Author Login

Correspondence to Author: Wanderimam R. Tuktur MBBS, PhD, Tobe Momah MD, MSc. 

1. District of Columbia, Department of Health 2201 Shannon Pl SE, Washington, DC 20020 ;Phone:202-442-5955 ; Email: Wanderimam.tuktur@dc.gov; https://orcid.org/0000-0002-6859-5691
2. Associate Professor, Department of Family Medicine University of Mississippi Medical Center 764 Lakeland Drive Jackson MS 39216; Phone: 6019846800 ; Email: tmomah@umc.edu

DOI: 10.52338/tjon.2025.4738

CASE REPORT:

Index patient is a 61 year old African American male, with a past medical history (PMHx) of morbid obesity (BMI = 73), osteoarthritis (bilateral knees), venous stasis dermatitis, Obstructive sleep apnea (OSA) on CPAP, HTN, and NIDDM .Patient underwent right nephrectomy following an incidental finding of right renal mass on evaluation in the Emergency Room (ER) for chest pain and shortness of breath (SOB). A CT chest with contrast done to evaluate for pulmonary embolism in the ER revealed a 5.3cm right thyroid lobe mass; an indeterminate partially imaged right renal mass and an indeterminate hyper enhancing mass adjacent to the pancreatic neck. Subsequently; a CT abdomen and pelvis with contrast demonstrated a 2.6 x 2.5 cm pancreatic soft tissue attenuation (figure 2) with centrally increased attenuation and a solid heterogeneous exophytic mass of the anterior upper right kidney, measuring 5.4 x 4.8 cm with multiple lobulations. On discharge, patient underwent a CT guided biopsy of the pancreatic body with pathology significant for well- differentiated PEN. He was then scheduled for a right nephrectomy and pancreatectomy. Unfortunately, surgery was aborted after the right nephrectomy was undertaken, secondary to patient’s body habitus. Pathology specimen showed right kidney renal cell carcinoma (RCC) measuring 6.8 x 4.5 x 2.4 cm (of the clear cell type) and limited to the kidney with no invasion of the renal capsule (Figure 2). All surgical resection margins were negative for carcinoma. Patient was discharged on post-operative day 6. He then underwent genetic evaluation for possible Von Hippel-Lindau (VHL) disease; results were negative. Following a post-nephrectomy CT Abdomen/Chest with contrast which showed hyper vascular metastatic liver lesions; 6months later, patient underwent a biopsy of the liver that revealed metastatic well differentiated neuroendocrine tumor. He subsequently underwent hormonal therapy with lanreotide monthly infusions ( x 12 infusions).

Citation:

Tobe Momah MD, MSc, Metachronous Malignancy (Pancreatic Endocrine Neoplasm And Renal Cell Carcinoma): Case Report. The Journal of Nephrology 2025.