86 year-old white female was in good heath. Two days before admission to ER, she had an increased abdominal pain in the left lower quadrant without bowel movement, and she had three times of vomiting with possible blood. On admission, she was found to have severe extensive abdominal pain (10/10) with movement, urinary tract infection, dehydration,hypercalcemia (13.9), elevated alkaline phosphatase (414), and white cell count (32K). One day later, she had decreased air entry bilaterally with minimal atelectasis, acute renal failure with metabolic and respiratory acidosis (Potassium 6.2, pH 7.11, BUN 84, Cr 2.7, AST 960, ALT 428, CK 2441, Myoglobin >1000). CT scan showed distended small bowel and colon with distal colon obstruction and abdominal aortic atherosclerosis. The patients expired two days later.

A cortical tumor is identified in the middle of the left kidney that measures 2.5 x 2.0 x 1.5 cm, and the tumor is well circumscribed with a homogenously pale brown cut surface.