Organ-Confined Giant Renal Cell Carcinoma: A Case Report and Literature Review.

Giant renal cell carcinoma (RCC) is a rare clinical entity with no universally accepted definition, typically used to describe exceptionally large renal tumors. With the widespread use of cross-sectional imaging, such massive tumors are increasingly uncommon. Tumor size is generally considered a prognostic factor; however, its correlation with biological behavior remains variable. We report the case of a 53-year-old female who presented with progressive abdominal distension over two years, associated with recent-onset abdominal discomfort and constipation. Clinical examination revealed a large, firm, non-tender abdominal mass occupying the left hemiabdomen and crossing the midline. Contrast-enhanced computed tomography demonstrated a large heterogeneous mass arising from the left kidney, measuring 25 cm × 23 cm × 18 cm, with no evidence of vascular invasion, lymph node involvement, or distant metastasis. The patient underwent left open radical nephrectomy via a midline transperitoneal approach. Intraoperatively, a massive renal tumor was identified, with challenging hilar dissection due to its size. The renal vessels were successfully controlled, and the tumor was excised en bloc. Enlarged para-aortic lymph nodes were removed. Histopathological examination confirmed clear cell RCC, staged as pT2bN0M0. The resected tumor weighed approximately 8.2 kg. Lymph nodes were negative for metastasis. The postoperative course was uneventful, and no adjuvant therapy was administered. This case highlights that even extremely large RCCs may remain organ-confined without nodal or distant metastasis, demonstrating a discordance between tumor size and biological aggressiveness. It underscores that tumor size alone may not reliably predict metastatic potential and supports the role of upfront radical nephrectomy as an effective treatment strategy in selected patients with giant but resectable tumors.