Male patient, 63 years old, of mixed race, diabetic and inveterate smoker. He presented to the outpatient clinic for pain in the right hypochondrium and low obstructive urinary symptoms consisting of nocturnal frequency of 2-3 times, weak urinary stream and postvoid dribbling. Total PSA was 2µg/mL, haemoglobin, ESR, haemochemistry and cyturia were normal.
The general physical examination and abdominal examination were negative. Rectal examination revealed the presence of a slightly enlarged prostate with an irregular surface and a stony consistency. A prostate biopsy was performed, which revealed moderately differentiated adenocarcinoma.
Abdominal ultrasound revealed a 6 cm diameter, heterogeneous and complex tumour in the lower pole and middle part of the right kidney and another of similar size and ultrasound characteristics in the upper pole and middle portion of the left kidney. A simple and contrasted renal CT scan was performed which confirmed the images reported in the ultrasound, being hypodense, well delimited and both showing enhancement with the administration of iodinated contrast. No abdominal adenopathy or tumour lesions in neighbouring organs were detected. Chest X-ray and bone scintigraphy were negative for metastases.

To establish the diagnosis of renal tumours, laparoscopy was considered, but the patient had a large right supra- and infra-umbilical paramedian scar, sequelae of laparotomy for acute perforated appendicitis with generalised peritonitis, and this procedure was avoided in order to prevent possible complications.
It was then decided to perform a fine needle aspiration biopsy on the right kidney lesion and, after two attempts, the samples were not useful for diagnosis. Subsequently, the patient refused to undergo any further investigative or therapeutic procedures for his renal disease.
He was treated for prostate cancer with LHRH analogues and anti-androgens. After three months of prostate cancer treatment, the evolving renal CT scan shows no changes from the initial one. The patient is currently asymptomatic and is in good general condition.