PMC4891575_01
32-year-old male with multifocal renal carcinoid and thyroid metastases. A. Contrast-enhanced coronal reformatted CT shows horseshoe kidney with enhancing nodules within the isthmus and a large enhancing lesion within right moiety with an area of necrosis; additional lesions are present. [Powerpoint Slide]
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The largest lesion within the right renal moiety measured 14.5 x 10.5 cm (Fig. 1A). There was mild bilateral hydronephrosis thought to be secondary to the renal masses. He was also noted to have a 2.5 x 1.9 enhancing left adrenal lesion (Fig. 1B). CT scan through the thorax revealed multiple 1-2 cm low density nodules scattered throughout both lobes of the thyroid gland, which were confirmed on ultrasound (Fig. 1C), and a 1 cm low density lesion along the left lateral pleural surface. A CT guided fine needle aspiration (FNA) of the right kidney mass showed numerous single cells and small tissue fragments composed of a monotonous population of cells with oval to round nuclei, fine chromatin and a moderate amount of granular eosinophilic cytoplasm (Fig 1D). Virtually all cells were strongly positive by immunohistochemistry for synaptophysin (Fig 1E), a neuroendocrine marker, and pancytokeratin (AE1,3), but negative for renal cell carcinoma (RCC) antigen and thyroid transcription factor (TTF-1). An FNA of the thyroid lesion showed identical morphological and immunohistochemical findings (Fig 1F).