PMC6413368_01
Patient imaging. (a) Contrast enhanced CT scan prior to ablation displaying 2-centimeter left renal mass in the upper pole. (b) An intra-therapy image of CT-guided left renal cryoablation probe displaying the tract of needle. (c) Contrast enhanced CT 1 year following cryoablation of left renal mass demonstrating absence of mass enhancement.
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Due to the posterior location of the 2-centimeter mass on the left kidney (Figure 1(a)), the patient opted for percutaneous cryoablation of the mass 4 months following the right robotic partial nephrectomy (Figure 1(b)). Follow-up cross-sectional imaging revealed no evidence of cancer recurrence in either kidney over a 2-year period (Figure 1(c)).
Patient imaging following cryoablation. (a) Contrasted MRI 2 years following cryoablation of left renal mass demonstrating new lesion development described as an ill-defined 2-centimeter focus of soft tissue highly suspicious for disease recurrence. The lesion appears to follow the cryoablation tract path. (b) Contrasted MRI 2-year status-post-partial nephrectomy of left renal lesion with full excision of perinephric fat displaying stable changes of bilateral partial nephrectomy without evidence of local recurrence.
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A new contrast-enhancing lesion was noted in the perinephric fat of the left kidney 2 years following therapy (Figure 2(a)). The patient underwent open subcostal partial nephrectomy with complete perinephric fat removal (Figure 2(b)).
Pathology of lesion following partial nephrectomy. (a) Pathology of lesion showing area with prominent hemosiderin laden macrophages and multinucleate giant cells (H/E, 20X). Lower inset demonstrating foci of giant cells associated with cholesterol clefts (arrow) (H/E, 20X). Upper inset shows necrotic fat (arrow) with surrounding inflammatory reaction (H/E, 4X). (b) CD68 (KP1) immunohistochemistry (10X). CD68 is highly expressed by monocytes, macrophages, and histiocytes and is positive in numerous histiocytes and macrophages in adipose tissue. (c) Immunohistochemistry demonstrating a negative study for cytokeratin AE1/AE3 confirming no recurrence of renal cell carcinoma (10X). (d) Immunohistochemistry demonstrating a negative study for PAX-8 confirming no recurrence of renal cell carcinoma (10X).
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Surgical pathology revealed the resected renal mass to contain organized tumefactive fat necrosis with multinucleate GC reaction (Figure 3(a)) without evidence of clear cell RCC recurrence (Figures 3(c) and 3(d)). CD68 (KP1). Cytokeratin AE1/AE3 and PAX-8 immunohistochemistry were both negative (Figures 3(c) and 3(d)).