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Objectives: Giant hydronephrosis, defined as the presence of a liquid volume over 1000 ml within the urinary collector system, is a rare clinical entity, the diagnosis of which is an excellent exercise because it lacks of a defined clinical presentation., Methods/results: We report the case of a 66-year-old male under study for a suspicious digestive tumor due to a long lasting clinical picture with severe cachexia, asthenia, anemia, constipation, and abdominal mass. Radiological tests showed a great right hydronephrosis secondary to a culculus in the ureteral-pelvic junction. Simple nephrectomy was performed, evacuating 7800 ml of serous-hematic liquid from the pyelocalicial system. A histological diagnosis revealed the presence of multiple foci of transitional cell carcinoma and renal cell carcinoma associated. We review the diagnostic and therapeutic features in the literature., Conclusions: Giant hydronephrosis represents a diagnostic dilemma. It may present as an asymptomatic process, with clinical features of abdominal organs compression (bowel or urinary obstruction) or simulate abdominal tumors, massive ascites, or cystic retroperitoneal lesions. Simple nephrectomy is the treatment of choice in most cases, due to the advanced deterioration of the renal unit. Nevertheless, in some cases, in compromised patients, percutaneous drainage may be necessary as previous or definitive treatment to avoid changes in the hemodynamic balance secondary to the sudden abdominal decompression.

Peculiar renal carcinoma tendency to unusual distant metastases suggest this primary neoplasm to be accounted in differential diagnosis of metastases as first clinical symptom of cancer. Renal cell carcinoma present metastases in 26-30% of cases at the time of diagnosis. Head and neck metastases from renal carcinoma are said to be present in 8% (6-15.2%) of patients, and half of them are asented on paranasal sinuses. We report a 70-years-old patient with recurrent epistaxis as first clinical sign of a nasosinusal metastases from renal disseminated carcinoma, who precised selective embolization. Epidemyologic, diagnostic and therapeutical aspects are briefly reviewed in literature. Nasosinusal metastases are uncommon in clinical practice. We emphasized the need of primary tumor investigation in the organs most often responsible for these metastasic deposits as: kidney (50%), lungs, breast, gastrointestinal tract, urogenital ridge and thyroid gland. Individualized treatment depends on leasions number and localization. On routine follow up of hipernephroma nephrectomized patients a high suspect index has to be considered as paranasal metastases can eventually occur.