Later on, MRI of the dorso-lumbar spine was performed which did not show any suspicious focal osseous lesion. Thyroid gland ultrasound examination and ultrasound-guided FNAC of the thyroid nodules were also performed which were negative for malignancy.

Then the patient underwent ultrasound-guided biopsy of the left renal mass, which was positive for grade 1 clear cell renal cell carcinoma.

Later on patient underwent laparoscopic left radical nephrectomy.

Histopathology (left radical nephrectomy): 6.5 x 6 X 6 cm, grade 2 clear cell renal cell carcinoma, with tumor extension into the perinephric tissue.  No necrosis or lymphovascular invasion identified. Negative resection margins. No lymph nodes submitted or found.