PMC5684584_01
(a) Biphasic tumour, composed of epithelial components dispersed in tubules and microcysts whose lining was flattened to cuboidal epithelium having vesicular nuclei and scanty cytoplasm. (b) The mesenchymal component was dispersed in sheets, fascicles, and focal storiform whose comprised cells were spindle-shaped with vesicular nuclei and scanty to moderate cytoplasm. H&E staining, magnification, x40.
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fig1
Abdominal ultrasound showing liver metastasis.
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fig2
Over the next 10 months, her management was progressively challenged by recurrent anaemia (packed cell volume ranges between 9% and 24%), worsening of renal function evidenced by rising urea from 5.6 to 34 mmol/l, rising creatinine from 59 umol/l to 312 umol/l, reducing glomerular filtration rate (GFR) from 98 to 19 ml/min/1.73 m2, increasing uric acid from 141 to 560 umol/l, and further dissemination of the tumour on the left renal bed with more hepatic (Figure 2) and splenic (Figure 3) metastatic deposits which led to her demise.
Abdominal ultrasound showing splenic metastasis.
CRIONM2017-2129450.003.jpg
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fig3
Over the next 10 months, her management was progressively challenged by recurrent anaemia (packed cell volume ranges between 9% and 24%), worsening of renal function evidenced by rising urea from 5.6 to 34 mmol/l, rising creatinine from 59 umol/l to 312 umol/l, reducing glomerular filtration rate (GFR) from 98 to 19 ml/min/1.73 m2, increasing uric acid from 141 to 560 umol/l, and further dissemination of the tumour on the left renal bed with more hepatic (Figure 2) and splenic (Figure 3) metastatic deposits which led to her demise.