case_images: PMC3970454_01
case_images: (a) and (b) show the presence of the renal lesion with multilobulated shapes, in the left kidney, 90 mm (LD) x 85 mm (TD) x 96 mm (APD) in size. (c) and (d) show the extension and the location of the renal lesion, mass infiltrates the renal pelvis and the mid calyx (c), and proximal ureter was encased but not infiltrated (d). Arrows indicate the lesion. (a) Axial CT scan, precontrast phase. (b) CECT, multiplanar reconstruction (MPR) Coronal Plane. (c) CECT-MPR: Sagittal Plane. (d) Axial-CECT, urographic phase.
case_images: CRIM2014-473431.001.jpg
case_images: PMC3970454_01_CRIM2014-473431.001.jpg
case_images: fig1
case_images: The lesion was 90 mm (Longitudinal Diameter-LD) x 85 mm (Transversal Diameter-TD) x 96 mm (Anteroposterior Diameter-APD) sized (Figures 1(a), and 1(b)). The mass infiltrated the renal pelvis and the mid calyx (Figure 1(c)); proximal ureter was encased but not infiltrated (Figure 1(d)).
case_images: Images show the contrastographic behavior of the renal lesion and its relations with the surrounding anatomical structures. The lesion showed an inhomogeneous enhancement after contrast medium administration due to the presence of solid parts (a), and many colliquative-necrotic areas and intralesional calcifications (b) were also seen. An enlargement of the ipsilateral splenic vein, 9 mm sized, (c) and many intralesional collateral vessels (d) were seen. (a) CECT-MPR-Sagittal Plane. (b) CECT-Arterial Phase-Axial. (c) CECT-Venous phase-Axial. (d) CECT-Arterial phase-Axial.
case_images: CRIM2014-473431.002.jpg
case_images: PMC3970454_01_CRIM2014-473431.002.jpg
case_images: fig2
case_images: The mass showed an inhomogeneous enhancement after contrast medium administration due to the presence of solid parts; many colliquative-necrtotic areas and intralesional calcifications were also found (Figures 2(a) and 2(b)). An enlargement of the ipsilateral splenic vein, 9 mm sized (Figure 2(c)), and many intralesional collateral vessels were also observed (Figure 2(d)).
case_images: Images show the presence of a round-lesion at the pancreatic istm; the lesion hypodense in the precontrast study (a), appeared hypervascularized in all the three phases of the exam ((b), (c), (d), and (e)). Circles indicate the lesion. (a) Precontrast-Axial. (b) CECT-Arterial Phase-Axial. (c) CECT-Venous Phase-Axial. (d) CECT-Venous Phase. Coronal Plane. (e) CECT-Late Phase-Coronal Plane.
case_images: CRIM2014-473431.003.jpg
case_images: PMC3970454_01_CRIM2014-473431.003.jpg
case_images: fig3
case_images: The lesion, isodense in the precontrast scans (Figure 3(a)), after contrast medium administration, appeared hypervascularized in all the three phases of the study with a rich vascular supply (Figures 3(b), 3(c), 3(d), and 3(e)) and was referable, due to its contrastographic behavior, to a local metastasis or to a primitive neuroendocrine tumor.
case_images: Images show the presence of the nodular lesion in the posterior basal segment of the inferior right lobe ((a) and (b)) and the pancreatic lesion after the treatment appeared hypodense due to necrotic-colliquative phenomena ((c) and (d)). (a) Axial CECT-Arterial Phase. (b) MPR-Coronal Plane-Lung Window. (c) CECT-Axial Plane. (d) CECT-MPR-Coronal Plane.
case_images: CRIM2014-473431.004.jpg
case_images: PMC3970454_01_CRIM2014-473431.004.jpg
case_images: fig4
case_images: CECT total body scan was performed. CECT scan showed in the posterior-basal segment of the inferior right lobe, close to the pleural wall, a solid nodular lesion, 10 mm (LD) x 8 mm (TD) x 8 mm (APD) sized (Figures 4(a) and 4(b)). The hypervascularized pancreatic lesion was not more observed; a hypodense round-shaped lesion in the same region was observed (Figures 4(c) and 4(d)) which was a colliquative-necrotic outcome of the therapy.
case_images: Images show the absence of local relapses after the surgery in the left kidney (a) and in the lung (b); the hypodense pancreatic lesion was not more detectable at the pancreatic istm and no other pancreatic lesions were seen (c). (a) CECT-MPR-Coronal Plane. (b) CECT-Axial. Lung Window. (c) CECT-Axial. Arterial Phase.
case_images: CRIM2014-473431.005.jpg
case_images: PMC3970454_01_CRIM2014-473431.005.jpg
case_images: fig5
case_images: The following CECT exams showed the outcomes, such as metallic clips, of the left nephrectomy and surrenalectomy (Figure 5(a)), and of the resection of the lung metastasis (Figure 5(b)); no local relapses were seen in both the organs. The previous hypodense lesion seen at the istm of the pancreas totally regressed and no other pancreatic lesions were observed (Figure 5(c)).