Left renal mass suggestive of renal cell carcinoma with radiologically suspected contralateral adrenal metastasis: A diagnostic challenge without histopathologic confirmation

Background

Renal cell carcinoma (RCC) may involve the adrenal gland, but isolated contralateral adrenal metastasis is uncommon. If metastatic, noncontiguous contralateral adrenal involvement constitutes distant (M1) rather than locally advanced (T4) disease. Imaging cannot reliably distinguish metastasis from adenoma, adrenocortical carcinoma, or an adjacent renal mass. Delayed first presentation may preclude tissue confirmation Case presentation: A 59-year-old man from a rural area presented with four months of progressive left abdominal and flank pain and hematuria. He had no past medical history and had never undergone previous examination. Contrast-enhanced CT demonstrated a left renal mass measuring approximately 10.6 x 14 x 14.2 cm, with heterogeneous enhancement, central necrosis, renal sinus invasion, and enlarged para-aortic lymph nodes, suggestive of RCC. A contralateral mass in the right suprarenal region, measuring approximately 7.4 x 7.6 x 10.1 cm, was interpreted as radiologically suspected metastasis versus a primary adrenal tumor. The disease was staged clinically as cT3aN1M1. Dedicated adrenal-protocol imaging, extra-abdominal staging, metabolic evaluation, and tissue sampling were planned but not completed. He developed anemia, electrolyte imbalance, and a left pleural effusion, and died on hospital day 9. Histopathology was not obtained.