PMC5675990_01
Cross sectional computed tomography imaging of the abdomen and pelvis, dated March 2017. The scan reveals an 8mm right renal lower pole hypodensity, consistent with a cyst.
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Of note, an 8mm hypodensity was seen in the lower pole of the right kidney, consistent with a cyst (Fig. 1).
Cross sectional computed tomography representative imaging of the abdomen and pelvis, dated July 2017. The scan reveals a 7.5cm heterogeneously enhancing right lower pole renal mass along with evidence of a level 2 tumor thrombus in the right renal vein.
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A CT scan of the abdomen and pelvis performed in the ER revealed a 7.5 cm heterogeneously enhancing right lower pole renal mass along with evidence of a tumor thrombus in the right renal vein, with slight extension into the IVC (Fig. 2).
(a): Diagnostic biopsy of the colon (2015). H&E stained section shows a poorly differentiated carcinoma without mucin and infiltrating the lamina propria and submucosa. The overlying colonic epithelium in the picture is unremarkable. These findings are consistent with anal gland adenocarcinoma. (b): Right renal mass biopsy (2017). H&E stained section shows a poorly differentiated carcinoma involving the renal cortex. This tumor is similar in morphology to the one in the colon and consistent with metastatic anal gland adenocarcinoma.
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This morphology and immunoprofile was consistent with AGA (Fig. 3(a)). AGA (Fig. 3(b)). After multidisciplinary consultation with urology, medical oncology and radiation oncology, the patient was deemed not to be a candidate for cytoreductive right radical nephrectomy and thrombectomy, given the rapid recurrence and presence of multiple metastatic sites.