Title: Synchronous Bilateral Renal Tumors: Diagnostic and Therapeutic Challenges - A Case Report
Authors: Hannaoui Ali , Elftouhi Hamza, Ouzidane Yassine, Kbirou Adil, Moataz Amine, Dakir Mohamed, Debbagh Adil, Aboutaieb Rachid
Volume: 9
Issue: 3
Pages: 100-106
Publication Date: 2025/03/28
Abstract:
Introduction: Bilateral renal tumors are rare and pose a significant diagnostic and therapeutic challenge. Clear cell renal cell carcinoma (ccRCC) is the most common histological subtype, with variable clinical presentations and prognosis. This case highlights the complexity of managing synchronous bilateral renal tumors and the importance of a multidisciplinary approach. Case Presentation: We report the case of a 69-year-old obese male with a history of long-standing hypertension and insulin-dependent diabetes mellitus who presented with left lumbar pain and total, non-clotting hematuria. Imaging revealed a 62 × 83.2 mm necrotic mass in the mid-cortical region of the right kidney and a 43.4 × 37.2 mm lesion in the lower pole of the left kidney. The patient underwent a laparoscopic left partial nephrectomy, and histopathology confirmed a clear cell renal cell carcinoma (Fuhrman grade 1, pT1a - R0). One month postoperatively, he developed a perirenal abscess, which was successfully managed with percutaneous drainage. Given the persistent suspicion of malignancy in the right kidney, a percutaneous biopsy was performed but was inconclusive. Follow-up imaging showed tumor progression, necessitating a laparoscopic right partial nephrectomy. Histopathology confirmed a high-grade clear cell renal cell carcinoma (ISUP grade 4, pT3aNxMx) with rhabdoid differentiation, extensive necrosis, and vascular invasion. Discussion: Synchronous bilateral renal cell carcinoma represents a rare entity, requiring individualized management to balance oncologic control and renal function preservation. Partial nephrectomy remains the standard of care for small and intermediate-sized renal masses, especially in bilateral disease. However, high-grade features such as rhabdoid differentiation and extensive necrosis indicate an aggressive tumor biology, necessitating close postoperative surveillance and potential adjuvant therapy. Conclusion: This case underscores the complexity of treating bilateral renal tumors, highlighting the need for a multidisciplinary approach and long-term follow-up. The presence of high-grade features in the right-sided tumor suggests an increased risk of recurrence and metastasis, reinforcing the importance of individualized patient management strategies.