case_images: PMC11810624_01
case_images: (A) Contrast-enhanced MRI abdomen and pelvis (axial section) shows significantly enhanced left renal mass about 7 x 7.4 cm with mixed T1/T2 signal intensity (yellow arrow). (B) Contrast-enhanced MRI pelvis (Coronal section) shows T2signal intensity soft tissue pedunculated lesion about 2 x 2.5 cm along the right lateral wall of the urinary bladder (pink arrow).
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case_images: Subsequent abdominopelvic computed tomography (CT) and MRI confirmed the presence of an ill-defined contrast-enhanced tumor in the middle and lower poles of the left kidney, measuring about 7 x 7.4 cm (Figure 1A). Furthermore, the MRI of the pelvis identified a contrast-enhanced lesion in the urinary bladder, measuring approximately 2.5 x 2.5 cm, located on the right lateral wall (Figure 1B).
case_images: (A) An anterior left subcostal incision is utilized for left radical nephrectomy. (B) Left renal mass of about 7 x 7 cm irregular in shape, non-capsulated, reddish-brown in color with areas of hemorrhage and mild infiltration of perinephric tissue (yellow arrow) and renal pelvis (green arrow). (C) An endoscopic view of the bladder tumor shows 2 x 2.5 cm solitary, pedunculated growth along the right lateral wall of urinary bladder.
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case_images: Both resected specimens were submitted for histopathological examination (Figure 2A-C).
case_images: (A, B) The hematoxylin and eosin stain (H&E) of renal and bladder growth shows a similar fashion of epithelial cells with clear cytoplasm and prominent nuclei arranged in nests with intervening branching vascular tissue.
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case_images: In gross appearance, an ill-defined hard mass pressing the hilum on one side, with detailed analysis, yielded a renal tumor that was non-capsulated, with areas of hemorrhage and necrosis, along with cystic spaces, and depicted novel findings indicative of the clear cell carcinoma subtype of renal cell carcinoma in both tumors on microscopy (Figure 3A,B) and involvement of the perinephric and peri-pelvic area in the renal specimen (Figure 4A,B).
case_images: (A, B) The Hematoxylin and eosin (H&E) stain of renal tissue shows the involvement of perinephric fat and pelvicalyceal area respectively.
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case_images: In gross appearance, an ill-defined hard mass pressing the hilum on one side, with detailed analysis, yielded a renal tumor that was non-capsulated, with areas of hemorrhage and necrosis, along with cystic spaces, and depicted novel findings indicative of the clear cell carcinoma subtype of renal cell carcinoma in both tumors on microscopy (Figure 3A,B) and involvement of the perinephric and peri-pelvic area in the renal specimen (Figure 4A,B).
case_images: (A) Immunostaining of bladder specimen shows positivity for PAX 8 expression (200 x) suggestive of the renal origin of the tumor. (B) Immunostaining of bladder tissue stains negative for GATA 3 expression (200 x) suggestive of no association with urothelium.
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case_images: On immunohistochemical staining, the metastatic bladder tumor was PAX 8 positive with GATA 3 negative, suggestive of the renal origin of the tumor and no association with the urothelium respectively (Figure 5A,B).