Male patient, aged 28 years, seen in urology for presenting left varicocele. In the study of this pathology, a large mass dependent on the left kidney was discovered, which displaced the abdominal structures; the left renal vein and cava were observed to be displaced, but permeable. Clinically, the patient reported abdominal pain, asthenia and weight loss. There was no haematuria or voiding syndrome. Physical examination revealed a large abdominal mass.
Laboratory tests (routine blood tests, blood and urine biochemistry, coagulation) were normal.
Testicular ultrasound confirmed a large left varicocele; abdominal ultrasound, magnetic resonance imaging and thoracoabdominal computed tomography (CT) demonstrated a mass in the left kidney, measuring 25 × 20 ×14 cm in maximum diameter, compressing and displacing abdominal structures, as well as the renal and cava vein. The rest of the examination was normal (T2N0).

The study was completed with a bone scan (negative for bone metastases), a fine needle puncture-aspiration (atypical cells suspicious for malignancy) and an arteriography where displacement and rotation of the abdominal aorta was observed.
In view of the results of the study, it was decided to perform a radical nephrectomy; the operation was uneventful and the postoperative period was favourable; the patient was discharged 7 days after surgery. The anatomical pathology report described macroscopically a large encapsulated tumour mass of 4,960 g, measuring 27 ×23 ×15 cm, where no kidney was recognised. The microscopic description confirmed the diagnosis of renal fibromyxoid sarcoma.
Subsequent evolution
Followed up in the outpatient clinic by the urology and oncology departments (which decided not to give complementary treatment), the patient was doing very well and all the complementary examinations carried out 9 months after the operation (blood and urine tests, thoracoabdominal CT scan) were normal. Three months later an extensive local recurrence was detected in the thoracoabdominal CT scan, a mass in the left renal cell with local extension (approximately 20 cm) affecting the spleen and pancreas, which it displaced but did not appear to infiltrate.

It was decided to treat with surgery for a large multiloculated tumour infiltrating the spleen, the tail of the pancreas, the greater gastric curvature and the left diaphragm. Resection of the tumour, including the affected diaphragm, vertical gastrectomy up to the angle of His, splenectomy with resection of the tail of the pancreas and splenic angle colectomy were performed.
The anatomical pathology report confirmed that this was an abdominal and retroperitoneal recurrence of high-grade sarcoma, compatible with fibrosarcoma, adherent to the gastric wall, spleen and pancreas.
Treatment was completed with chemotherapy (6 cycles of adriamycin/ifosfamide/monthly) and radiotherapy, which was well tolerated and responded (control CT scan within the normal range).
After four months, a new relapse was observed in the abdominal CT scan, for which he received chemotherapy treatment and 8 months later the patient died.