Neoplasia of the renal pelvis in duplex kidneys is extremely rare, especially in complete renal ureteral duplex cases. A 46-year-old aged male patient had presented with intermittent haematuria for the last seven months. A mildly enhancing well-defined, lobulated mass arising from the pelvis of lower moiety of right kidney was found on evaluation. Confirmatory findings of a renal pelvic malignancy couldn’t be obtained. Infective condition like pyelonephritis couldn’t be excluded. To clear the diagnostic dilemma, flexible ureteroscopy was done which revealed the renal pelvic malignancy. Right lap assisted radical nephroureterectomy was done. Histopathology was suggestive of transitional cell carcinoma. The increased incidence of chronic infection, obstruction and stone formation may be instrumental in producing a higher incidence of renal pelvic tumours in patients with anomalous kidney. Diagnosing a neoplasia originating from a duplex kidney is difficult and often a multiple battery of investigations like intravenous pyelogram, ultrasonography and rigid ureteroscopy may not be useful. Considering the fact that tumour recurrence is high in the ureteric stump after local resection, a total nephroureterectomy seems to be a better treatment choice. Flexible ureteroscope might be the saviour in such doubtful clinical situations to confirm our diagnosis beyond doubt. Partial nephrectomy cannot be recommended unless long-term follow-up reports of such cases are available.

A 59-year-old gentleman presented with the chief complaint of generalised abdominal distension for the last 2 years. It had achieved an uncomfortable size, which was disturbing his day-today activities. It was not associated with any pain, obstructive or compressive symptoms and no history of lowgrade fever, night sweats and anorexia or weight loss. Patient's nutritional status was good, had mild pallor and bilateral pedal oedema. On examination, the abdomen was found to be hugely distended with an inverted umbilicus (girth 160 cm). No venous engorgement or pigmentation were noted. A diffuse firm lump was palpated in all quadrants of the abdomen, nontender, non-mobile, no organomegaly and no evidence of ascites. Routine investigations were within normal limits. CT scan and USG revealed a lobulated mass with predominantly fat content and areas of soft tissue occupying most of the abdomen. It had fine septations, tiny calcifications measuring 39.4 by 36.9 by 29.1 cm (Fig. 1, 2).

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