PMC4062383_01
Posterior-anterior view chest X-ray showing left perihilar opacity and medial displacement of the gastric bubble.
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A chest X-ray revealed left peri-hilar opacification with medial displacement of the gastric bubble, raising concerns about splenomegaly (Figure 1).
Abdominopelvic MRI with gadolinium slide showing left renal mass with hydronephrosis and infiltration of the renal artery
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The patient was also sent for an abdomen and pelvis MRI with IV contrast, which revealed massive left hydronephrosis, multiple left renal cystic and solid lesions within the collecting system impairing renal perfusion and several mildly enlarged left para-aortic lymph nodes and osteolytic lesions on L2 and L3 vertebral bodies (Figure 2).
Cellular smear from patient's renal biopsy showing papillary projections (black arrow), fibrovascular core (yellow arrow) and malignant cells (red arrow)
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Biopsy stained positive for keratin AE1/AE3, CD 10, Vimentin, and PAX-2, and focally positive for cytokeratin 7 but negative for thyroid transcription factor 1 (Figure 3).
MRI of the lumbar spine showing osseous extension of primary tumor into left side of L3 vertebra.
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Imaging studies could not rule out cord compression but did not show fracture (Figure 4).