Introduction Primary sarcomas constitute only 1%-2% of malignant renal tumors in the adulthood and are usually found as incidental tumors1.Excluding Wilms tumors, leiomyosarcomas (LMSs) account for the majority of primary classifiable sarcomas arising in the kidney. Hence the clinical and treatment related information in the English literature is quite limited2. Case Report A seventy one year old male with morbid obesity had complaints of vague upper and left sided abdominal pain which was progressively getting worst for past six months. He also had experienced few episodes of hematuria in last two months in late 2009.He also had lost 20 pounds in the same time frame. At times he felt nauseous and quite weak. In February 2010, he had severe left sided abdominal pain not responding to regular non steroidal anti inflammatory drugs. The patient reported to local emergency. He had no other associated systemic symptoms. He had old history of myocardial infraction and obstructive sleep apnea. On clinical examination, the patient was very ill. There was an obvious swelling in left flank which seems to be moving with respiration. The mass was ballotable from the loin somewhat lobular to palpation. Urine analysis confirmed presence of red blood cells. Urine culture and cytology was negative for malignant cells. The basic blood work and renal panel was normal. Cardiac event was ruled out. Intravenous pyelogram showed normal right kidney but left kidney failed to concentrate the dye. The radiological appearances raised concern of a mass arising from the left kidney. CT scan of the abdomen confirmed a large heterogeneous mass arising from the left kidney measuring around 8.5 cm and metastatic foci within the left adrenal gland. There was evidence of lymphadenopathy medial to the kidney near the left renal hilum (Figure 1).
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