PMC4880432_01
Physical examination showing darkening and thickening of the skin. Note the darkening skin in the neck and the velvety appearance in the infra axillary region.
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The skin of the neck, axillary, and inframammary regions was darkened and thickened with a velvety appearance, which is consistent with the clinical diagnosis of acanthosis nigricans (AN) (Figure 1).
Axial computed tomography of the abdomen after intravenous contrast medium injection showing a large, heterogeneous and mixed attenuating mass anteriorly displacing the left kidney.
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It anteriorly displaced the renal hilum, which was apparently without invasion (Figure 2).
Photomicrography of the skin showing epidermal thickening due to "finger-like" papillomatosis and hyperkeratosis without melanocytic proliferation.
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The pathological findings were consistent with AN (Figure 3).
Gross findings of the formalin fixed surgical specimen. A and B - The huge extension of the tumor presentingthe golden color in some areas due to the intracellular lipid accumulation.
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The remaining renal tissue showed the corticomedullary limit, which was partially preserved in less than 10% of the kidney (Figure 4).
Photomicrography of the tumor. A and B - nests and sheets of epithelial cells with clear cytoplasm and distinct cell membrane, interspersed by a rich network of thin-walled vascular tissue (H&E, 200X). C and D - Note areas of eosinophilic cytoplasm (often seen in high-grade neoplasm) and nuclei of pleomorphic size and shape with loose chromatin, and the presence of macronucleoli characterizing the Fuhrman 4 nuclear grading.
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The microscopic examination showed that the morphology was consistent with renal clear-cell carcinoma (Figure 5), Fuhrman 4 nuclear grade with necrosis extending into nearly 40% of the neoplasia.
Skin examination of the neck region 50 days after tumor removal. Note the almost complete disappearance of the acanthosis nigricans in this area.
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The post-operative period was uneventful and the patient was discharged on the seventh post-operative day with skin bleaching (Figure 6).