PMC8064920_01
The Computerized Tomography (A) and the gross photograph (B) of the renal mass showing a well circumscribed tan brown mass in the right kidney extending into the renal hilum.
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F1
Abdominal computerized tomography scan showed a 6.8 x 6.6 x 8 cm mass in the right colon, and a 2.5 x 3.4 x 3.3 cm solid mass on the lower pole of the right kidney involving the hilum (Figure 1A), multiple hypodense nonenhancing lesions involving both lobes of the liver, and a 2.5 x 2.8 cm hypodense lesion in the body of the pancreas. The pathological evaluation of the kidney showed a 3.4 x 3.3 x 3.0 cm well-circumscribed solid brown mass in the lower pole, extending into the hilum and perinephric fat (Figure 1B).
(A) Sebaceous adenoma in the dermis with cystic dilatation (Hematoxylin and Eosin x40). (B) Proliferation of germinative cells in the sebaceous adenoma (Hematoxylin and Eosin x200). (C) Low magnification view of the colonic adenocarcinoma with normal colon on the right and the adenocarcinoma with mostly solid architecture (Hematoxylin and Eosin x40). (D) Poorly differentiated adenocarcinoma of colon with pleomorphic tumor cells and poorly formed glands with some extracellular and intracellular mucin (Hematoxylin and Eosin x200).
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F2
The multiple sebaceous adenomas histologically showed dermal tumors with varying proportions of basaloid cells and sebaceous cells with cystic changes (Figure 2A and B). Tumor infiltrating lymphocytes or germinal centers were not seen (Figure 2C and D).
Hematoxylin- and eosin-stained sections of the renal tumor (A). Low magnification showing a well-circumscribed tumor with papillary structures and normal kidney on the right (x40) (B). Well-circumscribed papillary tumor with fibrous septa separating the tumor (x40) (C). Papillary architecture of the tumor with thin fibrovascular core (x100) (D). The tumor cells have abundant granular eosinophilic cytoplasm and a round nucleus placed away from the basal lamina (x400) (E). Papillary tumor with foamy histiocytes (x200) and F. Papillary tumor with hemosiderin pigment (x200) (F).
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F3
Psammomatous calcification was absent (Figure 3A-F).
Immunohistochemical stains showing (A) Focal staining for AE1/AE3. (B) Membranous staining for epithelial membrane antigen (EMA). (C) Diffuse cytoplasmic staining for AMACR. (D) Diffuse nuclear staining for PAX8. (E) Focal staining for CAIX. (F) Diffuse strong luminal membranous staining for CD10.
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F4
There was a strong, diffuse cytoplasmic expression of vimentin, AMACR, luminal membranous expression of CD10, and nuclear expression of PAX8 (Figure 4A-F).
Immunohistochemical stain for mismatch repair proteins showing loss of expression of MSH6 and preserved nuclear expression of MLH1, PMS2, and MSH2.
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F5
IHC for mismatch repair proteins showed faint expression of MSH6 (1% of nuclei) and strong nuclear expression of MLH1, MSH2, and PMS2 (Figure 5A-D).