PMC9950125_01
Enhanced Computed tomography revealed a large cystic solid tumor in the left kidney. (A) An arterial enhancement (red arrow); (B) A venous enhancement (red arrow); (C) Coronal plane (red arrow).
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The enhanced computed tomography (CT) scan revealed a 14.3 x 9.4 x 6.8 cm cystic solid mass of the left kidney with retroperitoneal lymph node enlargement (Figures 1A-C).
HE (A, B) and IHC staining (C-H) of UC of the renal pelvis with trophoblastic differentiation. (A, B) HE staining showing the areas of UCTD. (A) x200 (B) x400. (C, D) Positive staining for beta-hCG in syncytiotrophoblastic cells. (C) x200 (D) x400. (E, F) Negative staining for PLAP (E) and hPL (F) in syncytiotrophoblastic cells. (E, F) x100. (G, H) Negative staining for CDX2 (G) and CK20 (H). (G, H) x200.
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Microscopically, a solid HGUC originating from the renal pelvis had numerous scattered bizarre cells or syncytiotrophoblastic cells (Figure 2A). These cells were frequently pleomorphic, with large hyperchromatic nuclei with abundant eosinophilic cytoplasm distributed throughout the UC component (Figure 2B). The immunoreaction of beta-hCG was localized in the cytoplasm of syncytiotrophoblasts with a diffuse, granular around the periphery of UC nests (Figures 2C, D), while urothelial neoplastic cells were negative. However, syncytiotrophoblasts showed negative for PLAP (Figure 2E) and hPL (Figure 2F). In addition, we also performed CDX2 and CK20 to identify UC with glandular differentiation due to the small amount of pseudo glandular architecture; however, the results of IHC staining were both negative (Figures 2G, H).
PET-CT scan showed the patient developed multiple nodules of metastasis in the left renal region, extensive systemic muscle, bone, lymph node, liver and bilateral lung metastases. (A) Multiple nodules of metastasis in the left renal region, extensive systemic muscle, bone, lymph node, liver and bilateral lung metastases. (B) Multiple metastases are seen in bilateral lower limb muscles. SUVmax, maximum of standardized uptake value.
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PET-CT scan showed the patient presented multiple nodules of metastasis in the left renal region (SUVmax7.24), extensive systemic muscle (SUVmax14.28), bone (SUVmax7.25), lymph node (SUVmax13.50), liver (SUVmax1.72) and bilateral lung (SUVmax1.28) (Figures 3A, B).A puncture biopsy of a space occupying lesion in lower limb muscle has confirmed metastatic UC (Figures 4A-F).
HE (A) and IHC staining (B-F) of puncture biopsy tissue of muscle metastatic tumor of left lower limb. (A) Metastatic UC cells diffusely infiltrate the muscle tissue of left lower limb. (B) The nuclei of metastatic tumor cells are scattered positive expression of Ckpan. (C) Tumor cells are diffuse strongly positive expression of Vimentin. (D) The membrane of metastatic tumor cells are strongly positive expression of CD10. [(A-D) x200]. (E-F) The nuclei of metastatic tumor cells are focal positive expression of GATA3. (E) x200 (F) x400.
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PET-CT scan showed the patient presented multiple nodules of metastasis in the left renal region (SUVmax7.24), extensive systemic muscle (SUVmax14.28), bone (SUVmax7.25), lymph node (SUVmax13.50), liver (SUVmax1.72) and bilateral lung (SUVmax1.28) (Figures 3A, B).A puncture biopsy of a space occupying lesion in lower limb muscle has confirmed metastatic UC (Figures 4A-F).