A 50-year-old woman with no relevant clinical or urological history.
She presented with left lumbar discomfort of about three weeks of evolution, without hematuria, and an anodyne physical examination was performed.
With the finding of left renal mass, a CT scan was continued.
The latter confirmed an encapsulated mass in the middle pole of the left kidney of 8x12 cm of heterogeneous density.
No lymphadenopathy was observed.
In the analytical studies, all parameters were within normal ranges.
The chest X-ray was normal.
With the diagnosis of left renal mass left radical nephrectomy was performed, intraoperatively a large renal mass dependent upper pole was observed, without observing lymphadenopathies.
The postoperative course was uneventful.
The pathological study confirmed macroscopically a left nephrectomy specimen of 247 g.
A 5x6x4 cm tumor that broke the capsule was observed externally.
Upon cutting, a whitish tumor with brown areas of central location extending to the periphery.
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The microscopic study described a renal tumor formed by laminae of small cells, monoforms with rounded nuclei of chromatin and moderate mitotic index.
With low, clear or eosinophilic cytoplasm.
Extensive areas of necrosis were observed with preservation in areas of perivascular cells, giving a pseudopapillary image.
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Immunostochemical study showed positivity for vimentin and 013 (CD-99).
Actinivity, Keratins (CK7, CK20, AE1-AE3, 34 beta E12) ALC, desmin, chromogranin, synaptophysin, CD34, CD31100 c-
Ki 67: low proliferative index.
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Definitive diagnosis was established as a neuroendocrine tumor located predominantly in the medullary bone that breaks the renal capsule and perirenal adipose tissue.
The study was completed with bone screening and CTEP, both normal.
Bone marrow biopsy was also performed without finding cellular changes at this level.
With this diagnosis, chemotherapy was initiated by the institution.
Seizures where alternate treatment with VAC-IE (Vincristine, Adriamycin, Cyclophoamide alternating with chemotherapy and chemotherapy plus intent) is administered for up to four cycles,
Six months after nephrectomy, the patient is asymptomatic and with an acceptable general status.
