case_images: PMC11325451_01
case_images: MRI imaging of abdomen without IV contrast: Multiplanar T1- and T2-weighted images of the abdomen were obtained without IV contrast. A large and complex mass is seen arising from the right kidney lower pole measuring 11.6 x 8.3 x 12.7 cm.
case_images: JKCVHL-11-033-g001.jpg
case_images: PMC11325451_01_JKCVHL-11-033-g001.jpg
case_images: F1
case_images: Following the renal ultrasound, further work up with chest X-ray showed no evidence of metastases; however, magnetic resonance imaging (MRI) of the abdomen and pelvis without intravenous (IV) contrast revealed an 11.6- x 8.3- x 12.7-cm right lower pole mass with little normal kidney remaining (Figure 1).
case_images: Kidney, right, radical nephrectomy (hematoxylin and eosin [H&E] staining). (A-C) Histologic sections showed variable degrees of epithelial differentiation ranging from more primitive rosette-like structures and cords to well-differentiated mature tubules lined by cuboidal to columnar cells with elongated nuclei; no significant blastemal or stromal component was identified. By immunohistochemistry, tumor cells were positive for (D) WT1 and (E) PAX8 with strong nuclear staining, and variable membranous and cytoplasmic expression of pankeratin I. Additional immunohistochemical staining for BRAF V600E mutation (not pictured) was negative. Overall, the histologic and immunohistochemical features were consistent with epithelial-predominant WT and favorable histology (absent anaplasia). Molecular testing revealed TP53 gene mutation.
case_images: JKCVHL-11-033-g002.jpg
case_images: PMC11325451_01_JKCVHL-11-033-g002.jpg
case_images: F2
case_images: Pathology revealed a 13.8-cm epithelial predominant WT with favorable histology, pT3aN0 (Figure 2).