A 69-year-old male patient with a history of hypertension, inguinal herniorrhaphy and prostate surgery was referred for urology consultation due to hematuria and right renal fossa pain.
Abdominal ultrasound identified a right renal mass in the upper pole of 8.5cm in diameter.
Abdominal CT was requested and reported as a right heterogeneous solid renal mass in the upper pole of about 9 cm in diameter with probable ipsilateral adrenal indisposition and right paraaortic adenopathies and minor preaortic vena cavae.
Having established the above findings, an extension study was carried out with normal chest X-ray and bone scintigraphy with doubtful metastatic lesion at D12 level, which was ruled out by selective radiography.
Analytically, all parameters were within normal limits.
Once extrarenal extension was ruled out, we proceeded to right radical nephrectomy in which several vascular anomalies were identified: left vena cava that crossed anteriorly to the aorta at the level of the renal vessels, dring into a right polar vein.
Renal mass appeared as a capsule of ipsilateral adrenal gland.
The anatomopathological diagnosis was clear cell renal cell carcinoma of 9 cm in diameter larger than Fuhrman grade IV (pT3bGIV), with involvement of the renal capsule and renal vein, but without identifying involvement of the adrenal gland
