PMC9300938_01
Upper abdominal computed tomography (CT) of the patient. (A) After more than 3 months' therapy with crizotinib in May 1, 2020, both kidneys have uniform density and no abnormity. (B) After 5 months' therapy in June 27, 2020, the right kidney appeared to have new slightly low-density lesions; the larger one was about 10 mm in diameter. (C) After more than 6 months' therapy in August 20, 2020, the right kidney appeared to have slightly low-density lesions larger than in June 27, 2020, and the larger one was about 13 mm in diameter, and the right kidney appeared to have a new low-density lesion, whose diameter was about 18 mm. Upper abdominal enhanced CT in October 2, 2020 (D) showed that multiple low-density lesions in and around the right kidney were enlarged and partially new; the larger one was about 24 mm in diameter.
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Until May 1, 2020, the reexamination of upper abdominal computed tomography (CT) showed that no obvious abnormality was observed in both kidneys ( Figure 1A ). In June 27, 2020, the examination of upper abdominal CT showed that the right kidney was occupied and the other lesions of this patient were evaluated to be stable ( Figure 1B ). In August 20, 2020, the reexamination of upper abdominal CT showed that the right renal lesion ( Figure 1C ), which was suspected to be a malignant tumor, not excluding metastatic tumors, was larger than in June 27, 2020, but the other lesions of this patient were still evaluated to be stable. In October 2, 2020, the examination of upper abdominal enhanced CT showed that multiple low-density lesions in and around the right kidney were enlarged and partially new ( Figure 1D ) compared to August 20, 2020 ( Figure 1C ).
CT-guided biopsy of the right renal lesion in August 24, 2020 and in September 4, 2020, respectively, The pathologic result revealed respectively that (A) there was fibrous tissue with extensive inflammatory cell infiltration and (B) there was lymphocytic infiltration in the stroma, but no tumor was observed. (C) After laparoscopic radical nephrectomy of the right kidney under general anesthesia, postoperative pathological analysis revealed that kidney tissue and perirenal adipose sac presented chronic suppurative inflammation and abscess formation, but still no tumor was observed.
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Figure 2A ). For a more cautious diagnosis, the patient accepted PET-CT examination in September 1, 2020, the results of which showed that the mass lesion of the right kidney was likely a malignancy ( Figure 3 ). The pathologic result still did not find tumor cells ( Figure 2B ). Eventually, postoperative pathological analysis revealed renal abscess formation ( Figure 2C ).
The result of the PET-CT examination in September 1, 2020 showed that there were two low-density foci in the parenchyma of the right kidney. The larger one had a higher metabolism, possibly a malignant lesion.
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Figure 2A ). For a more cautious diagnosis, the patient accepted PET-CT examination in September 1, 2020, the results of which showed that the mass lesion of the right kidney was likely a malignancy ( Figure 3 ).
Upper abdominal enhanced CT (A) in December 3, 2020; the right kidney was not shown and the left kidney appeared to have a new low-density mass, about 11 mm in diameter, with marginal enhancement. (B) In February 18, 2021, after more than 2 months of crizotinib withdrawal, the patient revealed that the abnormal enhancement of the left kidney was not obviously displayed.
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In December 3, 2020, when the patient re-checked enhanced CT of the chest and upper abdomen, although the result revealed that the lung tumor was stable (the right kidney was not shown), the left kidney appeared to have abnormal enhancement ( Figure 4A ). After more than 2 months, via enhanced CT of the abdomen, the abnormal enhancement of the left kidney was not obviously displayed ( Figure 4B ).