Case Presentation
A 64-year-old female with no remarkable comorbidities initially presented in 2018 (1397) with a left renal mass. She underwent laparoscopic partial nephrectomy.
First pathology (2018):
Histologic evaluation demonstrated clear cell renal cell carcinoma (ccRCC) measuring 3.7 × 3 × 2.5 cm, WHO/ISUP nuclear grade II. The tumor was confined to the renal capsule, with no evidence of lymphovascular or perineural invasion. However, the parenchymal surgical margin was positive for tumor, and the pathologic stage was reported as pT1aNxMx.
In 2019 (1398), follow-up imaging revealed a local recurrence in the left kidney. The patient subsequently underwent open partial nephrectomy.
Second pathology (2019):
The specimen showed ccRCC, 3 cm in greatest dimension, grade II, confined to the renal capsule. This time, the surgical margins were free of tumor, with no necrosis identified. The tumor was staged as pT1a.
The patient remained under surveillance until 2025 (1404), when she presented with abdominal discomfort. CT scan demonstrated multiple enhancing retroperitoneal soft tissue lesions adjacent to the left renal hilum. The largest mass measured approximately 52 × 35 mm, with associated perilesional fat stranding and vascular involvement. Two additional smaller lesions were also identified in the same region
.
Core needle biopsy (2025): revealed clear cell renal cell carcinoma, WHO/ISUP grade II, raising the concern for metastatic disease.
She subsequently underwent surgical excision of the retroperitoneal masses.
Final pathology (2025):
Grossly, the specimen consisted of irregular fibro-fatty tissue measuring 7.5 × 5 × 4 cm with a creamy solid cut surface. Microscopic examination confirmed metastatic clear cell renal cell carcinoma.
