A 65-year-old woman with no personal history of interest was admitted due to high fever with no apparent focus of 1 week of evolution. An abdominal CT scan was performed in a woman with a large renal mass (9x8x7 cm).
He did not report other symptoms except pain and functional impotence in the left lower limb of months of evolution in follow-up by Neurosurgery Service and with diagnosis, after performing CT of the spine and Magnetic Resonance Imaging (MRI)
There is no constitutional syndrome or abdominal pain.
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On physical examination, the abdomen was soft and depressible, globulous, with no signs of mass or enlargement.
No pain on physical examination.
Patient had a negative bilateral renal function.
The biochemical analysis showed no alterations with liver profile, total proteins and calcium in normal range.
Blood count with hemoglobin 9.4 g/dL, and 22,500 leukocytes (N: 72.9%).
Hemostasis was uneventful.
Sterile blood culture and urine culture <10,000 CBC/ml.
Antipyretic and broad-spectrum antibiotic treatment was established, despite which daily fever peaks with clinical repercussions in the form of asthenia were observed.
CT findings confirmed a solid mass in the right upper pole of 14X10X10 cm in diameter, with great signal heterogeneity and necrosis.
The lesion extends upward to the liver with signs of hepatic failure.
The right renal vein and vena cava are free.
There are lymphadenopathies, pleural effusion and thickening of the diaphragm.
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Given the hepatic involvement, the case is discussed with the General and Digestive Surgery Service agreeing to perform a Multislice CT scan to delimit with greater accuracy the level of involvement of this organ and planning of the surgical half lobe necrotic aspect 11 cm
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Previous renal embolization was performed surgically through supra and infraumbilical midline laparotomy.
The examination revealed a renal mass consistent with the liver (segment VII) and a diaphragm, showing pathological lymphadenopathy in renal hilium and free peritoneal fluid with no evidence of peritoneal implants.
Samples of peritoneal fluid were taken for culture, cytology and gram negative.
Right radical nephrectomy was performed including en bloc hepatic segment VII, right adrenal and portion of diaphragm.
Cholecystectomy and lymphadenectomy.
Anatomopathological analysis revealed a conventional type renal cell cancer of high cytological grade (Fuhrman grade 4), with foci of sarcomatoid transformation and extensive areas of tumor necrosis.
Two satellite nodules on the peritoneal surface of the diaphragm and metastasis to a lymph node of the renal hilium.
No involvement of the venous system or renal excretory or adrenal gland.
Stage pT4G3N1 according to UICC.
After a satisfactory postoperative period with progressive reduction of leukocytosis, oral chemotherapy with angiogenesis inhibitors was initiated.
The second CT scan performed two months after surgery showed right pleural effusion with nodular pleural lesions basal and posterior.
Pleural fluid cytology is compatible with adenocarcinoma.
