case_images: PMC10836450_01
case_images: Axial and coronal sections of a heterogeneously enhancing left renal tumor
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case_images: Ultrasonography, chest X-ray, and contrast computerized tomography (CT) scan of the abdomen and pelvis revealed a large, enhancing irregular mass of size 15.9 cm x 15.1 cm x 16.2 cm arising from the upper pole of the left kidney, with compression of the pancreas and involvement of the renal sinus [Figure 1].
case_images: (a) Resected specimen, (b) Photomicrographs showing alveolar pattern with an abundant amount of eosinophilic granular cytoplasm, (c) Immunopositivity for TFE3 (nuclear), and (d) Cathepsin K (cytoplasmic)
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case_images: Few of the cells demonstrated scattered PAS-positive, diastase-resistant cytoplasmic granules [Figure 2].
case_images: Electron micrographs: (a) Prominent Golgi apparatus, (b) Neurosecretory granules (arrow), (c) Numerous needle-shaped crystals, and (d) Rhomboid crystals
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case_images: S100, AMACR, MITF, and ALK were negative [Figure 3]. SDH-B immunoexpression was retained. Ultrastructural examination revealed well-developed smooth endoplasmic reticulum, prominent Golgi apparatus, occasional neurosecretory granules, and numerous needles to rhomboid-shaped crystalline structures [Figure 3].