PMC5769257_01
Case 1. (a) Computed tomographic image showing a well-marginated, heterogeneous exophytic mass (4.86 cm x 5.49 cm) in the upper pole with foci of calcification. (b) Computed tomographic image showing markedly thickened wall of the cecum, ascending colon, and terminal ileum, forming mass of 9.9 cm x 7.83 cm. (c) Cut specimen showing extensive pus formation. (d) Photomicrograph showing the papillary renal cell carcinoma Grade 1
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F1
He has a normal blood workup (hemoglobin [Hb]: 13.8 gm/dl, total leukocyte count [TLC]: 8300/mm3, and urea/creatinine: 37/0.94) with raised serum carcinoembryonic antigen (106 ng/ml); contrast-enhanced computed tomography (CECT) whole abdomen showed 4.4 cm x 4.8 cm exophytic, isoechoic, well-defined mass interpolar region of the left kidney and an asymmetrical circumferential mural thickening of the cecum and ascending colon [Figure 1a and b]. The specimen showed extensive suppuration in a renal mass [Figure 1c]. Histopathological examination (HPE) was suggestive of mucinous adenocarcinoma of the colon and papillary carcinoma nuclear grade 1 of the left kidney [Figure 1d].
PMC5769257_02
Case 2. (a) Computed tomographic image heterogeneous right Renal mass 13.2 cm x 8.5 cm, replacing entire right kidney, with mural calcifications. (b) Magnetic resonance imaging showing a 10 cm x 9 cm well-defined lobulated lesion with areas of necrosis which is hypo- or iso-intense on T2. (c) cut specimen showing extensive pus formation. (d) Photomicrograph showing papillary carcinoma with calcifications and osseous metaplasia
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F2
CECT abdomen showed 8 cm x 9 cm well-defined mass arising from the lower pole of the right kidney with few anechoic areas and multiple echogenic foci [Figure 2a and b]. On section, there was extensive suppuration inside the kidney [Figure 2c]. Final HPE showed it to be papillary carcinoma [Figure 2d].
PMC5769257_03
Case 3. (a and b) Computed tomographic image showing Bosniak Type 4 cyst at the upper pole of the right kidney in axial section and coronal section. (c) Postright radical nephrectomy specimen showing cystic mass with purulent material inside. (d) Low-power photomicrograph (x10) showing the papillary architecture of tumor with fibrovascular core
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F3
Type 4 cyst at the upper pole of the right kidney with possible pelvicalyceal system involvement [Figure 3a and b]. The patient underwent right radical nephrectomy. The specimen after surgery revealed a cystic mass full of purulent material [Figure 3c] which grew Escherichia col on culture. Her final HPE report was suggestive of papillary RCC, Fuhrman grade 2 capsular, and perinephric fat invasion [Figure 3d].