Spot Diagnosis 31

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This 47 year old women was referred by an office urologist for treatment with suspected diagnosis of renal cancer. She had completely asymptomatic and an ultrasound done for  general health check up had shown a left renal lesion. The ultrasound result was followed by computed Tomography scanning. There was no relevant history of medical disease and the patient had no medications and is a non smoker. Ct scan of the thorax showed no abnormalities and the full abdominal and pelvic CT did not show other lesions. Physical examination and clinical chemistry results were completely normal.

  1. What differential diagnosis should be considered?
  2. Are further investigations needed?
  3. Which treatment is appropriate?

(European Urology Today, March/ May 2016, Clinical challenge, Prof. Oliver Hakenberg)

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