Abstract

A Murinello, P Guedes, AM Figueiredo, P Gomes, LA Monteiro, HS Damásio, NC Ribeiro, L Mota, A Carvalho, C Teiga, M Albergaria, A Serrano

Renal cell carcinoma (RCC) is by far the most frequent type of kidney cancer, but synchronous bilateral neoplasms are rare, even more so in sporadic forms of RCC. An increasing amount of tumours are being found spuriously while small and before causing any symptoms, thus allowing less invasive surgery with potentially brighter outcomes. We report a 49-year-old Caucasian male who presented to the Emergency Department with a seven-day course of productive cough, worsening dyspnoea, and anorexia. He had no history of fever or any pain, and showed no abdominal or urinary complaints whatsoever. His physical exam was irrelevant apart from an enlarged liver, and kidney function tests were normal. Workup eventually revealed synchronous bilateral clear cell RCC and the patient underwent a successful total right nephrectomy with left tumourectomy. Two years on, he remains asymptomatic and with normal renal function. This case shows the seldom seen coexistence of sporadic RCC in both kidneys. We stress the fact that the patients frequently don’t show any urinary symptoms, which can delay the correct diagnosis and hinder treatment. Tumours found on an early stage can be dealt with using less drastic measures that spare nephrons and elude, or at least postpone, definitive haemodialysis.