A Huge Renal Cell Carcinoma, Nine Years after Its Primary Diagnosis and Obligate Observation.

The clinical diagnosis of renal cell carcinoma (RCC) is radiographic. Effective imaging of the kidneys can be achieved by ultrasound, CT or MRI [Chawla et al.: J Urol 2006;175:425-431]. Solid lesions detected by ultrasound and those showing enhancement on cross-sectional imaging are considered malignant until proven otherwise. The standard of care for clinically localized RCC remains surgical resection due to the favorable prognosis associated with surgery and the relative ineffectiveness of systemic therapy. Since patients with localized RCC are often symptom-free, they sometimes refuse to receive surgical treatment or are left untreated based on a diagnosis of benign lesions. There are also cases where an RCC is relatively large and causes symptoms but is not treated surgically because of complications and other reasons. We report a 54-year-old male who underwent a difficult radical nephrectomy 9 years after the primary RCC malignancy diagnosis.