Figure 1. (a) Lining of the first part of the duodenum. (b-c) Active duodenitis in the first and second portions of the duodenum.

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abdomen and pelvis showed a necrotic mass in the left aspect of the pelvis that appeared to erode the sigmoid colon (Figure A). A sigmoidoscopy revealed a 2 cm area in the sigmoid colon with direct communication to a mass that was biopsied (Figure B). The pathology findings were consistent with RCC (Figure C). A transverse colostomy with mucous fistula was successful. She completed 14 days of antibiotic therapy and the fever resolved. Five months later she has had no complications and continued treatment with immunotherapy and radiation. Discussion: GI involvement by RCC is very rare and mostly occurs by metastatic spread to the small bowel. Approximately 5-15% of RCCs spread to nearby structures and 20-30% of patients have metastasis at the time of diagnosis. Formation of a TBF might occur spontaneously from tumor eroding to the bowel or as a consequence of chemotherapy and/or radiotherapy. Due to the retroperitoneal location of the kidney, the colon is almost never affected. From rare reported cases, patients mainly present with lower GI bleeding. In our patient, migration of colonic contents to the tumor mass via TBF may have led to superinfection of the mass. In the presence of intra-abdominal tumors, especially several metastatic masses, the presence of fever can be a sign of TBF and appropriate imaging with CT scan and careful endoscopic examination are necessary to establish a diagnosis and guide the surgical management.[2158] Figure 1. (A) CT scan of the abdomen and pelvis shows a necrotic mass in the left aspect of the pelvis that appears to erode the wall of the sigmoid colon; (B) Flexible sigmoidoscopy revealing a 2 cm erosion of the sigmoid colon with direct communication to the mass; (C) H&E image of the colon biopsy. The large cells with variably sized nuclei, sometimes prominent nucleoli and abundant eosinophilic cytoplasm form a sheet of neoplastic cells. On the right-hand side of the image the smaller cells are plasma cells and lymphocytes with a few neutrophils.

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Figure 1. Calcification of epiglottis (red arrow) visualized on CT scan.