LAUSR

A 68-year-old male had presented with abdominal pain and vomiting of 3 months duration. He had undergone deceased donor renal transplantation 9 years back elsewhere. His general examination was normal. Abdominal examination revealed 15 cm × 15 cm firm palpable mass in the right lumbar region. His renal function tests were normal. Contrast-enhanced computerized tomography (CECT) scan of abdomen revealed encapsulated hypodense retroperitoneal mass lesion with calcification in the right lumbar region [Figure 1a-c]. The mass lesion was arising from the lower pole of the right native kidney with extension posterior to the transplant kidney [Figure 1d]. Subsequently the patient underwent open extraperitoneal exploration in flank position. A 15 cm × 12 cm tensely cystic encapsulated mass was noted between right native and transplant kidney [Figure 2a and b]. The mass was in continuity to the native kidney and densely adherent to psoas sheath. The mass was also adherent to the posterior aspect of the upper pole of the transplanted kidney. The mass along with right native kidney was mobilized all around before reaching the renal hilum. After ligating the renal vein and artery, the mass along with right kidney was removed in toto. Gross pathology revealed surgical sponge inside the tumor mass [Figure 2c]. Histopathology of the native kidney was normal. The patient's postoperative period was uneventful.