PMC9232330_01
Computed tomography of renal mass demonstrating exophytic and infiltrative components of a 9 cm left interpole renal mass.
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A 69-year-old male with hypertension, gastroesophageal reflux, and hepatitis presented with occasional gross hematuria for one month and was found to have a 9 cm left renal mass infiltrating the collecting system (Figure 1).
H&E-stained sections from the radical nephrectomy showed (a) areas of classic low-grade clear cell renal cell carcinoma (40x) and (b) an exophytic nodule of tumor undermining ureteral epithelium (2x). (c) Higher magnification of tumor invading the ureteral wall shows higher grade nuclei and tumor cells with voluminous and focally eosinophilic cytoplasm undermining urothelium (20x). (d) Transurethral resection of the subsequent bladder tumor showed tumor morphologically identical to that seen in the nephrectomy depicted in panel (c), undermining benign urothelium. (e) PAX8 shows diffuse nuclear labeling consistent with renal cell carcinoma metastatic to the bladder (20x). (f) Subsequent ureteral resection showed clear cell renal cell carcinoma forming an intraluminal mass with benign urothelium above (10x). (g) Focal lymphovascular invasion was noted within the ureteral wall (10x).
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Histologically, the tumor showed classic areas of low-grade clear cell renal cell carcinoma, as well as higher grade areas that demonstrated invasion into renal sinus fibroadipose tissue and ureteral urothelium as well as lymphovascular invasion (Figures 2(a)-2(c)). Pathology demonstrated clear cell RCC (Figures 2(d) and 2(e)). Left ureterectomy with partial cystectomy was performed and pathology again demonstrated metastatic clear cell RCC (Figures 2(f) and 2(g)).
MRI with left distal ureteral recurrence (arrow).
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Five months after transurethral resection of the bladder tumor, a left distal ureteral mass was identified on follow-up MRI (Figure 3).