case_images: PMC3189466_01
case_images: X-ray of the pelvis (anterior-posterior) showing pathological fracture of the left femur neck (arrow).
case_images: CRIM2011-432917.001.jpg
case_images: PMC3189466_01_CRIM2011-432917.001.jpg
case_images: fig1
case_images: The patient was placed on nonweight-bearing status of the left hip after a fall. 3 months later he suffered a pathological fracture to the left femur neck (Figure 1).
case_images: PMC3189466_02
case_images: MRI and CT scan (inset (a) without IV contrast and (b) with IV contrast) of the abdomen and pelvis showing a large heterogeneously enhancing (inset (b)) exophytic left renal mass measuring 11.6 x 10.7 cm with multiple small calcifications (arrow inset (a)).
case_images: CRIM2011-432917.002.jpg
case_images: PMC3189466_02_CRIM2011-432917.002.jpg
case_images: fig2
case_images: The findings could be confirmed by MRI (Figure 2).
case_images: Whole body bone scan performed after left hip replacement showing mild salt-and-pepper appearance to the skull, sternum, and posterior ribs. The axial skeleton and the posterior left hemipelvis showed increased radionuclide activity suggestive of metastatic disease to these regions.
case_images: CRIM2011-432917.003.jpg
case_images: PMC3189466_02_CRIM2011-432917.003.jpg
case_images: fig3
case_images: There was also increased radionuclide activity at the posterior left hemipelvis, suggestive of metastatic disease to the axial skeleton and the lower appendicular skeleton (Figure 3).
case_images: H&E stainings ((a) 200x and (b) 400x magnification) of the tumor showing a mixture of spindle cell (predominant) and epithelioid cells with abundant amphophilic, clear, and focally granular pink cytoplasm. Epithelioid cells often line spaces, spindle cells form fascicles.
case_images: CRIM2011-432917.004.jpg
case_images: PMC3189466_02_CRIM2011-432917.004.jpg
case_images: fig4
case_images: Necrosis is not present (Figure 4).
case_images: Radical nephrectomy specimen demonstrating an intact kidney mass without perinephric fat measuring 18 x 12 x 7 cm and weight of 920 g. The tumor appears as solid, tan-pink, and well-circumscribed mass grossly confined by the renal capsule. Of note is the extensive number of dilated blood vessels and lymphatics.
case_images: CRIM2011-432917.005.jpg
case_images: PMC3189466_02_CRIM2011-432917.005.jpg
case_images: fig5
case_images: The uninvolved renal parenchyma was unremarkable (Figure 5). 
case_images: Immunostaining demonstrating strong nuclear positivity for TFE3 protein with only minimal background staining.
case_images: CRIM2011-432917.006.jpg
case_images: PMC3189466_02_CRIM2011-432917.006.jpg
case_images: fig6
case_images: PAS with and without diastase and colloidal iron stains was equivocal (Figure 6). TFE-3 was present (Figure 6).