case_images: PMC11390422_01
case_images: Computerized tomography shows intra-abdominal and hilar lymphadenopathy and no evidence of disease on kidneys (A-C) contrast filling defect at the transition of the pylorus to the duodenal bulb (D, E).
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case_images: PMC11390422_01_fonc-14-1459470-g001.jpg
case_images: f1
case_images: The computerized tomography (CT) was performed 2 days after the admission to the hospital and described intra-abdominal and hilar lymphadenopathy and an infiltrative and stenosing process extending from the pylorus to the duodenal bulb at a length of about 4 cm ( Figure 1 ).
case_images: Intra-abdominal lymph node fine-needle aspiration showing atypical cells (signet ring) infiltration in lymph node (Hematoxylin and Eosin magnification x20) (A). Positive staining for CEA (magnification x20) (B), CKAE1AE3 (magnification x20) (C), CK7 (magnification x20) (D), CK20 (magnification x20) (E) in tumor cells from intra-abdominal lymph node fine-needle aspiration. Black point bar showing tumor tissue. Blue point bar showing normal tissue.
case_images: fonc-14-1459470-g002.jpg
case_images: PMC11390422_01_fonc-14-1459470-g002.jpg
case_images: f2
case_images: Only the endoscopic ultrasound fine-needle aspiration (EUS-FNA) confirmed adenocarcinoma of signet ring cell originating from the digestive system ( Figure 2 ). Immunohistochemistry (IHC) tumor was positive to cytokeratin (CK) 7, CK20, CKAE1AE3, carcinoembryonic antigen (CEA), and negative to thyroid trancription factor 1(TTF1) and littoral cell angioma (LCA) ( Figure 2 ).
case_images: Kidney biopsy showing infiltration of renal parenchyma by PAS positive tumor cells (PAS original magnification x100) (A) and by signet ring tumor cells (H&E, original magnification x200) (B).
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case_images: PMC11390422_01_fonc-14-1459470-g003.jpg
case_images: f3
case_images: The histopathological evaluation revealed mild acute tubular and interstitial damage with tumor thrombi and micrometastasis in the kidney medulla, while there were no glomerular deposits and negative immunofluorescence ( Figure 3 ).
case_images: Positive staining for CDX-2 (magnification x20) (A), CEA (magnification x20) (B), CK7 (magnification x20) (C), CK20 (magnification x20) (D) in tumor cells in kidney biopsy.
case_images: fonc-14-1459470-g004.jpg
case_images: PMC11390422_01_fonc-14-1459470-g004.jpg
case_images: f4
case_images: Immunohistochemistry (IHC) tumor was positive to CK7, CK20, CEA and CDX-2 ( Figure 4 ).