Atypical presentation of renal medullary carcinoma
Renal medullary carcinoma (RMC) is a rare renal neoplasm and highly aggressive. The present case has been reported in the journal Urology Case Reports.

A 68-year-old white male, known case of diabetes, hypertension and no past medical history of sickle cell trait presented with Right-sided loin pain, without hematuria. Ultrasound examination showed a right renal mass. Abdominal computed tomography (CT) scan confirmed the sonographic findings demonstrating a 9 cm mass in the lower pole of the right kidney, with enlargement of regional lymph-nodes and multiple bilateral lung metastases.

His hemoglobin was 14 g/dl, white blood cell count 7.5103/ml and creatinine 1mg/dl. Serum electrolytes and liver function test values were within normal. After the diagnosis, electrophoresis was done for the diagnosis of sickle cell hemoglobinopathy.

The result was negative for sickle cell hemoglobinopathy. Physical examination was unremarkable. Ultrasound-guided true cut biopsy was performed for the renal mass, which microscopically was consistent with renal medullary carcinoma in which tumor cells are positive for PAX8, cytokeratin AE1/AE3, and cytokeratin 7. They were negative for RCC immunostain BAF47 (INI1).

The patient was started on Sutent treatment. A repeat CT scans during one-year follow up showed that the bilateral pulmonary nodules had partial regression and stable right renal mass.

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