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With the increased use of advanced imaging techniques, incidental renal mass have become a very frequent finding (1). Approximately 13 to 27% of abdominal imaging studies incidentally identify a renal lesion , a fact that makes suspected renal cell carcinoma be diagnosed at an early stage (2). Most excised small renal cancers are classified as low grade at the time of diagnosis and synchronous metastases are very infrequent finding associated to such small lesions (3). Although partial nephrectomy remains the reference standard for treatment of small renal masses, the guidelines of the American Urological Association support consideration of thermal ablative techniques for the treatment of patients with T1a disease (< 4 cm) (4). Furthermore, the development of ablative techniques has widened the range of treatment options available to these patients and international consensus panels support other indications for ablative therapy for renal tumors (patients with a increased risk of multiple RCC tumors – e.g. von Hippel–Lindau syndrome, clinical conditions not suitable for surgery and solitary or transplanted kidney) (5).

Which is the best treatment on a 2 cm complete endophitic tumor on the posterior side of the left kidney?