PMC6296204_01
Ultrasonography of the right kidney.. Notes: (A) Giant complex cystic-solid mass (10.1x8.0 cm) with inhomogeneous liquid dark area and high-echo stripes on the medial aspect of the right kidney; (B) colored blood-flow signals displayed on the margins of the mass, which was located close to the right kidney.
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All this was accompanied by an inhomogeneous liquid dark area and strong-echo stripes (Figure 1).
Enhanced computed tomography (CT) scan showing a cross-sectional view of the urinary system.. Notes: (A) Fusion of both renal lower poles and hydronephrosis due to a large, well-circumscribed mass located medial to the right renal hilum. (B) Spherical cystic-solid mass (9.5x8.7 cm) of heterogeneous density with CT-attenuation values of 18-35 HU, likely arising from the anteromedial aspect of the right half of the horseshoe kidney. (C, D) Renal CT angiogram showing compression of the renal artery and narrow renal veins.
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Enhanced computed tomography (CT; Figure 2A and B) and magnetic resonance imaging (Figure 3) scans demonstrated a horseshoe-kidney anomaly with a spherical cystic-solid mass (9.5x8.7 cm), filling the proximal aspects of the right renal collecting system. CT angiography identified blood vessels supplying the tumor region (Figure 2C and D).
Magnetic resonance imaging of the abdomen, coronal view.. Notes: (A) Large unilocular hilar mass (8x7 cm) in the right kidney with high signal intensity on T2-weighted images. (B) The mass is isointense on T1-weighted images. The horseshoe-kidney anomaly can also be observed.
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Enhanced computed tomography (CT; Figure 2A and B) and magnetic resonance imaging (Figure 3) scans demonstrated a horseshoe-kidney anomaly with a spherical cystic-solid mass (9.5x8.7 cm), filling the proximal aspects of the right renal collecting system.
Histological examination of the tumor.. Notes: (A) Low-power view showing nests of tumor cells (H&E, 200x). (B) Pools of mucin lined by malignant glandular epithelium with complex architecture in high-power view (H&E, 400x).
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On microscopic examination, pools of mucin were lined by malignant epithelium and areas of inflammation (Figure 4).
Immunohistochemical analysis showing that the tumor cells were positive for CK20.. Notes: (A) 200x; (B) 400x; (C) CDX2, 200x; (D) CDX2, 400x; (E) villin, 200x; (F) villin, 400x.
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Immunohistochemical staining results (Figure 5) suggested gastrointestinal origin (CK20+, CDX2+, villin+, CK7-, PAX8-, ER-, PR-, P53-, Ki67+ cells 50%), indicating that the appendix was the most likely site of origin.