International Surgery Journal | June 2020 | Vol 7 | Issue 6 Page 2022 International Surgery Journal Kumar L et al. Int Surg J. 2020 Jun;7(6):2022-2025 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Dual malignancy: a rare presentation of synchronous periampullary carcinoma with renal cell carcinoma Lovekesh Kumar, Shyam Sundar*, Anubhav Vindal, Pawanindra Lal INTRODUCTION Patients which have diagnosed with a cancer, have a life time risk for developing another de novo malignancy depending on various inherited, environmental and iatrogenic risk factors. Recent improvements in the prognosis of cancer patients have led to an increase in the incidence of second primary cancers, and the frequency of multiple primary malignant tumors is expected to increase as the population ages. 1,2 The frequency of multiple primary tumors among all cases of malignancy has been reported as 1 to 3%. 3 The frequency of pancreatic cancer in association with cancer of other organs is estimated to range from 1% to as high as 20% with malignancies predominately of the stomach, colon, thyroid, and genitourinary tract. 4,5 Second malignancies reported to be associated with renal cell carcinoma (RCC) include Non-Hodgkin’s lymphoma, multiple myeloma, chronic lymphatic leukaemia, melanoma and cancers of the bladder, prostate, breast, rectum, and lung with an incidence that varies from 5 to 27%. 6,7 There has only been infrequent reporting of synchronous or metachronous tumors of the pancreas and the kidney. 5-8 ABSTRACT The occurrence of synchronous pancreatic cancer and other primary cancer is not frequent and reaches about 5.6% as reported in autoptic studies. Double resections of the pancreas with another organ due to synchronous malignancies have been published only in quite sporadic sets of cases or individual case reports. We present a case report of a 40 years lady who presented with intermittent pain, fever and jaundice for 15 days. Examination revealed a palpable gall bladder, firm in consistency and tender to touch. She was admitted with a provisional diagnosis of cholangitis and started on intravenous antibiotics. Patient’s clinical condition improved and she was planned for a CECT and MRCP which revealed an heterogenously enhancing mass lesion in upper pole of left kidney, s/o of renal cell carcinoma (RCC) and an enhancing lesion in periampullary region s/o periampullary carcinoma with no evidence of free fluid or metastasis. ERCP guided biopsy revealed moderately differentiated adenocarcinoma and USG guided renal biopsy revealed clear cell carcinoma. Whipple’s procedure with left nephrectomy was performed. Intra operative findings revealed post-operative course and hospital stay was uneventful. Biopsy revealed poorly differentiated pancreaticobiliary adenocarcinoma with no lympho vascular or lymph nodal invasion (pT3aN 0 ) and left sided clear cell renal carcinoma with no lympho vascular invasion (pT1N 0 ). Synchronous malignancy of pancreas and kidney is a very rare presentation. Literature describes presence of RCC with periampullary metastasis and patients presenting with RCC post whipple’s procedure but only a handful of case reports describe presence of dual malignancy as reported above. Keywords: Synchronus, Periampullary carcinoma, RCC Department of Surgery, Maulana Azad Medical College, New Delhi, India Received: 20 February 2020 Accepted: 10 April 2020 *Correspondence: Dr. Shyam Sundar, E-mail: ssskabr@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20202425