CT study revealed a large mass in the left kidney with mixed hyperattenuating hypervascular soft tissue components and hypoattenuation areas indicative of necrotic tissue.

A core-needle biopsy was requested by the oncologist. The procedure was made with the patient in ventral decubitus, local anesthesia, and one shot with 18G core-needle, without any complications. 

Histopathological study revealed a clear cell renal cell carcinoma.

A surgery approach was proposed.