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+Patient aged 66 years, ex-smoker, with a history of surgery for adenomatous polyp in the colon, inguinal hernia and oesophageal varices, who was admitted to the hospital for a study of chronic microcytic hypochromic anaemia and persistent cough.
+Blood tests showed haemoglobin of 10.2 g/dl, haematocrit of 33% and erythrocyte sedimentation rate of 87. Urine analysis and chest X-ray were normal.
+Abdominal ultrasound showed a hyperechoic mass in the cortical part of the right kidney measuring 7 x 5.6 x 6.6 cm, compatible with a solid tumour.
+Abdominal CT scan showed a right renal mass in the lower pole, suggestive of hypernephroma, 10 cm in diameter, which caused thrombosis of the renal vein and inferior vena cava. There was also evidence of locoregional adenopathy. The extension study showed no evidence of metastasis.
+With the diagnosis of hypernephroma, an extended right nephrectomy was performed with cavotomy and extraction of the tumour thrombus, as well as interaorto-caval lymphadenectomy.
+The pathological findings were clear cell renal cell carcinoma, 8 cm in diameter, with tumour invasion of the ureter and renal vein, nuclear grade III/IV. Nuclear grade III/IV. Nodes without tumour involvement (T3bN0).
+Three months after surgery, the chest X-ray showed multiple nodular images in both lung fields compatible with metastasis. He also presented with radicular pain in the left leg. The patient was treated with Interleukin-2 by the Oncology Service.
+Six months after surgery, he consulted for the appearance of two irregular, hard nodules, 2-3 cm in diameter, located below the right teste, at the root of the penis. Scrotal ultrasound showed an echogenic, solid, extratesticular mass with small cystic areas measuring 2.3 x 2.5 x 2 cm and another formation of similar characteristics in the penile root measuring 2.8 x 2 cm.
+
+FNA of these lesions was performed and the pathological diagnosis was clear cell carcinoma metastasis.
+The control CT scan showed a bilateral paravertebral mass infiltrating the vertebra at the C7-D1 level, which required the administration of analgesic radiotherapy.
+Fourteen months after surgery, he was treated with palliative radiotherapy for spinal cord compression syndrome, and died one month later.
+