BILATERAL INTRARENAL ADRENAL GLANDS IN CADAVERIC DONOR KIDNEYS RESEMBLING RENAL CELL CARCINOMA ON INTRAOPERATIVE FROZEN SECTION

Ectopic adrenal tissue has been observed in a variety of sites. We report an unusual case of bilateral symmetrical intrarenal adrenal glands in cadaveric donor kidneys which were suspicious for renal cell carcinoma on intraoperative frozen section. CASE REPORT A 46-year-old man and a 64-year-old woman with end stage renal disease underwent cadaveric renal transplantation from the same donor. The donor was a 43-year-old woman with a history of myocardial infarction and congestive heart failure whose cause of death was subarachnoid hemorrhage. The first recipient received the left donor kidney. At transplantation the left donor adrenal gland was noted to be densely adherent to the upper pole of the donor kidney. No obvious masses were noted and adrenalectomy, thought to be complete, was performed before transplantation. The procedure was performed without incident and the patient was brought to the recovery room in stable condition. The second recipient received the right donor kidney. Before transplantation the right donor adrenal gland was also noted to be closely applied to the upper pole of the kidney but no nodularity or mass was noted. Most of the adrenal gland was excised and the donor kidney was successfully transplanted. Following reperfusion and completion of the ureteral anastomosis, there appeared to be a thickened area at the upper pole of the donor kidney. Frozen section biopsy of the suspicious lesion was interpreted as a small oncocytic tumor, probable oncocytoma. However, the possibility of a chromophobe renal cell carcinoma could not be excluded (fig. 1). With the suspicion of a possible malignant renal neoplasm, the donor kidney was removed before closure. After finding a possible neoplasm in the right donor kidney and a densely adherent adrenal gland on the left donor kidney, reexploration of the first transplant recipient was undertaken. Two 1.5 cm. pieces of tissue were excised from the site where the adrenal would normally be found. Frozen section of this specimen was identical to that of the contralateral side. Nephrectomy was performed. Final pathological analysis of both specimens proved to be intrarenal adrenal gland (fig. 2, A). A fat stain showed that the cells contained lipid, and immunostains of these cells for cytokeratin and epithelial membrane antigen were negative. In addition, an endothelial marker, CD34, showed columns of these cells to be separated by well-defined sinusoids. These sinusoids were in continuity and insinuated into the paratubular capillary network and tubules in the adjacent renal paren