case_images: PMC6296204_01
case_images: Ultrasonography of the right kidney.. Notes: (A) Giant complex cystic-solid mass (10.1x8.0 cm) with inhomogeneous liquid dark area and high-echo stripes on the medial aspect of the right kidney; (B) colored blood-flow signals displayed on the margins of the mass, which was located close to the right kidney.
case_images: ott-11-9027Fig1.jpg
case_images: PMC6296204_01_ott-11-9027Fig1.jpg
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case_images: All this was accompanied by an inhomogeneous liquid dark area and strong-echo stripes (Figure 1).
case_images: Enhanced computed tomography (CT) scan showing a cross-sectional view of the urinary system.. Notes: (A) Fusion of both renal lower poles and hydronephrosis due to a large, well-circumscribed mass located medial to the right renal hilum. (B) Spherical cystic-solid mass (9.5x8.7 cm) of heterogeneous density with CT-attenuation values of 18-35 HU, likely arising from the anteromedial aspect of the right half of the horseshoe kidney. (C, D) Renal CT angiogram showing compression of the renal artery and narrow renal veins.
case_images: ott-11-9027Fig2.jpg
case_images: PMC6296204_01_ott-11-9027Fig2.jpg
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case_images: Enhanced computed tomography (CT; Figure 2A and B) and magnetic resonance imaging (Figure 3) scans demonstrated a horseshoe-kidney anomaly with a spherical cystic-solid mass (9.5x8.7 cm), filling the proximal aspects of the right renal collecting system. CT angiography identified blood vessels supplying the tumor region (Figure 2C and D).
case_images: Magnetic resonance imaging of the abdomen, coronal view.. Notes: (A) Large unilocular hilar mass (8x7 cm) in the right kidney with high signal intensity on T2-weighted images. (B) The mass is isointense on T1-weighted images. The horseshoe-kidney anomaly can also be observed.
case_images: ott-11-9027Fig3.jpg
case_images: PMC6296204_01_ott-11-9027Fig3.jpg
case_images: f3-ott-11-9027
case_images: Enhanced computed tomography (CT; Figure 2A and B) and magnetic resonance imaging (Figure 3) scans demonstrated a horseshoe-kidney anomaly with a spherical cystic-solid mass (9.5x8.7 cm), filling the proximal aspects of the right renal collecting system.
case_images: Histological examination of the tumor.. Notes: (A) Low-power view showing nests of tumor cells (H&E, 200x). (B) Pools of mucin lined by malignant glandular epithelium with complex architecture in high-power view (H&E, 400x).
case_images: ott-11-9027Fig4.jpg
case_images: PMC6296204_01_ott-11-9027Fig4.jpg
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case_images: On microscopic examination, pools of mucin were lined by malignant epithelium and areas of inflammation (Figure 4).
case_images: Immunohistochemical analysis showing that the tumor cells were positive for CK20.. Notes: (A) 200x; (B) 400x; (C) CDX2, 200x; (D) CDX2, 400x; (E) villin, 200x; (F) villin, 400x.
case_images: ott-11-9027Fig5.jpg
case_images: PMC6296204_01_ott-11-9027Fig5.jpg
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case_images: Immunohistochemical staining results (Figure 5) suggested gastrointestinal origin (CK20+, CDX2+, villin+, CK7-, PAX8-, ER-, PR-, P53-, Ki67+ cells 50%), indicating that the appendix was the most likely site of origin.