case_images: PMC10468567_01
case_images: Contrast-enhanced CT scan with an irregular soft tissue mass shadow in the left renal pelvis, calyces and upper ureter (A-D), the mass was significantly enhanced in the arterial stage (B-D). Multiple nodular dense shadows were observed in both kidneys (A-D). (The tumor was showed by white arrows, and the calculi was showed by yellow arrows.).
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case_images: The patient underwent contrast-enhanced computed tomography (CT) scan during a health check-up, which revealed bilateral renal calculi, a soft tissue mass in the left renal pelvis, calyces and upper ureter, therefore, a tumorous lesion was suspected ( Figures 1A-D ).
case_images: Contrast-enhanced MRI scan was performed (A-D), and it showed an enlarged left kidney, and a soft tissue mass was seen in the renal pelvis, calyces and upper ureter, and with bilateral renal calculi. (The tumor was showed by white arrows, and the calculi was showed by yellow arrows).
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case_images: T2WI showed a mixed, slightly high signal, and DWI showed an inhomogeneous high signal ( Figures 2A-D ). A nodular T2WI low signal was observed in the bilateral calyces( Figures 2A-D ).
case_images: Macroscopic view of the tumor (white arrow) (A). Microscopic overview of the tumor (B, E). [Hematoxylin-eosin staining, x100 (B), x400 (E)] TFE3 and TFEB fluorescence in situ hybridization (FISH) assay on paraffin embedded tissue. TFE3 and TFEB gene Break Apart Probes, confirmed the TFE3 gene rearrangement in tumor cells (one red and one green signals) (C), and no TFEB gene break rearrangement detected (D).
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case_images: The specimen was excised, and a soft tissue mass was seen from the upper pole of the kidney to the renal pelvis and upper ureter, with a size of about 10 x 7 cm, clearly demarcated from the surrounding tissues ( Figure 3A ). Hematoxylin-eosin (HE) staining and pathology considered as RCC, to be further confirmed by immunohistochemical examination ( Figures 3B, E ). TFEB gene break rearrangement detected ( Figure 3D ). The postoperative pathological stage was pT2bN0M0, stage I. There was no intestinal tube injury or other complications perioperatively. The patient was satisfied with the treatment. The patient was discharged from the hospital 8 days after surgery, and was followed up regularly for 4 months with no secondary infection, intestinal obstruction or local recurrence.
case_images: Immunohistochemistrical (IHC) analysis (A-I): (A) CAIX(-), (B) CD10 (+), (C) CK7(-), (D) CK20 (-), (E) Ki-67 (about 5%+), (F).AMACR (+), (G) PAX8 (+), (H) TFE3 (+), (I) vimentin (-), considered to be MiT family translocation RCC (in the left upper urinary tract). (x400).
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case_images: PMC10468567_01_fonc-13-1197578-g004.jpg
case_images: f4
case_images: CAIX (-), CD10 (+), CK7 (-), CK20(-), Ki-67 (about 5%+),AMACR (+), PAX8 (+), TFE3 (+) and vimentin (-), indicated MiT family translocation RCC (in the left upper urinary tract) with massive necrosis ( Figures 4A-I ). Considering the previous findings and the immunohistochemical examination, MiT family translocation RCC was suspected, and performing molecular testing was suggested to further confirm the diagnosis.