PMC9288148_01
A) upper jaw nodular lesion (arrow); B) ulcerated lesion in the scalp; C) H&E-stained slide at low power (x100) showing a subepithelial sarcomatoid renal cell carcinoma causing focal ulceration of overlying skin; D) post resection healthy jaw lesion; E) post resection healthy scalp lesion
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F1
The excisional biopsy revealed metastatic RCC with sarcomatoid features (Figure 1A). The disease continued to progress, and at 17 months, the patient had an ulcerated lesion (0.5 x 1 cm) on the scalp (Figure 1B). The surgical excision was performed and the pathology report revealed metastatic RCC with sarcomatoid features (Figure 1C). Follow-up after two years showed regression of the disease with post-healthy jaw and scalp lesions (Figure 1D, E).
PMC9288148_02
A) right upper forearm lesion; B) high power magnification (x400) showing alveolar nests of tumor cells separated by thin fibrovascular septa. Individual tumor cells are round to polygonal with well-defined borders, clear to eosinophilic cytoplasm and ovoid hyperchromatic nuclei
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F2
After two years, the patient developed a lesion over the right upper forearm measuring 5 x 3 cm, which was globular, solid, non-ulcerated with rounded margins (Figure 2A). The excisional biopsy revealed metastatic RCC (Figure 2B).
PMC9288148_03
A, B) craniocaudal view and mediolateral oblique mammography views breast; C): PET-CT axial film at breast level showing increased uptake in the right breast (arrow); D) post excision PET-CT showing no lesion in the right breast (arrow)
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F3
Mammography revealed a hypoechoic irregular mass with indistinct margins, a heterogeneous internal echo pattern, and non-parallel orientation suggestive of a grade IV lesion of the British Imaging-Reporting and Data System (Figure 3A). Positron emission tomography (PET) scan revealed a large enhancing exophytic mass lesion in the right kidney (16 x 12 x 10 cm), a solitary right breast lesion (3 x 3 cm), and right lung lesion (10 x 11 mm) (Figure 3B). After three years, follow-up imaging showed stable disease (Figure 3C).
PMC9288148_04
A) CT scan showing metastasis to the right trapezius muscle (arrow); B) metastasis to the right psoas (arrow); C) metastasis to left gluteus medius (arrow); D) metastasis to left hemidiaphragm (arrow)
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F4
The patient was followed up with regular imaging until after four years when he presented with generalised body pain, which on evaluation revealed RCC metastasis to the right trapezius muscle (Figure 4A), right psoas muscle (Figure 4B), erector spinae, left gluteus medius muscle (Figure 4C), and left hemidiaphragm (Figure 4D).
PMC9288148_05
A) right parotid swelling (pre-treatment) (arrow); B) MRI inT1 showing parotid involvement; C) MRI in T2 showing the tumor involvement (coronal view); D) low power magnification (x100): fibro collagenous tissue showing infiltration by a solid tumor arranged in sheets and nests; E) right parotid swelling (post-treatment) (arrow)
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F5
The clinical examination revealed a 6 x 4 cm mass in the right parotid region (Figure 5A). Contrast-Enhanced Magnetic Resonance Imaging (CEMRI) revealed tumor in the parotid's superficial and deep lobes, abutting the internal jugular vein and sternocleidomastoid muscle with loss of fat planes and engulfment of the adjacent vessels by 180 degrees (Figure 5B, C). Trucut biopsy revealed metastatic clear cell RCC (Figure 5D). The patient is on follow-up and shows stable disease (Figure 5E).