case_images: PMC9755666_01
case_images: Timeline of disease.
case_images: fonc-12-949400-g001.jpg
case_images: PMC9755666_01_fonc-12-949400-g001.jpg
case_images: f1
case_images: A 62-year-old man who is a Jehovah's Witness presented to an outside hospital in July 2020 and received antibiotics for presumed urinary tract infection ( Figure 1 ).
case_images: Gross examination revealed a 13.0-cm mass arising from the inferior renal pole with involvement of the interpolar region. The mass is multilobulated and variegated yellow-tan in color with areas of hyalinization and hemorrhage. It extends into the renal vein as a tumor thrombus.
case_images: fonc-12-949400-g002.jpg
case_images: PMC9755666_01_fonc-12-949400-g002.jpg
case_images: f2
case_images: The patient tolerated his procedure well; an image of the resected mass is shown in  Figure 2 . Pathology revealed a WHO nuclear grade 4 with necrosis measuring 13.0 cm in greatest dimension and invading into the renal vein ( Figure 2 ).
case_images: (A) Baseline CT abdomen and pelvis with left renal cell carcinoma. (B) CT abdomen 2 months after left radical nephrectomy.
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case_images: PMC9755666_01_fonc-12-949400-g003.jpg
case_images: f3
case_images: About 6 weeks post-nephrectomy, a CT abdomen/pelvis in November 2022 revealed no evidence of disease ( Figure 3 ) and the patient had recovered without major difficulties.
case_images: (A) Baseline CT chest demonstrating left upper lobe nodule. (B) CT chest after left thoracoscopic wedge resection.
case_images: fonc-12-949400-g004.jpg
case_images: PMC9755666_01_fonc-12-949400-g004.jpg
case_images: f4
case_images: Subsequently, the patient underwent an incomplete left upper lobe wedge resection of the previously biopsy-proven metastatic LUL nodule, with pathology showing a 3-mm nodular scar and no residual malignant cells ( Figure 4 ).