PMC9806257_01
(A, B) Computed tomography images demonstrating small bowel obstruction due to intussusception of the distal ileum (white arrows) containing an approximately 4 x 4 cm intraluminal soft-tissue mass (red arrows). (C) An intraoperative photo confirming intussusception whose lead point was a solitary ileal neoplasm. (D) Gross image of the surgical specimen with a 4 x 3 x 3-cm taupe cauliflower-like, pedunculated tumor.
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CT of the chest and abdomen with intravenous contrast demonstrated small bowel obstruction due to intussusception of the distal ileum containing an approximately 4 x 4 cm intraluminal soft-tissue mass with moderate enhancement ( Figures 1A, B ). After the reduction of intestinal invagination, a solitary ileal neoplasm was found to be the lead point of the intussusception ( Figure 1C ). Gross examination of the surgical specimen indicated a 4 x 3 x 3-cm taupe cauliflower-like, pedunculated tumor protruding into the ileum ( Figure 1D ).
Timeline of the case presentation with relevant data. CT, computed tomography; SICU, surgical intensive care unit; ERAS, enhanced recovery after surgery; ccRCC, clear cell renal cell carcinoma.
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The timeline with relevant data from the episode of care is shown in  Figure 2 .
Pathological findings of the surgical specimen. (A) Hematoxylin & eosin staining showing compact nests of tumor cells with clear cytoplasm separated by delicate vasculature (magnification power: 20x). Immunohistochemical staining of the tumor revealing (B) PAX-8 (+), (C) CD10 (+), and (D) EMA (+) (magnification power: 20x).
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Hematoxylin and eosin staining showed compact nests of tumor cells with clear cytoplasm separated by delicate vasculature ( Figure 3A ). The diagnosis of the ileal metastasis from ccRCC was established via the following immunohistochemical results: PAX-8 (+), CD10 (+), EMA (+), CK7 (-), CAIX (+), FH (+), SDHB (+), TFE3 (-), and Ki-67 (+, 30%) ( Figures 3B-D ).