A 75-year-old woman with a history of hypertension, depressive syndrome and chronic constipation.
No relevant urological history.
The patient was referred from the Digestive Service. A CT scan revealed hypnotic kidney disease, pelvic fat, which was performed during a study of the underlying disease. The left perirenal vein showed a mass of 3.6 cm 4,9.
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In the IVU study, the right kidney was normal, while the left kidney showed functional annulation, observing a discrete nephrogram within 2 hours, without reaching the top pole at any time.
Magnetic resonance angiography showed a 4 cm tumor that affected 1/3 middle and upper pole of the left kidney, with metastasis to the ipsilateral adrenal gland, locoregional lymph nodes and thrombosis of the left renal vein.
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Diagnosis of renal carcinoma was suspected, left radical nephrectomy was performed by lumbotomy, observing the presence of an adenopatic block at the level of the renal hilium.
The macroscopic description of the pathological study highlighted a piece of nephrectomy of 10 x 6 x 7 cm, most of which lost the corticomedullary delimitation, appreciating its irregular gray masses.
On the other hand, the microscopic description showed a malignant neoplasia involving tubular and ductal structures as defined by perirenal fat at the level of the renal sinus area, reaching the border.
These structures showed immunohistochemical positivity for keratins: CAM 5.2; AE1 - AE2 and 34 BE
Establishing thus the definitive diagnosis of collecting duct carcinoma with involvement of the renal sinus of the surgical edge.
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After a month and a half of the surgery, once assessed by the Ongo Country Service, it was decided to start chemotherapy with Carboplatin AUC 4 day 1st + Gemcitabine 1250 mg/m2 days 21st and 8th.
Cisplatin was not administered due to its nephrotoxicity and because it was a monorene patient with CrCl < 30.
After the 4th cycle of CMT, a CAT scan showed: tumor lesion in the left renal fossa, compatible with metastasis in the upper segment of the hepatic artery, probably accompanied by a left psoas muscle and also aorta,
