De novo multifocal renal cell carcinoma in the renal allograft

CASE PRESENTATION A 30-year-old Caucasian male on chronic hemodialysis presents with a 4-day history of right flank pain accompanied by fever, nausea, and anorexia. On physical examination, he had a heart rate of 100 beats per minute and a blood pressure of 147/95mmHg. The abdomen was soft. There was no tenderness or guarding over the allograft, and lymph nodes were not enlarged. His remaining examination was unremarkable. sBlood and urine cultures were negative. The patient had undergone ultrasonographic examination of the allograft every year since 1998 with evidence of simple cysts in the parenchyma (Figure 1a) and a persistent fluid collection adjacent to the lower pole representing a lymphocele. A CT scan of the abdomen showed two sub-centimeter low-density lesions within the enlarged right transplanted kidney, suspicious for an infectious or neoplastic process. A persistent and stable right lower quadrant lymphocele was also present. Aspiration of the lymphocele yielded sterile fluid without evidence of infection. A transplant nephrectomy was performed.