A 47-year-old man, with no past history of interest, who was diagnosed with a right renal mass by ultrasound accidentally during a routine study due to abdominal pain. Abdomino-pelvic CT scan confirmed the presence of a solid heterogeneous mass of approximately 6 cm, located in the upper pole of the right kidney with a permeable renal vein.

Radical right nephrectomy was performed by subcostal laparotomy, with no lymphadenopathies. The anatomopathological diagnosis was clear cell renal carcinoma of 8.4 centimetres, stage pT3aNoMo, Robson stage II and Fuhrman nuclear grade IV. The patient was discharged five days after surgery. Approximately three months later and before being seen in the consultation room for follow-up of his neoplasm, the patient came to the emergency department for pain in the right hypochondrium of recent onset. On examination, a painful mass was palpable in the right hypochondrium, for which reason a new CT scan was performed which revealed a tumour recurrence in the surgical site, infiltrating the right posterior diaphragmatic pillar and liver; peritoneal implants were also found, the largest measuring four centimetres, adjacent to the hepatic hilum.

It was decided to remove the tumour masses, resecting the mass adjacent to the liver as well as several peritoneal and retroperitoneal implants, and the intraoperative biopsy was compatible in all cases with high-grade clear cell carcinoma. The paravertebral retroperitoneal mass was inaccessible due to its close contact with the great vessels.
In view of these findings, it was decided to contact the Oncology Department and treatment was started with interferon (Intron A), which was poorly tolerated and the dose had to be reduced.
At check-ups, the patient reported non-specific abdominal discomfort that responded to mild analgesics, but a control CT scan of the abdomen 5 months after the second surgery revealed multiple liver lesions suggestive of metastasis, as well as growth of the recurrence in the surgical bed and several peritoneal implants in the omentum.

