Bellini duct carcinoma with ovarian metastasis.

Address correspondence to Saleh A. Binsaleh, Division of Urology, McGill University, 1212 Pine Avenue West, Montreal, Quebec H3G 1A9 Canada needle aspiration of the psoas mass. Both sites showed purulent fluid that grew E coli that was sensitive to the administered antibiotics. Patient defervesced, but white cell count and serum calcium did not normalize neither did the confusion state improve. With hydration, the creatinine normalized, however the serum calcium remained elevated despite treatment with calcitonin, pamidronate, and intravenous hydration. Work-up for hypercalcemia included a nuclear scan and CT of the neck to attempt to identify a PTH secreting tumor. CT neck showed two parathyroid adenomas that may have contributed to the persistent hypercalcemia. After the 14th day of intravenous antibiotics, patient underwent a sub-total parathyroidectomy. Our team was consulted at that time. Two day post-op, we decided to manage the patient surgically, given that there has been no improvement in the patient’s condition, radiologically and clinically. Figures 1 and 2 for the follow-up CT. Intra-op, after a radical nephrectomy was performed, frozen sections were sent on the lymph nodes and psoas mass. Pathology showed high-grade malignant cells in both specimens. There was as well a large mass in the pelvis continuous with cancer. At this time, we decided to close the abdomen and the patient was sent to recovery room. Postoperative recovery was complicated by left deep vein thrombosis, and re-elevation of the serum calcium. Patient was declared palliative and expired post-op day 27. Pathology revealed an invasive collecting duct carcinoma. Autopsy demonstrated collecting duct carcinoma metastatic to the left ovary.