No abstract

Renal cell carcinoma is a relatively uncommon cancer. Patients presenting with a renal adenocarcinoma are often found to have evidence of metastatic disease at the time of diagnosis. Herein, we describe the case of a 39-year-old male with renal cell carcinoma and a synchronous metastatic focus to the gallbladder. The patient underwent a successful simultaneous nephrectomy and cholecystectomy and is doing well 30 months after surgery without evidence of disease recurrence. A thorough metastatic work-up along with aggressive surgical intervention in patients with renal cell carcinoma and unusual metastatic foci can provide a long-term favorable outcome.

Purpose: Patients undergoing serial cross sectional abdominal imaging to evaluate abdominal symptomatology may develop a renal tumor during their follow up of an unrelated disease process. Evaluation of such patients provides an opportunity to further define the radiographic inception, natural history and growth patterns of renal tumors. Materials and Methods: A review of two institutions’ renal tumor databases was performed for patients who developed an enhancing renal tumor with a prior normal cross sectional radiographic examination of the kidneys. Variables evaluated included: age, gender, tumor size at presentation, calculated tumor growth rate from negative scan to radiographic presentation and pathology in patients undergoing definitive treatment. Results: We identified 36 patients with an average age of 65 yrs (range 44-82). Mean tumor size on presentation was 2.3 cm (range 1.0 -5.0). Presumed absolute growth rate based on timing of initial negative imaging study and tumor diameter at presentation was significantly greater compared to observed absolute growth rate following tumor detection (0.71cm/yr versus 0.039 cm/yr), p =0.028. No difference was noted between presumed and observed tumor growth based on absolute change in tumor volume (1.44cm3/yr versus 5.37cm3/yr), p=0.203. Presumed relative growth rates based on tumor diameter (665%/yr versus 23%/yr) and volume (1397%/yr versus 169%/yr) were significantly greater compared to observed relative growth rates, p=0.005 and p=0.013 respectively. Conclusions: The presumed growth rate of the tumors was significantly greater than the observed growth rate suggesting that tumor growth rates do not follow a linear patter throughout their development and progression.

No abstract

Internal hernias are a rare phenomenon, and even rarer is a herniation through the foramen of Winslow. We report a rare case of an 81 year old female presenting with vague abdominal symptoms who was found to have a cecal bascule herniating through the foramen of Winslow treated with surgery.