PMC7652618_01
CT imaging prior to nivolumab/ipilimumab treatment: (a) axial imaging demonstrating the heterogeneously enhancing left renal mass; (b) coronal imaging demonstrating the enlarged retroperitoneal lymphadenopathy.
CRIU2020-8846135.001.jpg
PMC7652618_01_CRIU2020-8846135.001.jpg
fig1
There was a 13.9 cm incidentally noted left renal mass concerning for renal cell carcinoma (Figure 1(a)). Upon further work-up, he was noted to have significant retroperitoneal and iliac lymphadenopathy, the largest measuring 6.4 cm (Figure 1(b)).
Fine needle aspiration from retroperitoneal lymph node biopsy. (a) Cytologic preparation (40x magnification) showing abundant large, pleomorphic tumor cells consistent with renal cell carcinoma. Small lymphocytes and neutrophils are present in the background for scale. (b) Cell block (20x magnification) demonstrating tumor cells with significant nuclear pleomorphism. Some cells have rhabdoid features with an eccentric nucleus and abundant eosinophilic cytoplasm. (c) PAX8 immunohistochemical staining is positive in the tumor cells, highlighting the renal origin.
CRIU2020-8846135.002.jpg
PMC7652618_01_CRIU2020-8846135.002.jpg
fig2
He underwent a biopsy of the retroperitoneal lymph nodes in November 2018 which was consistent with metastatic poorly differentiated renal cell carcinoma (Figures 2(a)-2(c)).
CT imaging after nivolumab/ipilimumab treatment: (a) axial imaging demonstrating significant decrease in size of the renal mass; (b) coronal imaging demonstrating resolution of the bulky retroperitoneal lymphadenopathy.
CRIU2020-8846135.003.jpg
PMC7652618_01_CRIU2020-8846135.003.jpg
fig3
Follow-up imaging revealed a significant decrease in disease burden with only subcentimeter retroperitoneal lymphadenopathy and shrinkage of the primary tumor to 9.5 cm (Figures 3(a) and 3(b)).
Final pathologic analyses of resected tumor specimen. (a) Resected tumor showing treatment effect (4x magnification). Large parts of the lesion are replaced by fibrosis with infiltrating lymphocytes. The relationship to normal viable kidney parenchyma is shown in the bottom right corner. (b) Resected tumor (4x magnification) demonstrating that the center of the lesion is entirely necrotic. No viable tumor cells remain.
CRIU2020-8846135.004.jpg
PMC7652618_01_CRIU2020-8846135.004.jpg
fig4
Pathology of the specimen returned as having no identifiable residual tumor present, with only extensive fibrosis, necrosis, chronic inflammation, hemorrhage, and edema (Figure 4).