Our patient has moderately high blood lead concentration and developed anemia as a systemic symptom. Long-term exposure and high levels of lead are the main risk factors for carcinogenesis. Retained bullet fragments can be the cause of systemic lead poisoning. The association between lead exposure and renal tumors has been demonstrated in laboratory animals and in several human studies There are few case reports of tumors resulting from the long-term toxic lead effect from shotgun wounds such as oral carcinoma, and metastatic bronchial carcinoma. Prolonged exposure results in the accumulation of lead in the bones and kidneys. The toxic effects of lead exposure are well known and documented in the literature. Further oncological monitoring is carried out. One year after the surgery, on CT no local tumor recurrences or metastases are visible. Blood lead concentration was tested after surgery, during follow-up and was 19 µg/dL. The patient was discharged from the hospital in good physical condition. The postoperative course was complicated by a mild pancreatic leak at drainage, which spontaneously resolved during the hospitalization. EMA, CK, CK7, p-63, s-100, desmin, chromogranin A, CD 10, CD34, CD 45 and CD 117 are negative” (Fig.

The tumor, positioned by the kidney, matches adrenocortical carcinoma, with vimentin, synaptophysin, and CD56 being diffusely positive, and inhibin and calretinin focally positive. On the lower kidney part, there is a tumor, 5 cm in diameter, with histopathological characteristics of a renal clear cell carcinoma, Fuhrman grade 2. The pathological diagnosis was formulated as follows: “A sample, 24 × 18 × 13 cm in size, consists of a kidney, 12 cm in height, surrounded by fatty tissue, and a well-confined, irregular tumor, 12 cm in height. Open surgery was performed through the left thoracoabdominal incision with partial resection of the tenth rib, and complete extirpation of the tumor, including the kidney, was performed (Fig. A CT scan was then performed which showed a huge tumorous mass, 21 cm in diameter, adjacent to the left kidney and remnants of gun pellets scattered around this area (Fig. After a thorough examination and diagnostics were conducted, it was evident that he had a palpable mass under the lower left rib cage, on the same side as the previous gunshot wound. Symptoms lasted for three months before a medical examination started. Mild pain in the left superior part of the abdomen was noticed hematuria is not registered. Thirteen years later, he presented with fatigue, weight loss, and anemia. Some of the gun pellets were not extracted from the site. We present a 43-year-old male who attempted suicide in 2005, inflicting upon himself a wound to his upper left abdomen, followed by surgery, resulting in a partial colon resection due to injury.

Adrenocortical