RENAL CELL CARCINOMA AT LOWER POLE MOIETY OF ADULT LEFT DUPLEX KIDNEY

Duplex kidney is an entity which is one of commonest congenital urinary tract anomalies. Overall incidence is 0.8-2 % with bilateral in 20% of cases along with female preponderance. Presentation of duplex kidney and diagnosis is common at pediatric age and rarely presents at adulthood because of complications associated with duplex kidney. Duplex system is defined as kidney with two pelvicalyceal system with single or double ureter or single renal parenchyma containing two pelvicalycealsystems. In literature review it is well documented that duplex system is associated with complications such as hydronephrosis, calculi formation, ureterocele,vesicoureteric reflux and recurrent infection. Duplex system is also prone to development of renal pelvis carcinomas as compared to normal kidney as was in our case.in literature only four cases of renal cell carcinoma have reported so far which were associated with duplex kidney but these were either multicystic transitional cell carcinomas of renal pelvis or one case of cystic renal cell sarcomatoid carcinoma. Here we present very rare case of duplex kidney with lower pole moiety renal cell adenocarcinoma of solid nature. Patient presented with left lion pain and burning micturition. Patient had history of recurrent infection with left lumber pain in the past. Ultrasound, intravenous pyelogram and CT SCAN of abdomen revealed duplex kidney and double ureters on left side with large solid enhancing mass in lower pole moiety left kidney. Histopathology confirms diagnosis of renal cell adenocarcinoma. It is vital to detect duplex system at earliest stage to detect associated complications especially renal carcinoma using imaging so as to conserve partial kidney and its function while remove tumor at early stage in order to reduce morbidity and mortality.