case_images: PMC10933076_01
case_images: Imaging features of the right renal lesion. The thick yellow arrow is the CCRCC and the thin blue arrow is the CCPRCT. (A-C) Color ultrasound. (A) The boundary between the two masses is clear. (B) The blood flow signals were abundant. (C) High-speed arterial spectrum. (D-F) CT. The density of the CCRCC was lower than that of the CCPRCT in plain scan, and the CCPRCT had some calcifications. Both masses were obviously enhanced in the arterial phase. The CCRCC has cystic areas. The enhancement degree of the two masses decreased during excretion. (G-I) MRI. (G) T1WI (H) T2WI (I) Contrast-enhanced scan.
case_images: fonc-14-1284194-g001.jpg
case_images: PMC10933076_01_fonc-14-1284194-g001.jpg
case_images: f1
case_images: In the subsequent whole-body examination, urinary ultrasound found that there were two masses with a clear boundary ( Figures 1A-C ) in the middle parenchyma of the right kidney with sizes of approximately 38 x 28 mm and 36 x 29 mm respectively. Computed tomography (CT) examination of the urinary system showed two round-like uneven density masses ( Figures 1D-F ) in the middle of the right kidney, with clear boundaries of approximately 32 x 28 mm and 36 x 25 mm, respectively. Magnetic resonance imaging (MRI) revealed that most of the masses showed long T1 and T2 signal intensity ( Figures 1G-I ), small cystic changes could be seen locally, diffusion was not limited, and no clear signal decreased area was found in the inverse phase and fat compression sequence.
case_images: Pathological features of the specimen. (A) General appearance of the specimen. The taupe area (thick yellow arrow) corresponds to the CCRCC and the grey area (thin blue arrow) corresponds to the CCPRCT. (B-D) Histologic features of the specimen. (B) In the lower left part of the image is the CCRCC, the lower right part is the CCPRCT. (C) The CCRCC showed acinar and vesicular arrangement. (H&E, x10). (D) The CCPRCT showed branched tubular and papillary arrangement. (H&E, x10). (E-I) Immunohistochemical results. (E) CD10 (x10) membrane-positive in the CCRCC region. (F) CD10 (x10) cytoplasm-positive in the CCPRCT region. (G) CA9 (x10) intact membrane-positive in the CCRCC region. (H) CA9 (x10) Cup-shaped positive in the CCPRCT region. (I) KRT7 (x4) The CCRCC region (left side of the picture) was partially positive, while the CCPRCT region (right side of the picture) was diffusely positive.
case_images: fonc-14-1284194-g002.jpg
case_images: PMC10933076_01_fonc-14-1284194-g002.jpg
case_images: f2
case_images: Two well-defined tumors were seen in the resected surgical specimen ( Figure 2A ) on the upper part of the kidney. By light microscopy, two tumors with different histological structures were observed ( Figures 2B-D ), of WHO/ISUP grade 2. Table 1 ;  Figures 2E-I ). Fluorescence in situ hybridization (FISH) showed that 24% of the larger tumor had a 3p chromosome deletion, whereas the smaller tumor did not. The FISH data supported the morphological and immunohistochemical findings that two different tumor components were coexisting in the same lesion.