PMC6380140_01
(a) A chest X-ray conducted in the emergency department revealed cardiomegaly and patchy airspace consolidations with infiltrations in the right lung field. (b) One year later, another chest X-ray revealed normal heart size without visible airspace consolidations
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F1
A chest X-ray revealed cardiomegaly and patchy airspace consolidations with infiltrations in the right lung field [Figure 1a]. One year later, a chest X-ray revealed a normal heart size without visible airspace consolidations [Figure 1b], and an echocardiography demonstrated normal left ventricular systolic function.
Magnetic resonance imaging with contrast demonstrated lobulated masses over lower pole of the right kidney (arrow) and left suprarenal area (arrow)
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F2
The masses were confirmed through magnetic resonance imaging [Figure 2].
The gross pictures of right renal mass (a) and left adrenal mass (b). (c) The right renal mass showed compact tumor cells with clear cytoplasm and thin-walled vasculature that were immunoreactive for epithelial membrane antigen (EMA), CD10, and vimentin (x50), indicating clear cell renal cell carcinoma (H and E, x100). (d) The left adrenal mass showed trabecular or solid patterns of polygonal shaped cells with vacuolated cytoplasm that were immunoreactive for S100 and chromogranin-A (x50), indicating pheochromocytoma (H and E, x100)
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F3
Tumors of Endocrine Organs, few foci revealed spindle cell change, nuclear hyperchromasia, and necrosis of tumor cells, indicating biologically aggressive behavior (atypical) pheochromocytoma of the left adrenal gland [Figure 3]. Genetic analysis of the patient revealed no mutation in the coding region of von Hippel-Lindau (VHL) gene.