PMC8378054_01
Radiological imaging: (a) Computed tomography scan show iso-dense heterogeneous renal mass (arrow); (b) Magnetic resonance imaging show iso-intense right renal mass with solid and cystic areas (arrow).
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The computed tomography (CT) scan showed enhancing heterogeneously iso-dense right renal mass (Figure 1a), and magnetic resonance imaging (MRI) showed heterogeneously iso-intense right renal mass with solid and cystic areas (Figure 1b).
(a) Nephrectomy specimen. Cut sections shows pale resident kidney (short arrow) with cystic degeneration, central necrosis (arrow head) with intact thin capsule that contain pus and necrotic material (long arrow); (b) Haemotoxylin and Eosin (H&E) stained sections show necrotic background with broad-based aseptated fungal hyphae with right-angle branching (x4 magnification); (c and d) (histochemical stain, 20x magnification). (c) Gomori methenamine silver (grocott) and (d) Periodic acid schiff (PAS) highlights the fungal hypae; (e) (x4 magnification) and (f) (x20 magnification and insertion at x50 magnification) show fungal angioinvasion.
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The cut surface showed pale resident kidney with cystic degeneration, central necrosis with pus (Figure 2a). The haematoxylin and eosin (H&E) stained sections of this specimen were similar to the initial renal biopsy finding (Figure 2b) with angioinvasion now noted (Figure 2e, f).