title: Surgical challenges in the treatment of a giant renal cell carcinoma with atypical presentation: A case report.
abstract: BACKGROUND
  For the management of localized renal cell carcinoma (RCC), surgical resection is the standard of care. Considerations are given to achieve good outcomes with conservative measures. When the tumor is exceedingly large the safest alternative is total nephrectomy.
  
  
  METHODS
  The patient is a 75year old man with a 5year history of increasing abdominal distension. There was no recent hematuria or any other genitourinary complaints. CT revealed a giant complex mass that occupied the majority of the abdomen likely arising from the retroperitoneum. Early in diagnosis, the mass was suspected to arise from the left kidney. The decision was made to proceed with surgery for both treatment and diagnosis. Resection of the tumor revealed a 28.0×25.0×15.0cm encapsulated neoplasm. Histopathology determined this to be a papillary RCC. Resection of the mass resulted in en bloc partial nephrectomy immediately followed by a completion of the nephrectomy, lymphadenectomy, and abdominal wall repair. Postoperative course was excellent.
  
  
  CONCLUSIONS
  The aim of this report is to determine the surgical challenges posed by a tumor of this magnitude and the multidisciplinary approach necessary to treat it. In the often indolent course seen with RCC, surgeons are faced with the task of handling advanced disease, requiring more radical procedures for good outcomes.
  
  
  CONCLUSIONS
  The size of the tumor in this case presented several challenges in the operative setting. The sheer mass of the tumor gave no other choice than to perform exploratory laparotomy and complete nephrectomy upon resection.
authors.affiliation: Capital Regional Surgical Associates, 2626 Care Dr. Suite 206 Tallahassee, FL, 32308, USA; FSU College of Medicine, Clinical Assistant Professor of Surgery, 1115 W Call St. Tallahassee, FL, 32306, USA. Electronic address: rodolfo.j.oviedo@gmail.com.
authors.forename: Rodolfo J
authors.initials: RJ
authors.lastname: Oviedo
authors.affiliation: FSU College of Medicine, 1115 W Call St. Tallahassee, FL, 32306, USA. Electronic address: Jcr09c@med.fsu.edu.
authors.forename: Jarrod C
authors.initials: JC
authors.lastname: Robertson
authors.affiliation: Ketchum, Wood & Burgert Pathology Associates, 1899 Eider Ct. Tallahassee, FL, 32308, USA. Electronic address: kwhit110@gmail.com.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Whithaus
keywords: Case report; Giant; Intraabdominal mass; Renal cell carcinoma; Retroperitoneal tumor; Surgical oncology