A 19-year-old woman presented with nausea. vomiting and bilateral loin pain of increasing intensity and duration which was unresponsive to antispasmolytic agents. Two months prior to admission the pain was predominantly localized to the right lumbar region and was associated with several episodes of painless haematuria, pyrexia, elevated blood glucose and 20 kg weight loss.Physical examination revealed severe cachexia, tenderness and pain on palpation of the right lumbar region. A large ill-defined mass was palpable. Abdominal ultrasonography showed an extensive tumour mass involving the right hdney. Hepatomegaly , splenomegaly and pancreatic enlargement were also identified.An intravenous urogram showed a right spaceoccupying lesion with distortion of the pelvicalyceal system. Renal arteriography revealed hypertrophied venous vessels but no hypervascularization. Computed