PMC9055886_01
Abdominal CT images with contrast. CT images of the abdomen in coronal (A) and axial (B) planes with contrast enhancement demonstrating a large left retroperitoneal mass.
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F1
This ultimately prompted computed tomography (CT) imaging which revealed a small left lung effusion, two nodules of the right lung, left hemidiaphragmatic elevation, and a 20-cm centrally necrotic neoplasm in the left upper quadrant (Figure 1).
Primary tumor histology. Under low magnification (x40), the lesion can be seen arising in the kidney (A). Under higher magnification (x100), the lesion is composed of pleomorphic eosinophilic cells with prominent nucleoli (B), with some tumor cells intimately associated with vessels (C), and extensive necrosis (D).
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F2
On microscopy, atypical mitoses, pleomorphic eosinophilic cells with prominent nucleoli, and extensive necrosis were identified (Figure 2).
Lung metastasis tumor histology with immunohistochemical staining. The metastatic foci in the lung (original magnification x100) have similar morphology compared to the primary lesion on H&E (A). By immunohistochemistry, these lesions are positive for MART1 (B), HMB45 (C), and Cathepsin K (D).
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F3
On immunohistochemistry, both the primary lesion and the metastatic foci were positive for MART1, HMB45, and Cathepsin K, patchy positive for SMA, and negative for Pankeratin, PAX8, S100, and Inhibin (Figure 3).
Abdominal CT image. CT image demonstrating massive tumor recurrence in the liver after surgical resection of primary tumor and prior to initiation of temsirolimus.
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F4
At 4 months follow-up from the VATS, a restaging CT scan demonstrated an enlarged liver with numerous low-density masses within the liver, including a conglomerate of masses within the right lobe of the liver, and an increase in the size and number of pulmonary nodules (Figure 4).