PMC7652543_01
Biopsies of the IDC and RCC.
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figure1
The tumour morphology demonstrated a predominance of low-grade clear cell renal carcinoma; however, the presence of scattered areas with syncytial-type giant cells raised the grade to 3/3 according to the WHO grading system (Figure 1).
CT scan showing the duodenal mass separated from the recurrence in the nephrectomy fossa.
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figure2
Therefore, a CT scan of the abdomen and pelvis was done and showed stenosis at the duodenal orifice by a large duodenal mass causing significant distension of the second and third duodenal loop and a large mass at the right nephrectomy fossa. The duodenal mass was separated from the recurrence in the nephrectomy fossa as shown in Figure 2, and accordingly, metastasis was suspected, and the patient underwent gastrojejunostomy with choledojejunostomy and cholecystectomy to relieve the outlet obstruction.
Biopsy from the duodenal mass showing RCC.
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figure3
CT scan showing rapid tumour progression.
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figure4
Another CT scan of the abdomen and pelvis (Figure 4) was done 20 days postoperatively demonstrating a marked increase in tumour size with infiltration of D2-D4 duodenal bulb and extending to the proximal part of the jejunum (about 29 cm), thus a 13-cm increase in the tumour size, along with areas of hypodensities representing possible areas of haemorrhage that might explain her drop in haemoglobin, and no apparent bleeding haemolysis was evident.