PMC6778928_01
Contrast-enhanced MRI of the abdomen on initial staging of the renal tumor. (a) Coronal T1-weighted image and (b) axial T2-weighted image demonstrated a left renal mass in the upper pole of the left kidney with cystic areas (arrows).
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He had a previous history of RCC (Figure 1) when he underwent left nephrectomy 11 years before (pT2, pV0, and pN0; Fuhrman grade 1).
Contrast-enhanced CT of the abdomen 11 years after the left nephrectomy. (a) Coronal and (b) axial images showed two solid-cystic splenic masses (arrows) with heterogeneous enhancement, infiltrating the diaphragm (arrowhead).
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The lesions extended through the splenic capsule and abutted the left diaphragm (Figure 2).
Contrast-enhanced MRI of the abdomen 11 years after the left nephrectomy. (a) Axial T2-weighted image and (b) axial postcontrast T1-weighted image depicted two solid-cystic splenic masses (arrows), infiltrating the diaphragm (arrowhead).
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Magnetic resonance imaging (MRI) was requested for further evaluation and demonstrated the splenic masses, with lobulated contours, heterogeneous signal intensity, and central necrotic areas (Figure 3).
Positron emission computed tomography (PET/CT) scan of the whole body showed two splenic masses (arrows) indistinct on CT without intravenous contrast (a), with increased FDG uptake (SUV 9,0) (b), and without other suspicious lesions (c).
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Additionally, a whole-body positron emission tomography scan (PET/CT) was performed, and it revealed an increase in FDG uptake within the splenic mass (SUV: 9.0), without other suspicious lesions (Figure 4).
Surgical specimen of splenectomy demonstrated two lobulated yellowish lesions within the spleen (a, b). A portion of the left diaphragm was also resected due to the adhesion process (c, arrowhead).
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On pathological examination, the spleen had two yellowish lesions (Figure 5), measuring up to 6.0 cm.
Detail of the neoplasm, composed of nests and solid sheets of cells with abundant and clear cytoplasm. The nuclei are enlarged with some conspicuous nucleoli (H&E 200x).
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Immunohistochemistry assay was positive for CK8/18, CD10, PAX8, and vimentin, being consistent with metastases of clear cell RCC (Figures 6 and 7).
The neoplastic cells expressed CK8/18 (a), CD10 (b), PAX8 (c), and vimentin (d), being consistent with metastasis of clear cell renal carcinoma.
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Immunohistochemistry assay was positive for CK8/18, CD10, PAX8, and vimentin, being consistent with metastases of clear cell RCC (Figures 6 and 7). It is important to note that PAX8 fixation was positive for nuclear staining although weak likely due to poor splenic parenchyma fixation (Figure 7(c)).