METHODS
Physical examination was normal. Routine blood investigations were within normal limits. Ultrasonography of the abdomen revealed a right-sided renal mass. Contrast-enhanced computed tomography (CECT) of the abdomen revealed an enhancing mass 11.2 cm x 10 cm x 12.3 cm involving the mid and lower pole of the kidney in its entirety along with an extension to the right psoas muscle, pelvic-ureteric junction, and renal vein.
A provisional diagnosis of right RCC with inferior vena cava thrombus was made. The patient underwent an elective right radical nephrectomy with inferior vena cava thrombectomy and the specimen was sent for histopathological examination.
On gross examination, the cut section of the right kidney showed a heterogeneous mass measuring 13.0 cm x 11.5 cm x 10.5 cm involving the entire kidney. The mass was grey-white with large friable dark brown areas of necrosis and hemorrhage. Focally, a grey-white area was noted which showed a whorling pattern (Figure 1). The ureteric resection margin was grossly free of tumor.