PMC10105324_01
a MRI right shoulder: The lesion involving the scapula was reaching up to the glenoid and had a significant soft tissue component, which is abutting the posterior aspect of the subscapularis muscle and displacing it. The coracoid process of the scapula is also involved. The scapular lesion approximately measures about 47 x 36 mm and the humeral lesion measures approximately 20 x 18 mm. b Bone scan: uptake in right temporoparietal skull, right shoulder joint, right 3rd anterior rib, right femur involving trochanter, mid-shaft and distal femur, right distal tibia, right SI joint, and ischium bone.
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F1
MRI of the right shoulder revealed multiple abnormal signal intensity expansile lesions in the scapula and in proximal third of the humerus (shown in Fig. 1a). A bone scan revealed multiple lesions (shown in Fig. 1b).
a-d Core biopsy: section comprises multiple cores all containing a malignant tumor composed of closely packed acinar tubular and cystic structures lined by a single layer of larger cuboid cells with eosinophilic granular cytoplasm and hyperchromatic nuclei with prominent large nucleoli. Hobnailing nuclei were also seen. The mitoses 3-4/10 HPF and the stroma showed myxoid material. The tumor cells are positive for PAX8, AMACR, and vimentin and negative for PSA, RCC, CD10, Glypican 3, CD30, S100, CK7, CKHMWC, PANCK, CEA, and PLAP. Ki67 staining showed 25% of proliferative activity. The morphology and immunophenotype were consistent with tubulocystic carcinoma of kidney.
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F2
An ultrasound-guided core biopsy from the right iliac bone soft tissue revealed the diagnosis of tubulocystic carcinoma of the kidney (shown in Fig. 2).
a MRI spine shows abnormal signal intensity mass lesions in multiple vertebral bodies involving D3, D4, L3, L5, and S2 vertebrae. The vertebra appears to be hyperintense on T2 and STIR sequences, and hypointense on T1-weighted sequences and showing post contrast enhancement and in keeping with vertebral body metastasis. Retropulsion of the posterior vertebral body element in the spinal canal at D4 level resulted in significant cord compression. Mild to moderate left lateral recess stenosis at L5-S1 level because of deposit in L5 vertebra. b MRI brain shows a large well-defined right parieto-occipital extra-axial expansile calvarial soft tissue mass measures about 65 x 62 mm. The lesion is low on T1-weighted and high on T2-weighted sequences and shows postcontrast enhancement.
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F3
MRI of the spine abnormal signal intensity mass lesions in multiple vertebral bodies involving D3, D4, L3, L5, and S2 vertebrae, and retropulsion of the posterior vertebral body element in the spinal canal, leading to significant cord compression (shown in Fig. 3a). These lesions had a significant mass effect, leading to compression of the underlying brain parenchyma and perilesional dural enhancement (shown in Fig. 3b).
a PET-CT showing widespread FDG avid metastasis to the right axillary/mediastinal lymph nodes, lungs, multiple skeletal, and left adrenal. b PET scan shows a partial response 10 months after treatment with pazopanib. (Although there is a small persistent right axillary lymph node, there is a significant reduction in the FDG-avid lesion in the left adrenal gland and multiple FDG avid skeletal lesions.) c, d Follow-up PET-CT at 15 and 21 months after commencing pazopanib, which shows a stable remission.
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F4
The PET scan showed disease in multiple sites (shown in Fig. 4a). A follow-up PET scan 10 months after commencing the treatment showed a reduction in the FDG-avid lesion in the left adrenal gland, and the right pelvic region anterior to the right iliac bone (shown in Fig. 4b). Most of the previous FDG avid expansile skeletal lesions show mild to moderate increased in FDG uptake, a picture consistent with stable metabolic disease (shown in Fig. 4c). A further follow-up scan 1.5 years after commencing treatment with pazopanib showed stable metabolic disease (shown in Fig. 4d).