A 66-year-old woman presented to the hospital with abdominal pain and fever, history of hiatal hernia, and was treated for hypertension.
Blood tests are irrelevant except for slightly elevated total cholesterol.
Normal tumor markers.
The ultrasound report of the abdomen suggests an adenopatic conglomerate, although a neoplasm of the head of the pancreas cannot be ruled out.
A CT scan showed pelvic non-contrast enhancement, which showed a 4 cm mass in the head of the pancreas, which showed intense intravenous contrast in the early phase, suggesting a hypervascular endocrine tumor.
Bone scintigraphy is normal, consistent with the age of the patient.
He underwent pancreatectomy, cholecystectomy and recurrence in April 2007.
Currently, 5 months later, the patient is well, with no evidence of other metastases.
Neither in the surgical act nor in the gross dissection of the specimen are lymphadenopathies.
In the pancreas, we found three well-defined nodules measuring 4 cm., 1 and 0.7 cms, respectively, whose cut surfaces are soft, homogeneous aspect and colorless.
The histological study of the tumor nodules of the two patients showed a similar microscopic picture consisting of a homogeneous cell population, with clear cytoplasms, with nuclear atypia corresponding to grades 3 (case 1) and a vascular tumor (case 1).
Immunohistochemical studies showed positivity for cytokeratin, vimentin, epithelial membrane antigen and CD10 and negativity for cytokeratins 7 and 20, chromogranin, thyroglobulin, without dementia antigen
A diagnosis of metastasis of clear cell renal carcinoma was emitted and upon reviewing the medical records it was found that both patients had been diagnosed 17 and 16 years before renal carcinoma of clear cells (not in the capsule), not without metastases of renal
