We report the case of a 66-year-old patient with a medical history of subtotal gastrectomy for gastric adenocarcinoma four years ago and arterial hypertension treated with conventional isolation.
The patient is bedridden by the Digestive Service, assessed for a long-standing condition characterized by anorexia, loss of 12 kilos in 6 months (current weight 42 kilos), hypochromic anemia and constipation.
Physical examination revealed a large tumor of firm consistency, painless, mobile and occupying three-quarters of the abdomen.
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Given the history of gastric adenocarcinoma, severe deterioration of general status, constipation and anemia, the first clinical suspicion suggested was ascites due to carcinomatosis, intestinal tumor obstruction or abdominal tumor.
Analytical data reflected hemoglobin 7.5 g/dl, 3.35 million controls, 27% haematocrits, MCV 71.3, RDW 18, VSG 37 mm/h, CRP 24ml PSA 0.89 2.6 ng.
Liver and digestive tumor markers were anodyne.
Gastroscopy revealed an inflammatory polyp in the gastric stump, with no evidence of tumor recurrence.
It was impossible to perform an intestinal metaplasia due to intestinal displacement and intolerance.
Contra-pelvic ultrasound revealed the presence of a cystic tumor with incomplete septa of mixed anechoic content occupying the entire abdominal cavity.
Left kidney with normal characteristics was identified, not affecting the presence of the right kidney.
e left cystic lesion finding intraabdominal cavity is remitted to our consultation where intravenous urography was performed with result of right functional annulation, contralateral normal and great mass effect displacing the digestive cyst lateral to the hypoconus.
The CT scan showed a large cystic mass of 29.5 cm x 27.5 cm x 16 cm, with multiple well-defined septa and walls occupying almost the entire abdomen.
An image is identified in theoretical kidney zone renal pelvis hydronephrotic with compression and displacement of all abdominal structures.
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The diagnostic suspicion of giant hydronephrosis secondary to lithiasic obstructive uropathy was evaluated the possibility of percutaneous drainage and subsequent nephrectomy.
A right simple nephrectomy was performed by subcostal lumbotomy evacuating 7,800 milliliters of seroposium content.
Extended hiliar lymphadenectomy was performed due to the finding of lymphadenopathies at that level.
Fluid culture was negative, and cytology was not performed because there was no clinical or radiological suspicion of urothelial tumor.
The result of the histological examination revealed the presence of a multicystic kidney with marked dilatation of the footlocalised system and parenquimatosa severe (weight 0.5 cm).
The epithelial lining showed dysplasia changes of different degrees, can areas of papillary pattern and zones of non-renal parenchyma.
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In other areas, solid nests of large, clear and high nuclear-grade cytoplasmic cells (Fuhrman grade 3) were identified, as well as non-lymph node metastases of clear cell renal cell carcinoma.
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The subsequent evolution was unfavorable, with appearance of liver metastases and eventual death of the patient at two months.
