A 47-year-old male, with no history of interest, who was incidentally diagnosed with right renal mass on ultrasound during a routine abdominal pain study.
CT scan confirmed the presence of a solid and heterogeneous mass of approximately 6 cm, located in the upper pole of the right kidney with a permeable renal vein.
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Right radical nephrectomy was performed by subcostal laparotomy without lymphadenopathy.
The pathological diagnosis was clear cell renal carcinoma 8.4 cm, pT3aNoMo stage, Robson II and Fuhrman nuclear grade IV.
The patient was discharged five days after surgery.
At approximately three months and before being seen in the clinic for follow-up of the neoplasm, the patient came to the emergency room for pain in the right hypochondrium of recent onset.
The exploration revealed a painful mass in the right hypochondrium, for which a new tumor was detected in the surgical bed, which revealed a major peritoneal pillar, hepatic implants as well as a new deformity in the adjacent surgical bed.
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It was decided to perform the removal of tumor masses, resecting the adjacent liver as well as various peritoneal and retroperitoneal implants, intraoperative biopsy being compatible in all parts with high-grade clear cell carcinoma.
The retroperitoneal mass was inaccessible due to close contact with the great vessels.
Once these findings had been identified, it was decided to contact the local emergency department in which treatment with interferon A was started, with poor tolerance, requiring dose reduction.
In the revisions carried out, the patient reported nonspecific abdominal discomforts that responded to soft analgesics but in the control abdominal CAT scan performed 5 months after the second surgery showed multiple peritoneal lesions.
