seemed to be beneficial. However, the ipsilateral adrenal gland need not be removed by the radical nephrectomy in the patients with low stage of mid or lower pole lesion.
Since all cases with adrenal involvement showed additional distant metastasis, such adjuvant therapy as chemotherapy or biological response modifier are required postoperatively.