PMC5460381_01
Axial CT images of the (a) right kidney with the largest mid-kidney mass and corresponding gross image [inset] and (b) left kidney with largest upper pole mass.
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Computed Tomography (CT) at that time showed a left upper pole 3.2 cm mass, left lower pole 1.4 cm mass, a right mid-kidney 6.6 cm mass, and an upper pole 2.1 cm mass (Figure 1) which were felt to be stable from a prior CT. Several months later, a radical nephrectomy of the right kidney was performed (Figure 1, inset).
Representative photomicrographs of the CCPRCC component. (a) H&E section shows tubular, papillary, and cystic components of classic CCPRCC with low-grade clear cells in linear alignment (x20) with (b) CAIX showing positivity in a "cup-like" pattern (x20), (c) diffuse positivity for CK7 (x10), and (d) GATA3 showing diffuse staining (x10).
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Pathologic evaluation showed a 6.5 cm CCPRCC, ISUP (International Society of Urological Pathology) grade 2, of the mid-lower pole which was limited to the kidney (Figure 2).
Representative photomicrographs of the well-differentiated neuroendocrine tumor component. (a) H&E section shows the nested pattern of the well-differentiated neuroendocrine cells (x10) with invasion into the hilar fat; (b) synaptophysin (x20) and (c) chromogranin (x10) are diffusely positive.
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Just adjacent to the CCPRCC, a microscopically separate 1.5 cm well-differentiated neuroendocrine tumor was identified focally invading the hilar fat (Figure 3).