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(A) Coronal abdominal magnetic resonance imaging. Post-contrast T1-weighted imaging (WI) demonstrated a mass originating from the middle and lower zone of the left kidney (arrows), with irregular contours and 83x97 mm in size. The mass enhanced post-contrast except for necrotic areas (arrow head) similarly to another mass in the right adrenal with heterogeneous enhancement (dashed arrow). (B) On T2WI, the central area of the mass is hyperintense due to necrosis (arrow head). Another mass in the right adrenal gland (arrows), 48x76 mm in size, whose signal characteristics are similar to those of the renal mass.
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In the right adrenal gland, there was a mass with similar signal characteristics as the renal mass, measuring 48x78x76 mm (Figure 1A, 1B).
(A) Clear cell RCC; Fuhrman nuclear grade 2 (left side) and 4 (right side) (Nephrectomy specimen, Haematoxylin & Eosin x40, x200). (B) Fine needle aspiration biopsy from the thyroid nodule; atypical epithelial cells with abundant clear or vacuolated cytoplasm, vesicular nucleui and concipious nuclei in the background of scant or no colloid (MGG left side, PAP right side x400). (C) Cell block preparation; tumoral cells showed positive immunostaining for Vimentin, Pax8 and EMA.
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The histopathological examination reported clear cell renal carcinoma with Fuhrman grade 4 and adrenal metastasis without infiltration of the Gerato capsule, perirenal fat, renal artery/vein, ureter and no involvement of the surgical border (Figure 2A). FNAB reported atypical epithelial cells that had eosinophilic or clear cytoplasm, with large nuclei and nucleoli (Figure 2B). Follicular cells were not seen in the specimen. Clinical and pathological data, together with immunostaining carried out in cell blocks and cytospin slides (negativeness of tyroglobulin, TTF-1, Calsitonin and positiveness Vimentin, Pax8 and EMA) confirmed the diagnosis of metastatic renal clear cell carcinoma (Figure 2C).
Ultrasound imaging showed a hypoechoic, nodular, solid mass in the thyroid gland, 30x22 mm in size, with microcalcifications and macrolobulated contours.
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Because of metabolically active areas in the thyroid gland, an ultrasound imagining was performed and a hypoechoic, round-shaped, solid nodule with macrolobulated contours, measuring 30x22 mm, was found along with multiple oval-shaped, hypoechoic, solid nodules (Figure 3).