case_images: PMC10769506_01
case_images: Axial (a1, b1, a3, b3) and coronal (a2, b2) images from CT scan examinations performed by the patient in June 2022 (a1, a2, a3) and in October 2022 (b1, b2, b3). Baseline CT scan showed a 11 x 8.5 x 10.5 cm exophytic mass with contrast enhancement originating from the middle/lower third of the right kidney. Focal lack of a surgical plane of cleavage with the back muscles was observed (a1, a2). Several nodules in the right and in the left lung were described (a3). The CT scan performed 3 months after the beginning of the oncological treatment showed a significant size reduction and the lack of contrast enhancement of the renal mass (b1, b2) and the vanishing of the lung metastases (b3). CT, computed tomography.
case_images: cro-2024-0017-0001-535460_F01.jpg
case_images: PMC10769506_01_cro-2024-0017-0001-535460_F01.jpg
case_images: F1
case_images: The radiological examination showed a 11 x 8.5 x 10.5 cm exophytic mass with a heterogeneous structure, lobular profile, and contrast enhancement originating from the middle/lower third of the right kidney (Fig. 1a1, a2). Several nodules both in the right and in the left lung were also described (Fig. 1a3). A significant size reduction of the renal lesion was described, the longest diameter of the mass now measuring 4.6 cm (Fig. 1b1, b2). The CT scan also revealed the vanishing of the lung metastases (Fig. 1b3).
case_images: Sections are from renal mass biopsy and stained as labeled. The renal biopsy revealed tumor cells with abundant and vacuolated cytoplasm and large nuclei with variably prominent nucleoli (a, b). Tumor cells were positive to PAX8 (c) and CAIX (d) immunohistochemical staining and negative for CTSK (e). FH expression was preserved (f). Based on the morphological and immunohistochemical features, the patient was diagnosed with a clear cell RCC. H&N, hematoxylin and eosin; CAIX, carbonic anhydrase IX; CTSK, cathepsin K; FH, fumarate hydratase.
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case_images: PMC10769506_01_cro-2024-0017-0001-535460_F02.jpg
case_images: F2
case_images: The radiological examination showed a 11 x 8.5 x 10.5 cm exophytic mass with a heterogeneous structure, lobular profile, and contrast enhancement originating from the middle/lower third of the right kidney (Fig. 1a1, a2). Meanwhile, an ultrasound-guided percutaneous biopsy of the renal mass was performed, revealing a PAX8+, CAIX+, and cathepsin K- clear cell RCC (Fig. 2). A significant size reduction of the renal lesion was described, the longest diameter of the mass now measuring 4.6 cm (Fig. 1b1, b2).
case_images: Sections are from surgical specimen and stained as labeled. The histopathological examination described coagulative necrosis foci with cholesterin, apoptotic bodies, and neutrophils surrounded by histiocytes (a-c). CK-PAN immunohistochemical staining was negative as no viable tumor cells were present (d). Histiocytes were positive to CD163 (e) and PGM1 (f) immunohistochemical staining. H&N, hematoxylin and eosin; CK-PAN, pan-cytokeratin.
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case_images: PMC10769506_01_cro-2024-0017-0001-535460_F03.jpg
case_images: F3
case_images: No viable tumor cells were present, classifying this as pCR (Fig. 3).