Abstract
A 60-year-old man presented with left flank pain 1 year in duration. Abdominal computerized tomography (CT) and ultrasonography demonstrated a 10 12.5 20 cm. simple cyst in the left kidney (part A of figure). The patient underwent uncomplicated 4 port transperitoneal cyst decortication. Intraoperative examination of the cyst base did not reveal any suspicious areas prior to fulguration. Final pathological evaluation showed the cyst wall was benign. Seven months postoperatively CT for recurrent pain revealed a solid contrast enhancing left renal mass, lymphadenopathy and metastases to the liver and lung (part B of figure). Four subcutaneous nodules were palpable near the port sites. As part of an immunotherapy protocol the left kidney was removed en bloc with the left colon and spleen. Regional lymph nodes and multiple peritoneal lesions were also excised. Pathological examination confirmed chromophil and sarcomatoid renal carcinoma (Fuhrman grade 4) in all specimens, stage pT4N2M1.
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