This is a 53-year-old man with no past history of interest who was admitted from the emergency department with pulmonary thromboembolism.

Given the suspicion of occult neoplasia and the presence of haematuria not previously evident, an abdominal ultrasound scan was carried out which revealed a right renal mass and the study was completed with CT and MRI.

Both studies confirmed the presence of a heterogeneous tumour infiltrating the lower two thirds of the right kidney measuring approximately 10x10 cms. with involvement of the renal sinus and hilum, also showing tumour thrombosis of the right renal vein and infrahepatic cava. No adenopathies or metastases were evident.

He underwent an anterior radical nephrectomy with cavotomy to remove the thrombus and an extensive right aorto-caval lymphadenectomy.

The anatomo-pathological result was Fuhrman grade 2 clear renal cell carcinoma of 9 cm with invasion of the renal hilum, perinephric fat and renal vein, without metastatic involvement of lymph nodes or the edges of the fat or the hilum, as well as free ureter. (Stage III, T3N0M0). The patient was discharged from hospital on the sixth day.

Three months after the operation, the patient reported slight pain and induration in the penis of recent onset. Palpation revealed an indurated mass.

An MRI of the pelvis was performed, which revealed the existence of a mass occupying and expanding the left corpus cavernosum, compatible with metastasis of previous renal carcinoma.

A biopsy was taken of the lesion, the result of which confirmed our suspicion, showing isolated nests of tumour cells in the histological sections compatible with metastasis of clear cell carcinoma.

Given this diagnosis, we considered the best therapeutic approach for the patient, taking into account the progressive increase in local pain, the patient's age and his good general condition. We therefore opted for a total penectomy until a disease-free surgical border could be confirmed intraoperatively.

One week after discharge, the patient was admitted to the oncology department with a picture of obnubilation and motor and sensory alteration, and showed lesions in the cerebellum and right cerebral hemisphere compatible with metastasis in the cranial CT scan. A CT scan of the chest also revealed multiple pulmonary nodules and bilateral paratracheal microadenopathies related to metastasis.

The patient died nine months after the first operation for his renal carcinoma, i.e. six months after the diagnosis of metastases in the penis.