title: Metastatic renal cell carcinoma mimicking diverticulitis in a patient with chronic lymphocytic leukaemia.
abstract: We present an unusual case of metastatic renal cell carcinoma (RCC) mimicking diverticulitis in a 76-year-old man with a 16-year history of chronic lymphocytic leukaemia (CLL) and a 2 cm left renal mass. The patient presented with severe abdominal pain and lower gastrointestinal bleeding with anticoagulation from recent pulmonary embolism. His clinical course was troubled by recurrent hospitalisations and complications that delayed investigations and potential treatments. Radiographic findings revealed stable CLL, mild sigmoid diverticulitis and a small renal mass. Small renal masses (less than 4 cm) are considered low risk for metastasising and are, thus, often observed or ablated, rather than resected. Furthermore, gastrointestinal metastases from RCC are rare. This case adds new perspective to the unpredictable nature of RCC and how synchronous malignancies may be masked in patients with long-standing CLL.
authors.affiliation: Mayo Medical School, Rochester, Minnesota, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Hwang
authors.affiliation: Section of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Kuyava
authors.affiliation: Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Grande
authors.affiliation: Section of Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Swetz
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000150:complications / Q000175:diagnosis / Q000556:secondary*; D003937:Diagnosis, Differential; D004238:Diverticulitis / Q000175:diagnosis*; D017809:Fatal Outcome; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications*; D008297:Male; D012810:Sigmoid Diseases / Q000175:diagnosis* / Q000209:etiology