PMC9479614_01
(a) Abdominal computed tomography (CT) scan showed a tumor on the left kidney (blue arrow). Axial view (b) and coronal view (c) of the brain CT scan showed a hyperdense lesion on the right temporal region (blue arrow) suggesting an intracranial tumor.
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F1
Following the neurologist suggestion, the brain CT scan was subsequently performed [Figure 1], CT scan showed hyperdense intracranial lesion on the temporal region with 6 x 4 x 5 cm in size suggestive for intracranial tumor.
Axial view of brain magnetic resonance imaging, T1 section with contrast (a) showed an irregular peripheral enhancing mass (blue arrow), T2-section without contrast (b), and T1-Flair section without contrast (c) showed a mass with intratumoral hemorrhage, on the deep temporal lobe involving the right basal ganglia with adjacent edema.
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F2
The brain magnetic resonance imaging revealed irregular enhancing mass with intra tumoral hemorrhage on deep temporal lobe involving right basal ganglia with 6.3 x 4.2 x 5.2 cm size and adjacent edema suggesting hemorrhagic intracranial metastasis [Figure 2].
Postoperative brain CT scan with contrast showed residual irregular enhancing lesion (blue arrow) in the right temporal with decreased midline shift.
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F3
The brain CT scan evaluation was performed and showed residual tumor with decreased midline shift [Figure 3].
Gross specimen. (a) The macroscopic features of the left kidney tumor and (b) the macroscopic features of the brain tumor.
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F4
Tumor was solid and friable, with yellow and brown in color [Figure 4].
Pathology examination of tumor in the left kidney and the brain. (a) The left kidney tumor showed tumor cells displaying rounded nuclei with mild pleomorphism, abundant, and clear cytoplasm, forming a lobular pattern with delicate fibrovascular septa (H&E, x400). (b) The brain tumor showed tumor cells with rounded to oval-shaped nuclei, coarse chromatin, and brisk mitosis (H&E, x400). (c) Immunohistochemistry of the brain tumor was positive for GFAP (x200). (d) The brain tumor showed negative for IDH1 R132 H (x200).
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F5
The final conclusion was glioblastoma, IDH1 wild type, the The World Health Organization (WHO) Grade 4; Coexistent with Clear Cell RCC in the left kidney, and the WHO/International society of urological pathology (ISUP) Grade 2, Stage I [Figure 5].