case_images: PMC6778928_01
case_images: Contrast-enhanced MRI of the abdomen on initial staging of the renal tumor. (a) Coronal T1-weighted image and (b) axial T2-weighted image demonstrated a left renal mass in the upper pole of the left kidney with cystic areas (arrows).
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case_images: fig1
case_images: He had a previous history of RCC (Figure 1) when he underwent left nephrectomy 11 years before (pT2, pV0, and pN0; Fuhrman grade 1).
case_images: Contrast-enhanced CT of the abdomen 11 years after the left nephrectomy. (a) Coronal and (b) axial images showed two solid-cystic splenic masses (arrows) with heterogeneous enhancement, infiltrating the diaphragm (arrowhead).
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case_images: fig2
case_images: The lesions extended through the splenic capsule and abutted the left diaphragm (Figure 2).
case_images: Contrast-enhanced MRI of the abdomen 11 years after the left nephrectomy. (a) Axial T2-weighted image and (b) axial postcontrast T1-weighted image depicted two solid-cystic splenic masses (arrows), infiltrating the diaphragm (arrowhead).
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case_images: PMC6778928_01_CRIM2019-7480479.003.jpg
case_images: fig3
case_images: Magnetic resonance imaging (MRI) was requested for further evaluation and demonstrated the splenic masses, with lobulated contours, heterogeneous signal intensity, and central necrotic areas (Figure 3).
case_images: Positron emission computed tomography (PET/CT) scan of the whole body showed two splenic masses (arrows) indistinct on CT without intravenous contrast (a), with increased FDG uptake (SUV 9,0) (b), and without other suspicious lesions (c).
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case_images: fig4
case_images: Additionally, a whole-body positron emission tomography scan (PET/CT) was performed, and it revealed an increase in FDG uptake within the splenic mass (SUV: 9.0), without other suspicious lesions (Figure 4).
case_images: Surgical specimen of splenectomy demonstrated two lobulated yellowish lesions within the spleen (a, b). A portion of the left diaphragm was also resected due to the adhesion process (c, arrowhead).
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case_images: fig5
case_images: On pathological examination, the spleen had two yellowish lesions (Figure 5), measuring up to 6.0 cm.
case_images: Detail of the neoplasm, composed of nests and solid sheets of cells with abundant and clear cytoplasm. The nuclei are enlarged with some conspicuous nucleoli (H&E 200x).
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case_images: fig6
case_images: Immunohistochemistry assay was positive for CK8/18, CD10, PAX8, and vimentin, being consistent with metastases of clear cell RCC (Figures 6 and 7).
case_images: The neoplastic cells expressed CK8/18 (a), CD10 (b), PAX8 (c), and vimentin (d), being consistent with metastasis of clear cell renal carcinoma.
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case_images: fig7
case_images: Immunohistochemistry assay was positive for CK8/18, CD10, PAX8, and vimentin, being consistent with metastases of clear cell RCC (Figures 6 and 7). It is important to note that PAX8 fixation was positive for nuclear staining although weak likely due to poor splenic parenchyma fixation (Figure 7(c)).