PMC5122699_01
Preoperative abdominal CT scans. The kidney was enlarged (+- 19,4 x 15 x 10,9 cm) and there was mass in the superior until inferior pole of the left kidney. Contrast imaging shows thrombus-like mass extending from the renal pelvis towards the distal left ureter that enhance after contrast administration (A, arrows) and multiple enlargements of paraaorta and paracaval lymph nodes with size of +- 1,8 cm (B, double arrow) that caused shifting of the aorta and inferior vena cava to the left, pancreas towards the anterior, and narrowing of the left renal vein. Thrombus-like mass have encompass the proximal ureter (C, circle) towards the tortuous length of the ureter (D, arrows). Cystoscopy examination. Normal right ureter orifice (E). Blood clot that originated from the left ureter orifice (F). Note there are no obvious tumorous lesions.
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Laboratory (Table 1), contrast abdominal CT scan (Fig. 1), cystoscopy (Fig. 1) and chest X-ray was performed, no metastasis was found.
Histologic examination. Two types of tumor found: clear (red circle) and papillary cell (blue circle) (A; HE, x40). On Immunohistochemistry examination CD 10 (B) and AMACR (C) was positive suggesting RCC. Thrombus-like tumor (T) inside the ureteral wall (U) (D; HE, x2,5).
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Histologically, there were 2 types of tumor found (Fig. 2A). The tumor had invaded the lymphovascular, pelviocaleceal system, and along the inside of the ureter (Fig. 2D). To further differentiate these 2 types of tumors, we performed immunohistochemistry examination (Fig. 2B and C).