Contralateral Adrenal Metastasis from Clear Cell Renal Cell Carcinoma After Right Radical Nephrectomy and Caval Thrombectomy: A Case Report and Review of the Literature

Contralateral adrenal metastasis from clear cell renal cell carcinoma (ccRCC) is considered an exceptionally uncommon event. Early detection is crucial for optimal management, especially in high-grade tumors with vascular invasion. We report a 50-year-old woman with type 2 diabetes mellitus and obesity (BMI 29) who underwent right radical nephrectomy and inferior vena cava thrombectomy for pT3bpNxMx ccRCC. One year postoperatively, imaging revealed a solitary metachronous metastasis in the left adrenal gland, which progressively enlarged despite being under systemic therapy with pembrolizumab. A laparoscopic transabdominal adrenalectomy was successfully performed, and histopathology confirmed metastatic ccRCC. Postoperative recovery was uneventful, with adequate endocrine management ensuring normal adrenal function. A review of literature suggests that contralateral adrenal metastasis at presentation is rare and usually associated with large, high-grade primary tumors. The mechanism may involve hematogenous spread through the renal and adrenal venous systems. Surgical resection remains the mainstay of treatment, offering the best outcomes in selected patients without extra-adrenal disease. Long-term oncologic surveillance is essential in patients with ccRCC. In oligometastatic disease, adrenalectomy can offer significant diagnostic and therapeutic value. A multidisciplinary approach is crucial for optimizing outcomes.