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A 58-year-old gentleman presented with history of fever and left loin pain for three months. On physical examination, he was found to have a renal mass. On laboratory evaluation he was found to be anaemic (PCV 23.8) with thrombocytosis (7,25,000/mm 3 ) and had an elevated ESR (77). His CT abdomen revealed an 11 x 13 cm heterogenously enhancing mass arising from the upper pole of left kidney [Table/ Fig-1]. There was no involvement of the contiguous structures but superiorly, it was adherent to the spleen. aBstRaCtMalignant Fibrous Histiocytoma (MFH) usually arises from the extremities with the retroperitoneum being the second most common site. We present the case report of a 58-year-old man presenting with fever and was detected to have a renal mass on evaluation. He underwent a radical nephrectomy with a preoperative diagnosis of renal cell carcinoma. But the final histopathological report was MFH. Primary renal MFH is extremely rare and is usually diagnosed on histopathology with the aid of immunohistochemistry.keywords: CD 68, Kidney, Radical nephrectomy microscopy: The renal parenchyma was infiltrated by a fairly circumscribed tumour [Table /Fig-2]; with clustered and scattered polygonal cells to spindle cells with markedly pleomorphic, vesicular nuclei and moderate amount of eosinophilic, cytoplasm. There were multinucleate giant cells, foamy macrophages and bizarre tumor cells. The intervening stroma showed many thick collagen bundle and dense infiltrates of lymphocytes, plasma cells, histiocytes, many neutrophils and eosinophils [Table/ Fig-3]. There was focal hyalinization. There was no lymphovascular invasion or nodal involvement. The tumour cells were negative for desmin and myogenin but showed positive staining with CD68 [Table/ Fig-4] on immunohistochemistry. These features were consistent with the diagnosis of inflammatory subtype of malignant fibrous histiocytoma. The tumour infiltrated the sinus fat with rest of the parenchyma being normal. Spleen showed features of congestive splenomegaly but was otherwise free of tumour [Table/ Fig-5].

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Objective To assess feasibility of robot-assisted laparoscopic radical nephrectomy (RALRN) and inferior vena cava thrombectomy (IVCT) in treating renal tumours with level I–III IVC thrombi and to assess their outcomes. Patients and methods We conducted a retrospective analysis of RALRN-IVCTs, involving four centres across India, from September 2015 to June 2019. We analysed patients who underwent RALRN-IVCT for level I–III thrombi according to the Mayo classification. The total operative duration with console time, length of hospital stay, preoperative and postoperative creatinine, IVC clamp time and intraoperative blood loss were recorded. Results Of the 13 patients that underwent RALRN-IVCT, five had a level I thrombus, seven had level II, and one had a level III thrombus. In all, 11 of the patients had right-sided tumours and the remaining two had left-sided tumours. The mean (SD) age of the patients was 56.5 (12.3) years, the mean (SD) operative time was 329.5 (97.22) min, the mean (SD) console time was 222.5 (70) min, the mean (SD) blood loss was 395 (170) mL, and the mean (SD) IVC clamp time was 19.14 (9.5) min. The mean (SD) length of hospital stay was 7.8 (3.27) days. Of the 13 patients, 12 had clear cell renal cell carcinoma (RCC) and one had papillary RCC. The mean (range) follow-up was 19 (4–50) months. One patient had upfront metastasis and two patients developed metastasis, while 10 patients remained disease-free during the follow-up. Conclusion With appropriate patient selection, surgical planning and robotic experience, completely intracorporeal robotic level I–III IVCT is feasible and can be performed efficiently. Larger experiences, with longer follow-ups and comparisons with open surgery are needed to confirm these initial outcomes. Abbreviations ECOG: Eastern Cooperative Oncology Group; IVC: inferior vena cava; IVCT: inferior vena cava thrombectomy; (RAL)RN: (robot-assisted laparoscopic) radical nephrectomy

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