Johan (64 years old)

Johan, a 64-year-old psychologist known for his skill in untangling even the most puzzling client dilemmas, once spent an hour trying to analyse his cat's peculiar obsession with his shoelaces. Despite his expertise, the mystery remained unsolved.

Unfortunately, he was recently diagnosed with RCC.

Assessment summary:

• ECOG PS: 1
• No relevant comorbidities
• Thoracoabdominal and pelvic CT scan: centrally located left kidney tumour of 10 cm, extension into vena cava, LN involvement

He underwent radical nephrectomy of the left kidney combined with tumour thrombectomy and removal of 2 enlarged lymph nodes 18 weeks ago.

Pathological findings:

• pT3bN1 tumour of 11 cm, with extension into vena cava below diaphragm
• WHO/ISUP grade 4 ccRCC
• Tumour necrosis present
• Sarcomatoid features 10%
• Negative surgical margins

The patient had a slow recovery due to post-surgery complications and comes to you for check-up. Post-surgery thoracoabdominal and pelvic CT scan: N0M0.