A 28-year-old male patient was seen in the urology department due to left varicocele.
The study of this pathology revealed a large mass dependent on the left kidney, which displaced the abdominal structures; the left renal vein and the vena cava were observed displaced but permeable.
Clinically, the patient complained of abdominal pain, asthenia and weight loss.
He had no hematuria or voiding syndrome.
Physical examination revealed a large abdominal mass.
Laboratory tests (systematic blood analysis, blood and urine biochemistry, coagulation) were normal.
Testicular ultrasound confirmed a significant left varicocele; abdominal ultrasound, magnetic resonance imaging and computed tomography (CT and abdominal vein) showed a mass in the left kidney, 25 × 20 × 14 cm in maximum diameter, with abdominal structures displacing
The rest of the examination was normal (T2N0).
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The study was completed with a bone scintigraphy (negative for bone metastases), aspiration puncture (needle aspiration), abdominal dislodgement, and arteriography of malignancy).
In view of the study results, it was decided to perform a radical nephrectomy; the intervention was uneventful and the postoperative period was favorable; the patient was discharged 7 days after surgery.
The pathology report described macroscopically a large encapsulated tumor mass of 4,960 g, measuring 27 × 23 × 15 cm, where no kidney was recognized.
The microscopic description confirmed the diagnosis of fibromyxoid renal sarcoma.
Subsequent payment
Followed in outpatient consultation by urology services and non-physician (which decides not to give treatment), the patient is very well and all complementary examinations performed 9 months after the intervention (analytical abdominal CT blood tests).
Three months later an extensive local recurrence was detected in the abdominal CT scan, a mass in the left renal cell with local extension (non-apparently, 20 cm) affecting the spleen and pancreas that displaces but did not appear.
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It was decided to treat a large multiloculated tumor involving the spleen, the tail of the pancreas, the greater curvature of the stomach and the left diaphragm.
A resection of the tumor was performed, including the affected diaphragm, a sleeve gastrectomy to the angle of His, a cholecystectomy with resection of the tail of the pancreas and a colectomy of the splenic flexure.
The pathology report confirmed that it was an abdominal and retroperitoneal recurrence of high grade sarcoma, compatible with fibrosarcoma, adhered to the gastric wall, the spleen and pancreas.
Treatment was completed with chemotherapy (6 cycles-adriamycin/ifosfamide/month) and radiotherapy, which showed good tolerance and response (control CT within normal limits).
After four months, she had a new recurrence observed on abdominal CT, so she received chemotherapy and 8 months later the patient died.
