[Synchronous bilateral renal cell cancer with a single ovarian metastasis and a fibromuscular dysplasia of the renal artery].

INTRODUCTION: Ovarian metastases of renal cell cancer (RCC) are extremely rare with less than 20 cases reported to date. These metastases occur in the majority of cases metachronous (i. e. prior to or after identification of the primary tumour) or--such as in our case--synchronous. CASE REPORT: A 42-year-old women was diagnosed for synchronous bilateral renal and a left-sided ovarian mass. In a first surgical step, the ovarian metastasis was removed laparoscopically and the 20 cm tumour on the right kidney via a transperitoneal tumour nephrectomy (histology: clear cell RCC, pT3bN0V1R0M1). Prior to nephron-sparing surgery of the left kidney an angiography was performed revealing a massive fibromuscular dysplasia. Under cold ischaemic perfusion, the two RCCs (pT1aV0R0) on the left side were excised and the renal artery replaced by a Goretex graft. Twelve hours postoperatively the patient became anuric and two stents were placed endoradiologically because of a stenosis of the proximal anastomosis. Two years after surgery the patient is recurrence-free and her renal function is normal.
CONCLUSION: Although extremely rare, the possibility of an ovarian metastasis should be considered in women with RCC. The presented case was unique because of synchronous bilateral RCC, an ovarian metastasis and a fibromuscular dysplasia of the renal artery requiring a sophisticated surgical approach.