Presentation
Flank pain.
Patient Data
Large, lobulated homogeneous left retroperitoneal mass displacing the left renal vein anteriorly and kidney inferiorly. Closely associated with the renal pelvis. Renal artery appears to run through it. Approximates the psoas with questionable invasion.
Partially calcified heterogeneous exophytic mass right renal pole. Small pericardial effusion.
Case Discussion
The most important thing to communicate in this case is that the masses are different processes and need to be addressed separately. The right renal mass looks like a typical RCC, and left mass is indeterminant for a primary renal versus retroperitoneal process (although the latter is favored given the unconvincing renal cortical involvement and displacement of the kidney inferiorly). Both were biopsied separately and diagnoses were confirmed. The left leiomyosarcoma was resected first due to greater risk for concern of metastatic spread.
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