PMC3866866_01
Abdominal computed tomography (CT) scan. Abdominal CT scan enhancement showed hypovascular tumors at upper poles (a), lower poles (b), and middle portions of the right kidney.
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Furthermore, abdominal CT showed multiple hypovascular tumors at the upper and lower pole and middle portions of the right kidney with sizes 3.3 cm, 2.5 cm, and 2.8 cm, respectively, without metastatic lymphadenopathy (Figure 1).
Abdominal magnetic resonance imaging (MRI). Abdominal MRI showed right kidney multiple lesions without enhancement during arterial phase of dynamic study (a), hypointense masses on T2-weighted images (b), and multifocal hypovascular hypercellular solid tumors of the right kidneys with bright lesion in diffusion weighted imaging (DWI) (c) and significantly decreased apparent diffusion coefficient (ADC) (d).
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Abdominal MRI revealed multifocal hypovascular solid tumors with significantly increased apparent diffusion coefficient (ADC) of diffusion weighted imaging (DWI) with enhancement during arterial phase of dynamic study and left renal hilar lymphadenopathy (Figure 2).
Renal pathology. Renal cortex replaced by medium-sized to large atypical lymphoid cells. The tumor cells show high nucleocytoplasmic ratio, prominent eosinophilic nucleoli, and single cell apoptosis in haemotoxylin eosin stain x100 (a). The tumor cells are positive for LCA x100 (b), CD20 x100 (c), but negative for CK x100 (d), CD3 x100 (e), and Ki-67 stain x100 (f) shows the positivity focally up to 60%.
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Renal pathology revealed renal cortex replaced by medium-sized to large atypical lymphoid cells and tumor cells, which are positive for Leucocyte Common Antigen (LCA), CD20, and CD10 immunohistochemical stain (Figure 3).