PMC5960536_01
(a) Enhanced CT of the abdomen showing a nonexophytic and hypervascular tumor (arrow) in the right kidney (left) and a cystic lymph node in the aortocaval area (right). (b) Macroscopic findings of the resected specimens showing an ash-colored, tessellated, and fibrous capsuled renal tumor (arrow) in the right kidney (left) and a tense and cystic lymph node (right); bars, 1 cm.
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In our institution, CT showed not only an enlarged and cystic aortocaval node (25 mm x 25 mm), which was located lower than the right kidney, but also a nonexophytic and hypervascular renal tumor (30 mm x 27 mm) (Figure 1). Macroscopic examination of the resected specimens showed an ash-colored, tessellated, and fibrous capsuled renal tumor and a tense and cystic lymph node (Figure 1).
The cancer nests of the epithelial cells with a clear cytoplasm and a distinct cell membrane, separated by many capillary vessels (a) and perinephric fat invasion in the renal tumor (b). The same histological nests are seen in the renal tumor and the cystic lymph node (c).
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On the other hand, in the cystic lymph node, there were the same features as the right renal tumor and a fibrous cystic wall (Figure 2).
Immunohistochemical findings showing many lymphatic ducts expressing D2-40 filled with cancer nests in the kidney (a) and lymph node (b) and the coated cell of the cystic wall expressing D2-40 (c).
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Furthermore, immunohistochemical examination showed that the many lymphatic ducts expressing D2-40 were filled with cancer nests in both the kidney and the lymph node, and a few coated cells of the cystic nodal wall expressed D2-40 (Figure 3).