A 63-year-old man with no relevant past medical history was diagnosed with HR with a solid mass located in the renal isthmus by abdominal ultrasound requested for the study of a prosthetic syndrome.
Abdominal CT confirmed the presence of an 8 cm tumor in the renal isthmus, with no evidence of lymphadenopathy, regional metastases or distant lesions in the extension study.
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The preoperative vascular study by arteriography showed the existence of two renal arteries with orthotopic birth.
Selective images of the right renal artery showed vessels neoformed at the medial branch in its bifurcation, with normal intra- and extra-renal venous tree.
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With the presumptive diagnosis of renal carcinoma, isthmectomy and left nephrectomy was performed through a midline laparotomy.
During surgery it was observed that the renal pelvis and left ureter were infiltrated by the tumor.
Pathology showed a neoformed renal lesion of 10 cm affecting capsule, perirenal fat, as well as the left urinary tract.
The histology was non-small cell neuroendocrine carcinoma.
The immunohistochemical study was positive for CD-56 and synaptophysin.
Four months after the operation, the abdominal CT scan showed a solid 2 cm nodule in the lower pole of the right kidney, as well as left para-aortic adenopathies and multiple retrocrural nodules.
The PET-CT study showed that the lesions described were suggestive of metastasis.
The patient underwent treatment with external beam radiotherapy (RT) and chemotherapy (CT) (carboplatin and PV-16) with good tolerance and partial response.
The patient was asymptomatic and had no late side effects of radiotherapy or chemotherapy.
Two years after surgery the abdominal CT shows the persistence of small retroperitoneal lymph nodes, without other remarkable findings.
