PMC5730422_01
Abdominal computed tomography (CT) scan showing active extravasation of a segmental renal artery (A, arrow), with a 17 x 8 x 4 cm retroperitoneal hematoma (B, arrow), and also a hematoma (retrospectively tumor) near the renal hilus (B, asterisk). Nephrographic phase revealed no urinary extravasation of the affected kidney, but with poor function (C, arrow).
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Multiphase abdominal computed tomography confirmed an active extravasation from a segmental renal artery during the arterial phase (Fig. 1A), with a consecutive 17 x 8 x 4 cm retroperitoneal hematoma (Fig. 1B), and also a hematoma near the renal hilus (Fig. 1B). Nephrographic and delayed pyelographic phase images revealed no urinary extravasation, but with poor function of the affected kidney (Fig. 1C).
Angiography demonstrating pathological vascular displacement caused by a centrally located mass and pathological tumor vessels (A, arrows). Transversal Maximum Intensity Projection Reconstruction (MIP) of the CT retrospectively showing the displacement as well (B, arrows).
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Retrospectively, the angiography was suggestive of a pathological vascular displacement caused by a centrally located mass (Fig. 2A-B). 24 hours later open surgery due to hemodynamic instability was necessary resulting in hematoma evacuation (2.5 L) and nephrectomy.
Hematoxylin and eosin staining of the tumor (A) and positive immunohistochemical staining for CD99 (B), Bcl-2 (C) and TLE1 (D).
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Immunohistochemical staining showed positive reactivity for CD99, bcl-2, and TLE1 but not CK7, CK20, S-100, synaptophysin, smooth muscle actin, desmin, myogenin and h-caldesmon (Fig. 3).
SYT FISH probe showing fused green and orange signals (white arrow) and split-aprat green and orange signals (red arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Molecular fluorescence in situ hybridization (FISH) analysis showed the t(X;18)(p11;q11) chromosomal translocation thus confirming a diagnosis of monophasic spindle cell synovial sarcoma (Fig. 4).