PMC7478167_01
Coronal view of computed tomography of abdomen/pelvis revealing a large left renal mass with direct extension into the left gonadal vein.
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F1
Subsequent computed tomography (CT) imaging revealed a 16-cm left-sided renal mass with caudal tumor extension and bulky regional lymphadenopathy along the left gonadal vein (Figure 1).
Axial view of computed tomography of the abdomen and the pelvis revealing a heterogeneous appearance of the uterus.
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F2
Upon further review of the abdominal and pelvic CT scan, there was a heterogeneous appearance of the uterus, which had been assumed to be related to fibroids (Figure 2).
Gross examination of the surgical specimen revealed a large necrotic left renal mass extending via the gonadal vein to the uterus and bilateral ovaries.
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F3
The mass invaded the perinephric fat abutting Gerota's fascia, the hilar fat, calyces, and distorted the renal sinus (Figure 3). Grossly, the uterus showed approximately 70% of the endomyometrium involved by the tumor and necrosis, with diffuse tan-white nodularity on the serosal surface (Figure 3).
Microscopic evaluation of the tumor revealed nests of clear cells surrounded by interconnecting vascular framework, consistent with the ultimate diagnosis of clear cell renal cell carcinoma.
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F4
These findings rendered a diagnosis of left kidney clear cell RCC, which extended into the renal vein, left ovarian vein and uterus, left fallopian tube, and bilateral ovaries (Figure 4).