PMC9677308_01
Abdominal ultrasound showing a heterogeneous right kidney (A) (white arrow)
with a large, irregular, heterogeneous tissue mass at its upper and middle
pole, containing areas of central necrosis (A) (red arrow), and
calcifications (B) (yellow arrow).
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An ultrasound was performed and showed a right retroperitoneal mass with a right renal origin, heterogeneous, with areas of central necrosis and calcifications (Figure 1).
Axial (A and B) and coronal (C) sections of an abdominal MRI scan showing the
presence of a large right retroperitoneal tumor process occupying the right
renal compartment in hypo T1 signal (A) with heterogeneous T2 signal (B),
containing areas of necrosis and enhancing after Gadolinium injection
(C).
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T2 signal, T1 hyposignal, diffusion restriction, containing necrotic areas, and heterogeneously enhancing after Gadolinium injection (Figure 2). This process encompasses almost the entire kidney with capsular effraction and pyelocalic dilatation, it pushes back the adjacent digestive and vascular structures, responsible for a voluminous endoluminal thrombus of the right renal vein, extended to the inferior vena cava and to the right atrium and associated with lombo-aortic adenopathies (Figure 3), evoking in the first place a sarcoma.
Axial (A) and coronal (B) T2 sequences showing reflow of adjacent digestive
and vascular structures (white arrow) and a Voluminous endo-luminal thrombus
of the right renal vein, extended to the IVC and right atrium (yellow
arrow).
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T2 signal, T1 hyposignal, diffusion restriction, containing necrotic areas, and heterogeneously enhancing after Gadolinium injection (Figure 2). This process encompasses almost the entire kidney with capsular effraction and pyelocalic dilatation, it pushes back the adjacent digestive and vascular structures, responsible for a voluminous endoluminal thrombus of the right renal vein, extended to the inferior vena cava and to the right atrium and associated with lombo-aortic adenopathies (Figure 3), evoking in the first place a sarcoma.
Axial sections of thoracic CT in parenchymal window (A) and mediastinal
window (B) showing a metastatic pulmonary nodule (yellow arrow),
subcutaneous emphysema dissecting the right cervical and thoracic soft
tissues (red arrow), and left pleurisy of small to moderate volume (white
arrow).
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A thoracic CT scan was performed for a workup of extension and showed the presence of secondary pulmonary nodules with pleurisy (Figure 4).
(A) Clusters of round cells with reduced cytoplasm and finely nucleated
hyperchromatic with no obvious signs of differentiation. (B) Cytoplasmic
staining of tumor cells by anti-WT1 antibody. (C) Absence of anti-LCA
antibody staining.
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An echo-guided biopsy was performed and the anatomopathological study showed cytoplasmic labeling of the tumor cells by the anti-WT1 antibody, confirming the diagnosis of nephroblastoma (Figure 5).