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51-year-old female with fatigue and shortness of breath. On exam L upper quadrant mass found, was admitted for workup.
CT abd/pelvis: large soft tissue mass arising from L kidney, 15.0 x 17.5 cms. No bone involvement, lung bases negative.
PET scan – FDG uptake surrounding L renal mass, focus of activity seen in cranial aspect of mass which may represent lymph node involvement. No uptake seen in liver.
L radical nephrectomy, lymph node dissection: large mass palpated approximately 15 cms.
L kidney FNA: renal cell carcinoma.
L kidney: papillary renal cell carcinoma, G3, 16.5 cms. Ureter and vascular margins negative. 14/15 L para-aortic LNs positive for mets. Gerota's fascia margin negative.
Surgery: L radical nephrectomy, para-aortic lymph node dissection.
Immunotherapy: Began Betaseron.