right kidney with renal vein invasion and metastases to the ipsilateral adrenal gland and regional lymph nodes (pT3aN1M1). Conflicts of interest: The author has nothing to disclose. http://dx.doi.org/10.1016/j.euf.2015.08.005 Case Discussion: A 63-year-old Man with Bilateral Adrenal Mass and Large Renal Cell Carcinoma—The Case for Surgery Vincenzo Ficarra a,b, *Alessandro Crestani a a Urology Unit, Academic Medical Centre Hospital ‘‘Santa Maria della Misericordia,’’ Udine, Italy; b Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy 1. Case description This is the case of a young patient with a large solid mass of the right kidney suggestive of renal cell carcinoma (RCC) and multiple lesions that are highly suspicious for metastases in regional lymph nodes, both adrenal glands, both lungs, and pancreas. He has no symptoms associated with either primary tumour or distant metastases. He has no major comorbidities, his performance status is very good, and his preference is for maximal treatment. 2. Discussion The first point is whether this patient could benefit from cytoreductive nephrectomy (CN). According to current European Association of Urology (EAU) guidelines [1], CN Fig. 1 – Axial contrast-enhanced computed tomography scan of the abdomen: (A) 8 T 6-cm large solid enhancing mass of the lower pole of the right kidney; (B) 7 T 5-cm large enhancing mass of the right adrenal gland; (C) 5 T 3-cm large mass suspicious for enlarged necrotic lymph nodes posterior to IVC (asterisk); (D) 4 T 2-cm large enhancing mass of the left adrenal gland. * Corresponding author. Urology Unit, Academic Medical Centre Hospi- tal ‘‘Santa Maria della Misericordia,’’ Piazzale Santa Maria della Miser- icordia 15, IT-33100 Udine, Italy. Tel.: +390432552931; Fax: +390432552930. E-mail address: vincenzo.ficarra@unipd.it (V. Ficarra). E U R O P E A N U R O L O G Y F O C U S 1 ( 2 0 1 6 ) 2 9 3 – 2 9 7 294