PMC9366061_01
(A) Multislice spiral computed tomography (CT) showing a lobulated soft tissue density nodule above the hilum in the medial upper pole of the left kidney (arrow). (B) The preoperative three-dimensional reconstruction image showing the tumor in the renal sinus (yellow).
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CT value was slightly of lower density in the delayed phase (Figure 1A). CT was considered concerning for renal cell carcinoma. AH + 3 = 7AH. A transabdominal laparoscopic partial nephrectomy of the left kidney was planned, and accurate evaluation and preoperative planning were performed by three-dimensional (3D) visualization and reconstruction technology (Figure 1B).
Real-time image of intraoperative ectopic adrenal tumor. The tumor was located behind the anterior lip of the left kidney, and the lower edge of the tumor was adjacent to the renal vein.
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The lower edge of the tumor was adjacent to the renal vein (Figure 2).
(A) The tumor was well circumscribed and surrounded by non-neoplastic renal parenchyma (x4 H&E stain). (B) The tumor growth pattern was characterized by nests, cords, and acini of adrenal cortical cells separated by abundant sinusoids and little stroma (x10 H&E stain). (C) The clear cells in the tumor were large and polygonal with small nuclei, and the cytoplasm was lipid-rich and vacuolated, resembling normal zona fasciculata (x20 H&E stain).
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The tumor was well circumscribed and surrounded by non-neoplastic renal parenchyma (Figure 3).
Immunohistochemical findings. (A) Tumor cells showed nuclear SF-1 expression. Their cytoplasm showed positive staining for (B) Syn and (C) Melan-A but negative for (D) CK and (E) CgA. (F) Ki-67 labeled approximately 3% of the lesional cells.
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Ki-67 labeled approximately 3% of the lesional cells (Figure 4).