case_images: PMC10614438_01
case_images: Preoperative CT and intraoperative imaging examination. a Plain scan showed a heterogeneous mass about 175 x 130 mm in size on the right kidney, with multiple low-density shadows and nodular calcification. b Significant enhancement of the arterial mass. c The mass density is relatively low compared with the parenchyma of the venous stage. d Coronal mass. e A mass on the sagittal plane. CT, computed tomography.
case_images: uin-2023-0107-0008-531059_F01.jpg
case_images: PMC10614438_01_uin-2023-0107-0008-531059_F01.jpg
case_images: F1
case_images: The arterial mass was significantly enhanced and was supplied by the right renal artery without metastasis (Fig. 1a-e).
case_images: Arteriography: (a) before embolization of the main and branch of the right renal artery; (b) After embolization of the main and branch of the right renal artery. Intraoperative landscape: (c) intraoperative mass and severe adhesion of inferior vena cava (arrow indicates inferior vena cava). Gross specimen: (d) complete tumor capsule can be seen by naked eye; (e) the inside of the tumor is gray yellow, gray red, soft, partially translucent, and the kidney is severely squeezed to the side. HE staining: (f) tumor cells were distributed in glandular or solid form, with eosinophilic cytoplasm, oval or polygonal karyotype, fine chromatin, low ISUP grading, and unclear nucleoli (x400). Immunohistochemistry: (g) positive expression of SDHB antibody in the remaining renal tubules (x200); (h) absence of SDHB expression in tumor cells (x200).
case_images: uin-2023-0107-0008-531059_F02.jpg
case_images: PMC10614438_01_uin-2023-0107-0008-531059_F02.jpg
case_images: F2
case_images: For this patient, open radical resection of the right kidney was initially considered, and selective and super-selective embolization of the main and partial branches of the right renal artery was performed before surgery (Fig. 2a, b). During the operation, the tumor seriously adhered to the inferior vena cava (Fig. 2c), which was clearly demarcated from other tissues and organs. The gross specimen showed that the tumor was 205 x 195 x 95 mm in size, round in shape, with a complete capsule and brown color (Fig. 2d). Inside the tumor, it was gray yellow and gray red, soft and partially translucent, and the kidney was severely squeezed to one side (Fig. 2e). ISUP grading, and no apparent nucleoli (Fig. 2f). Immunohistochemistry indicated that SDHB antibody was positive in the remaining renal tubules (Fig. 2g). SDHB was lost in tumor cells (Fig. 2h).