case_images: PMC10335400_01
case_images: Under 200x microscope (A) Tubular area of renal carcinoma: tumor cells arranged in tubular shape, translucent cytoplasm, round nuclei. (B) solid lamellar area of renal carcinoma: tumor cells arranged in solid lamellar shape, translucent cytoplasm, pyknotic/round nuclei, coarse chromatin, visible nucleoli. (C) sarcoma-like area of renal carcinoma: spindling cells, red-stained cytoplasm, coarse chromatin, visible nucleoli. (D) immunohistochemical PAX-8 nuclei, Positive expression.
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case_images: The pathology of our hospital showed the following: the tumor was consistent with renal cell carcinoma ( Figure 1 ), with a histological grade of G3, but was not specifically classified; the tumor was located in the middle and lower pole of the kidney with a maximum diameter of about 8.5 cm, with local necrosis, sarcoma-like changes, tumor invasion of the perineurium, and no invasion of the renal sinus and perinephric fat; no tumor was seen at the ureteral end and renal tip end; and no lymph node was found.
case_images: Before immune-targeted therapy: (A) Retrospective retroperitoneal parietal abdominal aorta and left iliac artery with several foci of slightly large round-like isointense nodules; the larger one is approximately 13 mm*11 mm. (B) Left iliac bone destruction with localized soft tissue shadow. (C) Right upper femur with local bone destruction and soft tissue shadowing. During immune-targeted therapy: (D) Reduced foci of round-like isodense nodules in the retroperitoneal abdominal aorta and left iliac artery; larger nodules are approximately 10mm*7mm. (E) Reduced soft tissue shadowing and less extensive bone destruction in the left iliac bone than before. (F) Similar foci in the right femur as before. Tumor progression: (G) Retroperitoneum with multiple enlarged lymph nodes adjacent to the abdominal aorta and fused with each other, the larger node being approximately 29mm*43mm. (H) The left iliac bone has a reduced soft tissue shadow, (I) the Lesion in the right femur is less extensive than before.
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case_images: Pelvic and abdominal CT revealed enlarged lymph nodes in the retroperitoneal abdominal aorta and left iliac artery ( Figure 2A ). A bone scan and MRI suggested bone metastases in the left iliac bone and proximal right femur ( Figures 2B, C ). According to the RECIST score, the tumor efficacy was classified as partial remission ( Figures 2D-F ). Her joint MRI showed smaller left iliac and right femoral lesions than before, while abdominal MRI suggested new metastases in the liver and larger retroperitoneal lymph nodes than before, suggesting tumor progression ( Figures 2G-I ).
case_images: (A) under 400x microscope Thyroid cytology: Pap stained tumor cells were arranged in solid sheets with medium cytoplasm under 400x Pap staining, irregular nucleus morphology, vacuolated, chromatin border set, thickened nuclear membrane, and deviated nucleoli were seen, which are morphological features of typical papillary thyroid carcinoma. (B) Pap stain 400 times. (C) Picture shows one HE stain 400 times for cell wax block section.The tumor cells can be seen in clusters with three-dimensional distribution, rich cytoplasm, oval or irregular-shaped nuclei, vacuolated, with one or more large red nucleoli and visible nuclear division, which is consistent with the morphological characteristics of adenocarcinoma. (D) Immunohistochemistry TTF-1 positive expression, (E) Immunohistochemistry NapsinA positive expression positive expression of TTF-1 and NapsinA revealed a high probability that the tumor originated from the lung.
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case_images: Thyroid cytology was consistent with the morphologic features of typical papillary thyroid carcinoma on the papillary stain ( Figure 3A ). The anisotropic cells of the neck lymph nodes matched cancer cells ( Figures 3B-E ).
case_images: Timeline of the patient's entire treatment process.
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case_images: The timeline of the patient's entire treatment process was depicted in  Figure 4 .