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+A 75 year old patient, diagnosed by chance by routine ultrasound scan of a solid mass in the upper pole of the right kidney. One and a half years later she came to our clinic. She had not followed any treatment. She remained asymptomatic.
+Radiological examinations
+Chest PA and L: calcified adenopathies in the mediastinum, presence of an isolated fibrous tract in the left base.
+Abdominal CT scan: at the level of the upper pole of the right kidney and internally, there is a solid mass of about 5 cm, growing downwards and touching the renal sinus, growing behind the vascular structures.
+
+After administration of contrast, intense uptake is seen, highlighting the presence of a central scar. The contours are clear and the mass appears encapsulated with respect to the renal parenchyma.
+There are no signs of involvement of the renal vein, nor extension to the perirenal space, nor adenopathy.
+In conclusion, renal mass to be determined, although with oncocytoma.
+Bone scan: increased uptake deposits at the level of the 5th lumbar vertebra, and another at the cervical level, compatible with osteodegenerative processes.
+Treatment and evolution: with the presumptive diagnosis of localised renal adenocarcinoma, a right upper partial nephrectomy was performed. The intraoperative diagnosis classified the tumour as clear cell adenocarcinoma and indicated free resection margins (T1G1).
+However, the definitive anatomical pathology report states that 'the renal tumour has an apparently thyroid differentiation. The immunohistochemical study seems to confirm the thyroid origin of the tumour, as antithyroglobulin, vimentin, AE3-AE1, CAM5.2, alpha1 antitrypsin, calcitonin, neurospecific enolase and carcinoembryonic antigen antibodies have been used. The cells are positive for antithyroglobulin, CAM5.2 and S-100'.
+The patient refused complementary examinations and immediate treatment, but after 4 months she began to experience dysphonia and a sensation of a foreign body in the neck.
+The cervico-thoracic CT scan showed a mass in the left thyroid lobe measuring 5-3-6 cm, growing towards the upper mediastinum, with involvement of the thyroid isthmus, lymphadenopathy measuring 1 cm in diameter in the middle jugulo-carotid group and a large number of nodular lesions in both lung fields, compatible with micrometastasis.
+Total thyroidectomy and left functional lymph node emptying and total laryngectomy were performed due to local invasion of the neoplasm.
+The anatomopathological report confirmed the existence of a poorly differentiated follicular thyroid carcinoma.
+He underwent a complementary session with an ablative dose of Iodine-131.
+