A 67-year-old male was admitted to the internal medicine service due to constitutional syndrome, anemia and right flank mass.
The personal history of interest included cerebrovascular accident in the territory of the middle cerebral artery, secondary to atrial fibrillation at 64 years of age; chronic obstructive pulmonary disease; usual treatment with oral dicoumarin and amiodarone.
The patient has anorexia, asthenia, and weight loss of 12 kilograms in 4 months.
Twenty days prior to admission, a sudden pain in the flank and right renal fossa began.
The urological history is normal.
Physical examination revealed a painful mass in the right hemiabdomen.
Rest of the anodyne exploration.
In the analytical study, normocytic and normochromic anemia (hemoglobin 10, 6) and prolongation of ESR stand out; biochemical, urinary and tumor markers study normal.
Objective abdominal ultrasound, right renal mass with mixed ultrasonographic pattern of 17 x 13 cm in diameter, with an extraparenchymatous area compatible with hematoma.
Complete body computed tomography (C.A.T.) showed a mixed mass with solid predominance in the upper pole of the right kidney, with probable non-muscle invasive psoas muscle; neither adenopathies nor vascular thrombosis were observed.
Before surgery, and given the large size of the tumor mass, arteriography was performed, selectively embolizing the renal artery using colis.
Three days later radical nephrectomy was performed by anterior approach, observing a large tumor mass dependent on the right kidney, which does not affect the psoas muscle.
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Histologically, a tumor mass of 10 centimeters in diameter that affects perirenal fat without involvement of the excretory or venous systems was observed macroscopically.
Microscopically, it is a very undifferentiated spindle cell malignant tumor, sarcomatoid type 4 of Fuhrman, with perirenal G3N degree but without involvement of the excretory and venous systems; pT30.
After surgery the patient evolved favorably and was discharged on the tenth postoperative day.
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In the first review, six months after the intervention, the control CT scan showed two heterogeneous cystic masses in the retroperitoneal space, the first adjacent to the ascending psoas muscle of about 12 centimeters in diameter.
Ultrasound guided needle aspiration (FNA) was performed as the result of metastasis from renal carcinoma.
Complete-body bone scintigraphy showed no metastatic lesions.
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72 hours after P.A.A.F., the patient presents dizziness, abdominal distention and anemia, performing the loss of 5 gr/dl of hemoglobin with respect to discharge.
The CT scan at that time showed a large retroperitoneal mass with intense hemorrhagic component.
An exploratory laparotomy was performed, evacuating retroperitoneal hematoma, and exeresis of cystic haemorrhagic tumor, adhered to the cauda lobe of the liver. In the intraoperative biopsy, a cystic retroperitoneal tumor with a new fusocellular recurrence was reported.
