A 47-year-old male that presented with right flank pain in the absence of gross haematuria. He underwent a CT abdomen/pelvis due to suspicion for an obstructing ureteral stone. He was found to have an obstructing punctate right ureterovesical junction stone with mild hydronephrosis, but more notably a 12cm right renal mass concerning for a primary renal neoplasm was incidentally discovered (Figure 1). Renal function was within normal limits. He was managed with medical expulsive therapy for the ureteral stone and referred to a tertiary care centre for further work-up of the right renal mass.
Radiographically, the mass was centrally located and possibly invading or originating from the renal collecting system. A CT-urogram was performed, which was significant for the enhancing large right renal mass with no filling defect of the renal pelvis, thus decreasing the likelihood of urothelial cell carcinoma. A urine cytology was also found to be negative for urothelial carcinoma. There was no tumour thrombus noted, but there was mass effect on the renal hilum (Figure 2).
Staging nuclear medicine bone scan and CT thorax were negative for evidence of metastatic disease. A biopsy of the right renal mass was conducted.
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