A 66-year-old ex-smoker patient with a history of adenomatous polyposis in the colon, inguinal hernia and persistent esophageal varices was admitted for study for chronic microcytic hypochromic anemia.
Laboratory tests showed a hemoglobin of 10.2 g/dl, hematocrit of 33% and a erythrocyte sedimentation rate of 87.
The systematic urine and chest X-ray were normal.
Abdominal ultrasound showed a hyperechoic mass in the cortex of the right kidney of 7 x 5.6 x 6.6 cm, compatible with solid tumor.
Abdominal CT showed a right renal mass in the lower pole, suggestive of hypernephroma of 10 cm in diameter, which produced thrombosis of the renal vein and inferior vena cava.
Locoregional lymphadenopathy was also evident.
The extension study showed no metastases.
With the diagnosis of hypernephroma right extended nephrectomy was performed with cavotomy and tumor thrombus extraction, as well as interaortocaval lymphadenectomy.
The pathology was renal cell carcinoma of the clear cell type of 8 cm in diameter with tumor invasion of the ureter and renal vein.
Nuclear grade III/IV.
Ganglios without tumor involvement (T3bN0).
Three months after surgery, the chest X-ray showed multiple nodular images in both lung fields consistent with metastases.
He also had left radicular pain.
The patient was treated with Interleukin-2 by the Ongoing Referral Service.
Six months after surgery she consulted for the appearance of two irregular hard nodules measuring 2-3 cm in diameter, located below the right test, in the root of the penis.
Ultrasound showed an echogenic extratesticular solid mass with small cystic areas of 2.3 x 2.5 x 2 cm and another similar formation in the penile root of 2.8 x 2 cm.
1.
FNAC of these lesions was performed, resulting in the pathological diagnosis of metastasis from clear cell carcinoma.
A control CT scan showed a bilateral mass for malignancy, showing the vertebra at C7-D1, requiring the administration of analgesic radiotherapy.
Fourteen months after surgery, the patient was treated with radiotherapy due to spinal cord compression syndrome and died one month later.
