case_images: PMC10542702_01
case_images: CT revealed the mass in the right kidney with a right renal vein thrombosis (black arrows). At non-enhanced CT (A, B), the mass was slightly hyperattenuating compared with the adjacent cortex with calcifications on the caudal side of the mass (white arrow). At dynamic contrast-enhanced CT (C, D, E), the solid portions of the mass were enhanced less intensely compared with the adjacent renal cortex and enhanced more intensely compared with the adjacent renal medulla during the corticomedullary (C) and nephrographic phase (D) of enhancement. The mass showed slight washout during excretory phase (E). There was lymphadenopathy approximately 14 x 8 mm in the right renal hilus (white arrowheads), and metastasis was suspected.
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case_images: F1
case_images: CT, the tumour was approximately 10 cm in size in the right kidney, with calcifications in the caudal portion (Figure 1A-B). Contrast-enhanced studies revealed tumour thrombus extension into the right renal vein (Figure 1C-E) and lymphadenopathy in the right renal hilus (Figure 1C-E).
case_images: At T1-weighted magnetic resonance imaging (MRI) in coronal (A), the right renal mass was slightly hyperintense compared with the renal cortex, with scattered high-intensity areas that appeared to be haemorrhage (arrow). At half-Fourier acquisition single-shot turbo spin-echo (HASTE) T2-weighted imaging (B), the mass has relatively uniform low intensity with a slight mixture of hyperintense areas. The mass appeared to be hyperintense on diffusion-weighted magnetic resonance imaging (MRI) (C).
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case_images: F2
case_images: T1 and T2-weighted imaging, the tumour was slightly heterogeneous and had an abnormal intensity area that was suspicious for haemorrhage (Figure 2A-B). The mass appeared hyperintense on diffusion-weighted MRI (Figure 2C).
case_images: 18F-FDG PET-CT images show that the standardised uptake value (SUVmax) of the right renal mass was 7.14 (arrow).
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case_images: F3
case_images: Notably, the tumour showed partially increased FDG uptake, with a standardised uptake value (SUVmax) of 7.14 (Figure 3).
case_images: PMC10542702_02
case_images: At non-enhanced CT (A), the margins of the mass on the left kidney were hyperattenuating compared with the renal parenchyma, and the interior portion of the mass was hypoattenuating. At contrast-enhanced CT (B, C), the solid portions enhanced less intensely compared with the adjacent renal cortex and enhanced more intensely compared with the adjacent renal medulla. The interior portion of the mass was poorly contrasted, and necrosis was suspected. A capsule-like structure was observed at the tumour margins (arrow). There was lymphadenopathy approximately 25 x 25 mm in the left common iliac area (arrowhead), and metastasis is suspected.
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case_images: F4
case_images: CA125 levels (76.4 U/mL). CT revealed a mass approximately 8.5 cm in size in the left kidney (Figure 4A-B) and lymphadenopathy in the left common iliac area (Figure 4C).
case_images: 18F-FDG PET-CT images (A, B) show that the SUVmax of the mass on the left kidney was 6.25 (arrow). SUVmax of the lymphadenopathy in the left common iliac area was 3.71 (arrowhead), and metastasis was suspected.
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case_images: F5
case_images: FDG PET-CT imaging, performed for staging purposes, showed increased FDG uptake focally in the renal mass and prominently in the lymphadenopathy with respective SUVmax of 6.25 and 7.31 (Figure 5).
case_images: Eosin-stained section of renal tumour: tumour cells with slightly eosinophilic cytoplasm and round nuclei are forming irregular tubular or papillary structure.
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case_images: F6
case_images: TFE-stained section of renal tumour. The nuclei of tumour cells are diffusely positive for TFE3.
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case_images: F7
case_images: CD10 and TFE3 (Figure 7), and negative for CK7. Collectively, the tumour was diagnosed as a TFE3-rearranged RCC.