case_images: PMC11811579_01
case_images: Histopathological findings of testicular metastasis.. A: Hematoxylin and eosin (H&E) staining following right orchiectomy shows tumor cells with vesicular round nuclei, pale eosinophilic to clear cytoplasm and a tubular growth pattern with sheet formation (x200).. B-F: Immunohistochemistry following right orchidectomy reveals AE1/AE3 (B), epithelial membrane antigen (C), CD10 (D) positivity, renal cell carcinoma (RCC) marker (E), and steroidogenic factor 1 (F) negativity (x100).
case_images: cureus-0017-00000077304-i01.jpg
case_images: PMC11811579_01_cureus-0017-00000077304-i01.jpg
case_images: FIG1
case_images: Immunohistochemical analysis revealed AE1/AE3, epithelial membrane antigen, and CD10 positivity and CK7, CK20, RCC marker, and steroidogenic factor 1 negativity (Figure 1).
case_images: Imaging findings at presentation.. A: Computed tomography (CT) shows 24 x 18 mm mass in the upper pole of the left kidney (arrow).. B: 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography reveals multiple enlarged para-aortic lymph nodes with increased FDG uptake (arrow), measuring up to 10 mm in the short axis diameter.. C: Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping showed the restricted diffusion of the corresponding retroperitoneal lymph nodes (arrow).
case_images: cureus-0017-00000077304-i02.jpg
case_images: PMC11811579_01_cureus-0017-00000077304-i02.jpg
case_images: FIG2
case_images: Magnetic resonance imaging characterized the renal lesion as an 18-mm multilocular cystic mass with contrast enhancement at its superior margin (Figure 2A). Suggestive of malignancy, 18F-fluorodeoxyglucose-positron emission tomography/CT revealed tracer uptake in the retroperitoneal lymph nodes (Figure 2B); there was no significant uptake in the renal mass. Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping showed the restricted diffusion of the corresponding retroperitoneal lymph nodes (Figure 2C).
case_images: Histopathological findings of primary renal cell carcinoma and the para-aortic lymph nodes.. A: Hematoxylin and eosin (H&E) staining following robot-assisted left partial nephrectomy and laparoscopic para-aortic lymph node dissection shows a clear cell RCC (x100).. B: Higher magnification shows tumor cells with clear cytoplasm, a low nuclear-to-cytoplasm ratio, and mild nuclear irregularity (H&E, x400).. C: Metastatic involvement of the para-aortic lymph nodes with a characteristic small nest is shown (H&E, x100).
case_images: cureus-0017-00000077304-i03.jpg
case_images: PMC11811579_01_cureus-0017-00000077304-i03.jpg
case_images: FIG3
case_images: However, the treatment was discontinued after two cycles owing to grade 2 glucose intolerance and hypothyroidism secondary to destructive thyroiditis (Common Terminology Criteria for Adverse Events, version 5) (Figure 3).