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A computed tomography image, with intravenous contrast.. Note: The mass in the left renal middle pole is shown (white arrows).
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Scattered calcifications were also detected (Figure 1).
Color ultrasound images of the space-occupying lesion in the left kidney.. Notes: (A) A hyperechoic mass was detected in the mid pole of the left kidney, with a definite boundary and an irregular shape. (B) A rod-like blood signal was detected in the mass, and renal perfusion was normal.
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Color ultrasound imaging confirmed the presence of a hyperechoic mass (2.2x1.5 cm) in the mid pole of the kidney, with an intense blood signal (Figure 2).
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Macroscopic appearances.. Notes: Gross examination of the left kidney showed that (A) the tumor was located in the mid pole of the kidney, with observable solid and cystic areas. (B) The surface of the cystic areas had tiny papillary excrescences (red arrows), and the solid area seemed grayish white (black arrows).
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Some large cysts included grayish yellow papillary excrescences (Figure 3).
Histomorphological features.. Notes: (A) The tumor was composed of a papillary RCC and WT, with fibrous connective tissues between the fibers (magnification, x40). (B) The RCC area was arranged in a papillary shape, and the thin fibrovascular cores could be observed. The papillary surface was covered with a monolayer or pseudostratified columnar cancer cells (magnification, x400). (C) Psammoma bodies were detected in the stroma (magnification, x400). (D) The WT was mainly composed of epithelium, and the original tubular structure and well-differentiated tubules were visible under a microscope (magnification, x100); (E) Under a high-magnification microscope, the well-differentiated tubules were made up of columnar epithelial cells, with long and thin wedge-shaped nuclei (magnification, x400). (F) The stromal consisted of immature fusiform-shaped cells, with slightly basophilic mesenchyme. A small number of eosinophil cells were scattered between the juvenile fusiform cells (magnification, x400).. Abbreviations: RCC, renal cell carcinoma; WT, Wilms' tumor.
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The thin fibrovascular cores could be observed in these papillae, and some of the tumor tissue invaded the cyst wall (Figure 4A-C). The majority of the WT tissue was epithelium, and well-differentiated tiny tubes coexisted with poorly differentiated original tubular structures (Figure 4D and E). Loose connective tissues (Figure 4A) and immature mesenchymal tissues were discovered between the WT and papillary RCC (Figure 4F).
Immunohistochemistry.. Notes: (A) Cytokeratin 7 was strongly positively expressed in the cytoplasm of the papillary RCC cells (magnification, x400). (B) Alpha-methylacyl coenzyme A racemase displayed weak positive expression in the cytoplasm of papillary RCC cells (magnification, x400). (C) Cluster of differentiation 10 was slightly positively expressed in the papillary RCC cells (magnification, x400). (D) WT1 exhibited strong positive expression in the WT nuclei (magnification, x400).. Abbreviations: RCC, renal cell carcinoma; WT, Wilms' tumor; WT1, Wilms tumor gene 1.
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The immunoprofile of WT region was contrary to the former (Figure 5).
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