PMC6694747_01
Abdominal and pelvic non-contrast CT revealing a 36 x 31-mm, well-demarcated, ellipsoid and hypodense mass with a CT value of about 27 Hounsfield units (HU) in the external branch of the right adrenal region. (A) Hypodense lesions with a diameter of 15 mm and 39 mm discovered in the upper (B), and lower (C) poles of the right kidney, respectively. Non-contract CT of the chest suggesting lung metastasis: multiple nodules in both lungs, the largest one being located in middle lobe of the right lung (D).
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F1
Work-up: An abdominal and pelvic non-contrast CT revealed a 36 x 31-mm, ellipsoid, and hypodense mass in the external branch of the right adrenal region (Figure 1A). Hounsfield units (HU). Hypodense lesions with a diameter of 15 mm and 39 mm were discovered in the upper and lower poles of the right kidney, respectively (Figures 1B,C). CT of the chest revealed multiple nodules in both lungs, the largest one being located in the middle lobe of the right lung (Figure 1D). Compared with findings of a follow-up chest CT taken in February 2016, some of the nodules were enlarged, suggesting a metastasis.
TTE revealing a 23.9 x 13.4-mm, hyperechoic mass with a smooth surface in the left atrium, close to the posterior leaflet of the mitral valve, and moving without extension to the outflow tract during the cardiac cycle; the mass was suspected to be a myxoma (A). Repeat TTE showing a 27.7 x 16-mm isoechoic mass attached to the posterior leaflet annulus of the mitral valve in the enlarged left atrium (B).
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F2
TTE was performed, revealing a 23.9 x 13.4-mm, hyperechoic mass with a smooth surface in the left atrium, close to the posterior leaflet of the mitral valve, and moving without extension to the outflow tract during the cardiac cycle (Figure 2A). The patient was then transferred to cardiac surgery department where a repeat TTE showed a 27.7 x 16-mm isoechoic mass attached to the posterior leaflet annulus of the mitral valve in the enlarged left atrium (Figure 2B).
Two specimens of 2.7 x 1.5 x 1.5 cm, and 2 x 1.7 x 0.7 cm (A). They were yellowish and cystic-solid with a tumor pseudocapsule (B,C).
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F3
Two specimens of 2.7 x 1.5 x 1.5 cm and 2 x 1.7 x 0.7 cm were obtained (Figure 3A). They were yellowish and cystic-solid with a tumor pseudocapsule (Figures 3B,C).
Immunohistochemical staining showing positivity for CAIX, CD10, and Vimentin. (A) CAIX (x200). (B) CD10 (x200). (C) Vimentin (x200). (D) Histological examination of the tumor using Hematoxylin & Eosin stain.
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F4
Microscopically, the tumor cells were of clear cytoplasm with an acinar architecture (Figure 4D). Immunohistochemical staining showed positivity for CAIX, CD10,Vimentin, and PAX-8 and negativity for CK7, calretinin, WT1, WT1,CK5/6, CK20, Villin, and CDX2 (Figure 4).