A 53-year-old man with no relevant past medical history was admitted to the emergency department with pulmonary thromboembolism.
The suspicion of occult neoplasia and the presence of hematuria not previously evidenced are carried out abdominal ultrasound where a right renal mass is evident and the study is completed with CT and MRI.
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Both studies confirm the presence of a heterogeneous tumor objectifying to the inferior thirds of the right kidney of approximately 10x10 cm. with involvement of the sinus and renal hilium also being hypothesized tumor thrombosis of the right renal vein.
No lymphadenopathy or metastases were evident.
She underwent surgery with anterior nephrectomy with cavotomy for removal of the thrombus and extensive right radical lymphadenectomy.
The anatomopathological result was a 9 cm Fuhrman grade 2 clear renal cell carcinoma with invasion of renal hilium, perinephric fat and renal vein, without metastatic involvement of the lymph nodes or fat free margins.
(Stage III, T3N0M0).
The patient was discharged on the sixth day.
Three months after surgery the patient reported mild pain and recent penile induration.
Fixation is characterized by an indurated mass.
MRI of the pelvis showed a mass occupying and expanding the left pelvis, compatible with metastasis to a previous renal carcinoma.
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Biopsy of this lesion was taken, the result of which confirms the suspicion and presence in histological sections isolated from tumor cells compatible with metastasis of clear cell carcinoma.
Having established this diagnosis, we propose which would be the best therapeutic attitude for the patient, and we took into account the progressive increase of local pain, the age of the patient and his good general condition.
Therefore, we opted for a total penectomy until intraoperative confirmation of a disease-free surgical margin.
A week after discharge, the patient was admitted with an episode of obtundation and motor abnormalities and metastases. On cranial CT scan, the patient presented cerebellum and right hemisphere brain lesions.
A chest CT is performed and multiple pulmonary nodules and bilateral paratracheal microadenopathies related to metastases also appear.
The patient died nine months after the first intervention for renal carcinoma, that is, six months after the diagnosis of penile metastases.
