case_images: PMC11736278_01
case_images: Computed tomography image and gross findings. (A) Computed tomography scan reveals a well-defined, huge, solid-cystic tumor with focal enhancement (arrow). (B) A well-demarcated large solid tumor with cystic change in the renal pelvis.
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case_images: Abdominal pelvic computed tomography showed a large cystic lesion measuring 8 cm in diameter with peripheral and septal enhancement in the left kidney (Fig. 1A). A well-demarcated, lobulated, solid, and firm tumor measuring 9.5 cm x 7.5 cm x 5.0 cm was identified in the renal pelvis (Fig. 1B).
case_images: Microscopic and immunohistochemistry findings of the tumor. (A) Solid growth pattern separated by fibrous septa. (B) Cystic change. (C) Necrosis. (D) Vascular networks with extravasated red blood cells. (E) Round to oval tumor cells with vesicular nuclei, irregular nuclear membrane, inconspicuous nucleoli, and clear to eosinophilic cytoplasm. (F) Increased mitotic activity (circles) up to 23/10 high-power field. (G) Diffuse strong nuclear positivity for TLE1. (H) Focal nuclear positivity for cyclin D1. (I) Diffuse cytoplasmic and membranous positivity for BCL2. (J) Diffuse membranous positivity for CD56. (K) No immunopositivity for CD99. (L) CD34 highlighted vascular networks.
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case_images: Microscopic examination revealed that the mass was composed of solid sheets of small round to oval or spindle cells, interspersed with fibrous septa (Fig. 2A). The mass exhibited focal cystic change, hemorrhage, necrosis, and focal hyalinization (Fig. 2B, C). A delicate vascular network was observed with extravasated red blood cells (Fig. 2D). At high-power magnification, the tumor cells exhibited vesicular nuclei, pale chromatin, and inconspicuous nucleoli (Fig. 2E). TLE1 and focal nuclear positivity for cyclin D1 (Fig. 2G, H), diffuse cytoplasmic and membranous positivity for BCL2 (Fig. 2I), and membranous positivity for CD56 (Fig. 2J). The tumor cells were negative for CD99 (Fig. 2K). CD34 immunostaining showed extensive vascular proliferation within the tumor (Fig. 2L).
case_images: Patient clinical course after left radical nephrectomy. VAC/IE, vincristine, adriamycin, cyclophosphamide alternating with ifosfamide and etoposide; HD-IF, high-dose ifosfamide.
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case_images: The clinical course following nephrectomy is depicted in Fig. 3.