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+A 62 year old patient consulted for pain in the right hemiscroct of three months' evolution. On physical examination, a grade IV right varicocele was found, and a large mass was also palpated at the level of the right renal area. An abdominal ultrasound scan was performed, which revealed a heterogeneous mass of approximately 10 cm in the right kidney and no pathological findings in the left kidney. A computed axial tomography of the abdomen and pelvis with intravenous contrast showed a heterogeneous right renal formation measuring 110 x 120 mm in diameter, with no retroperitoneal adenomegaly. Difficult evaluation of the right renal pedicle.
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+An MRI was requested which confirmed the right renal heterogeneous formation in the upper pole of 12 cm. in diameter, without involvement of the renal vein or the inferior vena cava.
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+A radical right nephrectomy was performed. Good progress, the patient was discharged on the fifth postoperative day.
+Pathological anatomy revealed: Undifferentiated malignant tumour of lineage to be differentiated by immunohistochemistry (IHC). Tumour size 13 cm. Local invasion: the tumour extends through the renal capsule, causing focal infiltration of the perisuprarenal fat. Renal hilum free of lesion. Vascular embolisms present, surgical margins free of tumour lesion. Non neoplastic kidney: chronic pyelonephritis. Arterio- and arteriolonephrosclerosis and retention cyst 4 cm. in diameter. Adrenal gland free of lesion. IHQ:WT1 +++,CD 117 +++,CD56 +++,P53 -.
+
+Diagnosis: Nephroblastoma (Wilms' tumour), stage II of the NWTS classification.
+CT scan one month postoperatively showed tumour recurrence at the level of the nephrectomy bed.
+He started chemotherapy with vincristine, dactinomycin and doxorubicin. During the course of chemotherapy, she developed pneumonia with deterioration of general condition, sepsis and months of nephrectomy.
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