case_images: PMC11447487_01
case_images: Sections of CECT abdomen (A) sagittal, (B) coronal, (C) axial. Suggestive of a deformed right kidney with soft tissue mass the size of 11 x 7 x 6.5 cm in the mid and lower pole extending to the hilar region with the compression of pelvicalyceal system and an upper pole calculi the size of 2.4 x 1.2 cm. Post contrast examination showed inhomogenous enhancement of the mass with no evidence of contrast excretion from the kidney.
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case_images: PMC11447487_01_JKCVHL-11-010-g001.jpg
case_images: F1
case_images: Abdominal and pelvic computed tomography (CT) scan revealed a deformed right kidney with soft tissue mass of size 11 x 7 x 6.5 cm in the mid and lower pole extending to the hilar region, with compression of pelvicalyceal system and an upper pole calculus of size 2.4 x 1.2 cm (Figure 1).
case_images: Intraoperative picture. Suggestive of opened up duodenum after radical nephrectomy.
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case_images: PMC11447487_01_JKCVHL-11-010-g002.jpg
case_images: F2
case_images: The procedure involved the excision of the infiltrated mass in the duodenum with subsequent repair of the duodenum and the creation of feeding jejunostomy and retrograde duodenostomy (Figure 2).
case_images: Microscopic images of the tumour. (A) Tumor with dual morphology H&E, 4x; (B) Tubulo-papillary architecture H&E, 4x; (C) Lined by columnar epithelial cells with nuclear pseudostratification with enlarged moderately pleomorphic oval to elongate nuclei, finely dispersed chromatin, visible nucleoli, and pale eosinophilic scant cytoplasm. H&E, 40x; (D) Tumor foci arranged in lobules, nests and sheets separated by intervening delicate fibrovascular septae H&E, 4x; (E) Large polygonal cells with moderate to markedly pleomorphic enlarged irregular nuclei, with dispersed chromatin, visible to prominent nucleoli and scant eosinophilic to clear cytoplasm H&E, 40x; (F) Intervening large areas of necrosis H&E, 4x.
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case_images: PMC11447487_01_JKCVHL-11-010-g003.jpg
case_images: F3
case_images: Immunohistochemistry performed showed diffuse positivity in the tumor cells for OCT-3/4 of moderate to strong intensity; patchy cytoplasmic granular staining for alpha-fetoprotein (AFP) was noted mostly in the solid areas:focal cytoplasmic granular positivity for alpha-methylacyl-CoA racemase (AMACR) and focal membranous positivity for CD10:and were negative for PAX-8, CD117, GATA-3, Vimentin, and CD30 (Figures 3 and 4).
case_images: Immunohistochemistry images. (A) Near diffuse positivity in the tumor cells for OCT-3/4 of moderate to strong intensity, 20x; (B) Patchy cytoplasmic granular staining for AFP is noted mostly in the solid areas, 20x; (C) Negative for PAX-8, 40x; (D) Negative for Vimentin 40x; (E) Retained nuclear expression of INI-1 40x; (F) Negative for CD30, 10x.
case_images: JKCVHL-11-010-g004.jpg
case_images: PMC11447487_01_JKCVHL-11-010-g004.jpg
case_images: F4
case_images: Immunohistochemistry performed showed diffuse positivity in the tumor cells for OCT-3/4 of moderate to strong intensity; patchy cytoplasmic granular staining for alpha-fetoprotein (AFP) was noted mostly in the solid areas:focal cytoplasmic granular positivity for alpha-methylacyl-CoA racemase (AMACR) and focal membranous positivity for CD10:and were negative for PAX-8, CD117, GATA-3, Vimentin, and CD30 (Figures 3 and 4).
case_images: Immunohistochemistry. (A, B) Focal incomplete membranous staining for CK-7 and CK-20 is noted in the papillary areas, DAB, 40x.
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case_images: PMC11447487_01_JKCVHL-11-010-g005.jpg
case_images: F5
case_images: There was no loss of expression of INI-1; focal incomplete membranous staining for CK-7 and CK-20 was noted in the papillary areas (Figure 5).