PMC6332729_01
Skin lesions demonstrate, a nodular lesion at scalp (A) and a flat skin lesion at chest wall (B). Multiplanar coronal (C) and sagittal (D) contrast-enhanced CT of the abdomen demonstrate a heterogeneous solid enhancing mass in the right upper renal pole (arrows) causing anatomic distortion at the renal parenchyma. Malignant peritoneal implants (arrowhead) and ascites (A) are noted. A cirrhotic liver is incidentally seen (*)
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The chest lesion was flat (2.0 x 1.5 cm) with a palpable nodule underneath it (Figure 1A,B). CBC with increased creatinine (1.4 mg/dL). CT abdomen, chest and bone scan demonstrated a large heterogeneous exophytic mass of the upper right kidney measuring 11.0 x 11.0 x 10.0 cm (Figure 1C,D).
FNA smear of skin lesion showing mix population of cells with abundant wispy cytoplasm, round and naked nuclei with prominent nucleoli (A), Few large cells with less vacuolated cytoplasm (B), cell block is positive for AE1/AE3 (C) and for Pax8 (D). The magnification for A, B, C, and D is x40, x60, x10, and x10, respectively
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Diff Quick preparation of FNA smear was hypercellular, with a mixture of discohesive and cluster of cells (Figure 2A,B). Tumor cells in the cell block were positive for Pax8 and AE1/AE3 (Figure 2C,D) by immunohistochemistry.
Core biopsy demonstrating infiltrating pattern of tumor cells with H&E stain (A), tumor cells are strongly positive for vimentin (B), Pax8 (C), RCC (D), CD10 (E) and negative for CK7 (F). The magnification for A, B, C is x10 and for D, E, and F is x20
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The tumor cells had similar cytomorphology to those observed in the FNA smear (Figure 3A). Tumor cells were positive for Pax8, RCC, vimentin, CD10 and negative for Ck7 (Figure 3).