PMC8121607_01
Ultrasound showing malignant looking left renal mass with mixed solid and cystic component.
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Score (NEWS) was 1 (blood tests outlined in Table 1). She was referred for abdominopelvic ultrasonography which revealed left renal mass around 18 cm with a mixed solid and cystic component; also, hypoechoic foci were noted within the pancreas (Figures 1 and 2).
Ultrasound showing hypoechoic masses within the pancreas.
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Score (NEWS) was 1 (blood tests outlined in Table 1). She was referred for abdominopelvic ultrasonography which revealed left renal mass around 18 cm with a mixed solid and cystic component; also, hypoechoic foci were noted within the pancreas (Figures 1 and 2).
CT showing confirmed a large malignant looking left renal mass with central necrosis.
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Subsequent chest CT and CT urogram were done and confirmed a large left renal mass of 18 cm x 10 cm x 12 cm with central necrosis and peripheral hypervascularity (Figure 3).
Follow-up CT of the abdomen showing liver deposits.
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Initially, the patient had shown stable minimal progress of the metastatic disease for which systemic therapy was not indicated at that time. 16-month postnephrectomy, CT follow-up revealed stable chest disease with new hepatic metastasis for which she started sunitinib treatment (Figure 4).
CT of the brain with contrast showing brain metastasis with surrounding edema.
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Three months later, brain CT showed brain metastasis after she got an episode of confusion (Figure 5).
(a) Bilateral mammogram MLO view showing rounded density in the upper part of the right breast. (b) Mammogram in CC view showing a rounded right breast dense lesion.
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Bilateral mammography showed a dense new mass lesion as compared to her previous mammogram done 2 years earlier (Figures 6 and 7).
New lesion as compared to previous mammogram.
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Bilateral mammography showed a dense new mass lesion as compared to her previous mammogram done 2 years earlier (Figures 6 and 7).
US showing a hypoechoic solid mass lesion in the right breast at 1 o'clock.
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U5 in ultrasound. US-guided core biopsy was done in the same clinic (Figure 8).
The standard H&E-stained section showing cells with small nuclei and abundant clear cytoplasm typical of clear cell RCC.
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A panel of immunohistochemical markers reveals positive staining with the renal markers PAX 8 and carbonic anhydrase (Figures 9-11).
Image shows positive immunohistochemical cell nucleus staining with PAX8.
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A panel of immunohistochemical markers reveals positive staining with the renal markers PAX 8 and carbonic anhydrase (Figures 9-11).
Image shows positive cell membrane staining with carbonic anhydrase.
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A panel of immunohistochemical markers reveals positive staining with the renal markers PAX 8 and carbonic anhydrase (Figures 9-11).