A 52 year old patient with a personal history of terminal renal failure of an unaffiliated aetiology who received a heterotopic transplant in FID from a cadaveric donor in January 1999. He had previously required haemodialysis from 1980 to 1983, and peritoneal dialysis from then until the time of renal transplantation.

There were no post-transplant complications. The patient was given triple immunosuppressive therapy with Cyclosporine, Prednisone and Mycophenolate, presenting immediate diuresis with progressive improvement of renal function, with creatininemia at discharge being 1.8 mg/dl.

After an uncomplicated and asymptomatic post-transplant period of 51 months in which he maintained stable renal function (creatininemia: 1.2-1.4 mg/dl), a 1.5 cm vascularised solid nodule was observed in the lower pole of the renal graft in a control ultrasound scan. Subsequent ultrasound-guided FNA revealed RCC.

In June 2003, by reopening the previous Gibson incision in FID, and after freeing the renal graft from the surrounding adhesions, a 1.5 cm well circumscribed exophytic tumour was identified in its lower pole-anterior aspect. Lumpectomy was performed with a margin of more than 0.5 cm of macroscopically healthy parenchyma, and samples of the base were sent intraoperatively and reported to be free of tumour involvement. For haemostatic purposes, intraparenchymal stitches of the bleeding vessels and 'mattress' approach stitches supported by Goretex and Surgicel were performed.

The definitive histopathological diagnosis was Fuhrman type I papillary renal carcinoma, Fuhrman grade 2, UICC stage I (pT1a, Nx, Mx) with resection margins and peritumoural fat without tumour involvement.

There were no complications in the postoperative course of the lumpectomy, and immunosuppressive therapy was not modified.

In the almost three-year follow-up, carried out initially quarterly and subsequently every six months, by means of a renal function study and ultrasound or MRI, there is no evidence of tumour recurrence to date, maintaining adequate renal function with creatininemia of 1.18 mg/dl, and creatinine clearance of 115.5 ml/min without proteinuria.