Figure 5d.

Metastatic RCC involving the pancreas and left adrenal gland in a 65-year-old man. (a, b) Axial (a) and coronal (b) contrast-enhanced CT images acquired during the arterial phase show an avidly enhancing mass in the pancreatic neck (red arrow in a) resulting in upstream dilatation of the pancreatic duct (arrow in b). A large left adrenal metastasis (black arrow in a) is present. The patient was subsequently administered ipilimumab and nivolumab. (c, d) Axial (c) and coronal (d) contrast-enhanced CT images from an examination performed 3 months after the initiation of therapy show a dramatic decrease in the size and enhancement of the pancreatic (red arrow in c) and adrenal (black arrow in c) metastases. Note the associated resolution of pancreatic ductal dilatation.