Renal cell carcinoma with an unusual presentation

A 24-year-old woman presented to Accident and Emergency with a 2 day history of gradually worsening left upper-quadrant abdominal pain associated with pyrexia and with intermittent hypertension over the past year. Abdominal ultrasonography showed a welldefined 10 cm mixed echogenic mass superior to the left kidney. A computed tomography (CT) scan showed a 1012 cm soft tissue mass in the left upper abdomen between the left kidney and the spleen, with a welldefined smooth outline (Figure 1). The exact location of the lesion was uncertain, as the left adrenal gland was not properly visualized. Magnetic resonance imaging (MRI) showed the mass attached to the upper pole of the left kidney, showing multiple locules containing fluid with the adrenal gland compressed medially (Figure 2). A metaiodobenzylguanidine (MIBG) scan showed areas of increased uptake lying above the left kidney, suggesting a phaeochromocytoma. A venogram was performed to ensure this was a separate mass to the kidney and it showed that the relative functions of both kidneys were equal (50%). Urinary and plasma