case_images: PMC7652618_01
case_images: CT imaging prior to nivolumab/ipilimumab treatment: (a) axial imaging demonstrating the heterogeneously enhancing left renal mass; (b) coronal imaging demonstrating the enlarged retroperitoneal lymphadenopathy.
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case_images: PMC7652618_01_CRIU2020-8846135.001.jpg
case_images: fig1
case_images: There was a 13.9 cm incidentally noted left renal mass concerning for renal cell carcinoma (Figure 1(a)). Upon further work-up, he was noted to have significant retroperitoneal and iliac lymphadenopathy, the largest measuring 6.4 cm (Figure 1(b)).
case_images: Fine needle aspiration from retroperitoneal lymph node biopsy. (a) Cytologic preparation (40x magnification) showing abundant large, pleomorphic tumor cells consistent with renal cell carcinoma. Small lymphocytes and neutrophils are present in the background for scale. (b) Cell block (20x magnification) demonstrating tumor cells with significant nuclear pleomorphism. Some cells have rhabdoid features with an eccentric nucleus and abundant eosinophilic cytoplasm. (c) PAX8 immunohistochemical staining is positive in the tumor cells, highlighting the renal origin.
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case_images: PMC7652618_01_CRIU2020-8846135.002.jpg
case_images: fig2
case_images: He underwent a biopsy of the retroperitoneal lymph nodes in November 2018 which was consistent with metastatic poorly differentiated renal cell carcinoma (Figures 2(a)-2(c)).
case_images: CT imaging after nivolumab/ipilimumab treatment: (a) axial imaging demonstrating significant decrease in size of the renal mass; (b) coronal imaging demonstrating resolution of the bulky retroperitoneal lymphadenopathy.
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case_images: PMC7652618_01_CRIU2020-8846135.003.jpg
case_images: fig3
case_images: Follow-up imaging revealed a significant decrease in disease burden with only subcentimeter retroperitoneal lymphadenopathy and shrinkage of the primary tumor to 9.5 cm (Figures 3(a) and 3(b)).
case_images: Final pathologic analyses of resected tumor specimen. (a) Resected tumor showing treatment effect (4x magnification). Large parts of the lesion are replaced by fibrosis with infiltrating lymphocytes. The relationship to normal viable kidney parenchyma is shown in the bottom right corner. (b) Resected tumor (4x magnification) demonstrating that the center of the lesion is entirely necrotic. No viable tumor cells remain.
case_images: CRIU2020-8846135.004.jpg
case_images: PMC7652618_01_CRIU2020-8846135.004.jpg
case_images: fig4
case_images: Pathology of the specimen returned as having no identifiable residual tumor present, with only extensive fibrosis, necrosis, chronic inflammation, hemorrhage, and edema (Figure 4).