A 62-year-old patient consulted due to pain in the right hemiscrotum of three months of evolution. Physical examination revealed right varicocele IV, also showing a right varicocele mass in the right renal area.
Abdominal ultrasound showed a heterogeneous mass of approximately 10 cm in the right kidney, left kidney without pathological findings.
It is complemented with computed axial tomography of the abdomen and pelvis with intravenous contrast where a heterogeneous right renal formation of 110 x 120 mm diameter is evident, no retroperitoneal adenomegaly is observed.
Difficulty in evaluating the right kidney.
1.
Magnetic resonance imaging confirmed the heterogeneous formation of the right kidney in the upper pole of 12 cm in diameter, without involvement of the renal vein or the inferior vena cava.
1.
A right radical nephrectomy was performed.
Good evolution was observed and the patient was discharged on the fifth postoperative day.
Histopathology reveals: Undifferentiated malignant tumor of strain to differentiate by immunohistochemistry (IHC).
Tumor size 13 cm. Local invasion: The tumor extends through the renal capsule, provoking focal infiltration of perisuprarenal fat.
Lesion-free renal hilum.
Vascular embolisms, surgical margins free of tumor lesion.
Non-neoplastic kidney: chronic pyelonephritis.
Arterioration and arterio-effect diameter and retention cyst of 4 cm.
Lesion-free adrenal gland.
IHC:WT1 ++,CD 117 +++,CD56 +++,P53 -.
1.
Diagnosis: Nephroblastoma (Wilms tumor), stage II of the NWTS classification.
CT one month after surgery showed tumor recurrence at the nephrectomy bed level.
She was started on chemotherapy with vincristine, dactinomycin and doxorubicin.
It presents during the course of chemotherapy a picture of pneumonia with deterioration of the general state, sepsis and months of nephrectomy.
