CLINICAL HISTORY
A 49-year-old male with no significant past medical history presented with a three-month history of left lower back pain associated with poor appetite and weight loss. No palpable mass was noted on physical exam. The patient does not smoke nor does he have a family history of carcinoma. The patient underwent and abdominal CT scan which showed an enlarged left kidney with a cortical mass (shown below). The patient underwent left nephrectomy. A CT scan taken three months later showed an irregular osteolytic lesion with sclerotic margins. Bone marrow biopsy was also performed.
LABORATORY DATA
Noncontributory.
ANCILLARY STUDIES
The abdominal CT. CT scan showed an enlarged left kidney (Figure 1). A cortical mass is present (Figure 2). Vertebral bodies CT scan showed a dense spiculated lesion.
GROSS PATHOLOGY
The bisected kidney (Figure 3 and Figure 4) shows:
- A wedge-shaped, yellow 2.2 cm mass in cortex extending from capsule into the medulla;
- The pelvis and the ureter are grossly unremarkable;
- The remaining cortex and perinephric fat are grossly unremarkable.
MICROSCOPIC PATHOLOGY
- The mass is composed of oval- to spindle-shaped cells with large vesicular nuclei and prominent nucleoli. Few lymphocyes are also present (Figure 5).
- Areas of necrosis are also present (Figure 6).
- The mass extends into the perinephric fat (Figure 7).
- Urothelial lining of the collecting system does not show any dysplasia (Figure 8).
The bone marrow showed similar tumor. The tumor showed positive staining for keratin and vimentin. It was negative for Ulex, CD31, and CD34. |
