What is the differential diagnosis?

What is the most likely diagnosis?

The most likely diagnosis is local recurrence of RCC possibly within a retrocaval or paracaval LN or within the R adrenal gland.

Less likely possibilities include a primary adrenal tumor, retroperitoneal sarcoma, lymphoma or metastatic cancer such as from testicular cancer. Given a history of R Radical nephrectomy a diagnosis of local recurrence of RCC must be considered highly likely.

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What other evaluation should be considered as the next step?