Fig. 1

a Initial MRI scan PADUA 12p. b Tumor thrombus occupying the renal vein. c Back-table tumor resection and renal reconstruction. d MRI scan showing tumor-recurrence laterally in the autotransplanted kidney in the right iliac fossa. a–d MRI-images and photographs demonstrating a rare case of an extensive clear cell renal cell carcinoma of the lower pole, extending into the renal hilum and forming a venous tumor thrombus in the inferior vena cava grades PADUA 12p (a). A radical nephrectomy, cavotomy, and tumor-thrombectomy were performed (b). In ice water, a tumor resection and renal reconstruction was undertaken (c) followed by autotransplantation. Local recurrence occurred at 48 months, and a partial nephrectomy of the autotransplanted kidney was undertaken. Finally at 105 months, a nephrectomy was performed for a second recurrence (d). At 42 months after nephrectomy, a systemic therapy was introduced for metastases