PMC4531551_01
Abdominal CT scan showing 12x10 cm-sized, well-defined mass on the lower pole of the left kidney. The mass shows heterogenous enhancement.
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Abdominal computed tomography (CT) scan showed a well-defined mass with heterogenous enhancement on the lower pole of the left kidney with hilar infiltration, measured to be 12x10 cm in size (Figure 1).
The cut surface of the mass shows grayish-white mixed with focal necrosis and hemorrhage.
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The cut surface of the mass was grayish-white mixed with focal necrosis and hemorrhage (Figure 2).
Microscopic study revealed a highly cellular tumor composed of mitotically active, atypical plump spindle cells, and indistinct cell borders arranged in short, intersecting fascicle (H&E, x200).
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A light microscopic finding revealed a highly cellular tumor composed of mitotically active (to the degree about 30 mitoses/10 high power field), atypical plump spindle cells, and indistinct cell borders arranged in short and intersecting fascicles, mainly involving the renal pelvis with extension to the renal cortex and capsule (Figure 3).
Immunostaining for vimentin shows positive reaction (x 20).
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On immunohistochemical stains, the tumor cells showed positive reaction to vimentin (Figure 4), but showed negative reactions to cytokeratin, epithelial membrane Antigen (EMA), S-100 protein, and CD34.
Chest CT scan shows hematogenous dissemination of variable sized, multiple nodular opacities with vascular connection in the entire lobe of the right lung.
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Chest CT scan showed variable sized, nodular opacities with vascular connection in the entire lobe of the right lung (Figure 5).
Microscopic findings of PTNB of the lung nodule show plump spindle cells, of which are consistent with renal synovial sarcoma (H&E, x200).
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Percutaneous transthorasic needle biopsy (PTNB) on the right lower lung nodule was performed, and the pathologic finding was consistent with renal synovial sarcoma (Figure 6).
Follow-up chest CT scan shows complete disappearance of multiple nodular opacities after 6 cycles of chemotherapy.
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After 6 cycles of chemotherapy, complete remission was achieved (Figure 7).