PMC4074721_01
CT image showing a 19 x 14 x 17 cm left retroperitoneal mass with solid and cystic components in the left kidney.
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On further evaluation, the CT findings showed a large (19 x 14 x 17 cm) left retroperitoneal mass with solid and cystic components on the inferior aspect of the left kidney (Figure 1) showing effaced fat planes, inseparable from the lower pole of the kidney, with mild-moderate left hydronephrosis due to compression of the left ureter.
Hematoxylin-eosin stained section (A: chromophobe renal cell carcinoma cell nests with fascicles of spindle cells in between). The cells had eosinophilic cytoplasm with accentuated cell borders and centrally located nuclei that had wrinkled peripheral borders and varying degrees of hyperchromatism (magnification x10).
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Chromophobe RCC, as the carcinomatous element, is comprised of groups of polygonal cells with resinoid nuclei, perinuclear halo and prominent cell membranes (Figure 2).
Hematoxylin-eosin stained section (B: spindle cell component). The spindle cells were arranged in ill-defined fascicles that had a focal storiform pattern, mitoses and some bizarre forms.
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The sarcomatoid component is represented by pleomorphic spindle cells in between forming fascicles at places, fibrosarcoma-like pattern, occasionally tumour gaint cell and bizarre forms noted, Furhman nuclear grade was 3, comprising 40-50% component in tumour (Figure 3).
IHC studies showing epithelial cells positive for pan-cytokeratin and EMA, whereas spindle cells are negative for EMA and few are positive for pan-cytokeratin.
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Table 1, Fig. 4 and 5 show the immunohistochemistry (IHC) study.
IHC studies showing spindle cells positive for CD10 and vimentin, whereas epithelial cells are negative.
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Table 1, Fig. 4 and 5 show the immunohistochemistry (IHC) study.