A synchronous lesion: Papillary renal cell carcinoma mistaken as an adrenal gland mass

In this case report, we describe a diagnosis of papillary renal cell carcinoma in a 76-year-old male patient who was incidentally found to have a left adrenal mass during routine aneurysm surveillance. Computed tomography demonstrated a left adrenal mass and left renal structure which was concerning for renal cell carcinoma. He underwent left adrenalectomy and initial histopathology demonstrated papillary renal cell carcinoma. He subsequently underwent left radical nephrectomy with lymph node dissection. Histopathological analysis of the removed left renal and nodal specimens revealed papillary renal cell carcinoma with lymph node metastasis. However, re-review of the adrenal pathology slides determined the specimen as represented by primary kidney tumor and not adrenal metastasis. This report reviews the presentation and radiological findings of synchronous papillary renal cell carcinoma and differential diagnosis for indeterminate adrenal mass on computed tomography.