Small renal tumor with lymph nodal enlargement: A histopatho
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Renal cancer with lymph nodal mass on the investigation is clinically suggestive of an advanced tumor. Small renal cancers are not commonly associated with lymph nodal metastasis. Association of renal cell carcinoma with renal tuberculosis (TB) in the same kidney is also rare. We report here a case of small renal cancer with multiple hilar and paraaortic lymph nodes who underwent radical nephrectomy, and histopathology report showed renal and lymph nodal TB too.

Case Report:
A female, aged 54 years, without any co-morbid illness was incidentally detected to have a renal tumor. Computerized tomography-urogram revealed a 39 mm × 34 mm, exophytic, solid, enhancing lesion, with the necrotic area within in the left kidney, with multiple enlarged paraaortic and left renal lymph nodes. There was no obvious abnormality in the rest of the parenchyma or the urinary tract. A laparoscopic radical nephrectomy was performed during which multiple enlarged lymph nodes were seen in the renal and paraarotic region. The entire specimen was sent for histopathology.The final histopathology was reported as conventional clear cell carcinoma, Fuhrman Grade II with tuberculous nephritis. The paraaortic lymph nodes were reported as tuberculoid granulomas, with no tumor metastasis.The search for tubercular bacilli performed in urine and sputum after surgery was negative. Neither had the preoperative chest radiograph showed any signs of TB. A quadruple anti-tubercular regimen was subsequently started. The patient is on regular follow-up and is doing well...