PMC5066022_01
CT image showing involvement of kidney and liver by the tumor.
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fig1
Imaging studies revealed an 18 cm heterogeneous mass involving the liver as well as multiple masses involving the native kidneys bilaterally (Figure 1).
(a) Hypercellular cores comprised of sheets of noncohesive large tumor cells and neutrophils infiltrating renal tubules (H&E, 40x). (b) Tumor cells engorged with neutrophils and intimately juxtaposed with renal tubular epithelium (H&E, 400x). (c) Pleomorphic tumor cells with abundant eosinophilic to vacuolated cytoplasm, coarse nuclear chromatin, and multiple prominent eosinophilic nucleoli (H&E, 600x).
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fig2
The needle core biopsy comprised of highly cellular cores almost entirely replaced by sheets of noncohesive large cells was intimately juxtaposed with renal tubular epithelium, partially destroying and replacing the tubules (Figure 2(a)). Tumor cells were pleomorphic, 3-4 times the size of tubular epithelial cells, with abundant eosinophilic to vacuolated cytoplasm, round nuclei with coarse chromatin, and multiple prominent eosinophilic 1-2 nucleoli (Figures 2(b) and 2(c)).
(a) Immunohistochemistry for CD68 highlights the tumor cells (100x). (b) Immunohistochemistry for lysozyme shows granular positivity in the cytoplasm of the tumor cells (100x). (c) Immunohistochemistry for HAM56 shows granular positivity in the cytoplasm of the tumor cells (100x). (d) Immunohistochemistry for PAX8 highlights the nuclei of renal tubular epithelial cells (100x).
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fig3
Tumor cells were positive for CD68 (Figure 3(a)), lysozyme (Figure 3(b)), HAM 56 (Figure 3(c)), and CD4. The renal tubular epithelial cells were highlighted by CK7 and PAX8 (Figure 3(d)).