PMC3407439_01
CT-scan 6 months following radio therapy with CyberKnife. (A) Axial and (B) coronal images demonstrate the renal mass between the 2 fiducial markers (arrows).
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F1
After 30 Gy of radiation divided between 3 fractions, repeat imaging revealed persistent enhancement suspicious for residual tumor (Figure 1A-B).
Intraoperative images of (A) the lower pole renal mass (solid arrow) and ureter (dashed arrow) prior to resection and (B) the reconstructed kidney following renorrhaphy with the sliding-clip technique.
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F2
The mass was clearly identified (Figure 2A) both visually and with the aid of a laparoscopic ultrasound. Following mass excision, renorrhaphy was performed with the sliding-clip technique (Figure 2B).
(A) Bisected partial nephrectomy specimen with well-circumscribed, variegated 2.2-cm neoplasm. (B) Renal cell carcinoma with areas of extensive hyalinization (arrows), H&E 4X. (C) Tissue adjacent to fiducial marker showing viable renal cell carcinoma, conventional (clear cell) type, Fuhrman nuclear grade 1 (arrow), H&E, 40X. (D) Renal parenchyma with nonspecific chronic inflammation (arrows), H&E, 20X.
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F3
Gross pathologic analysis of the excised mass revealed a well-circumscribed lesion with areas of hemorrhage measuring 2.2x2x1.8cm (Figure 3A). Microscopic analysis of the mass demonstrated the remaining viable tumor to be Fuhrman nuclear grade 1 conventional (clear cell) type renal cell carcinoma with areas of extensive inflammation and hyalinization (Figure 3B-D).