PMC9431006_01
CT of the abdomen and pelvis with IV contrast. (A) Transverse and (B) coronal views demonstrating a 9.2 x 9.3 x 12.4 cm left renal mass with extension into the left psoas.
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F1
Further evaluation via CT revealed a complex enhancing renal mass measuring 9.2.2 x 9.3 x 12.4 cm with extension into the left psoas muscle and abutting the pancreatic tail, spleen, and stomach (Figure 1).
PET-CT of the chest, abdomen, and pelvis. (A) Axial and (B) coronal views demonstrating a FDG uptake of the right atrium suggestive of a cardiac metastasis. There are also FDG avid pulmonary nodules. (C) Axial and (D) coronal views demonstrating a heterogeneously attenuating 9.6 x 8.7 cm left renal mass and accompanying 5.9 x 4.3 FDG avid adrenal mass. There is also a 2.6 x 1.2 cm FDG avid right adrenal metastasis and multiple FDG avid abdominopelvic nodules.
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F2
PET-CT scan revealed multiple avid lesions including lung nodules of up to 1.5 cm, a left adrenal mass, retroperitoneal adenopathy, and soft tissue metastases in the pelvic muscles as well as a lesion near the right atrium (Figure 2).
Cardiac MRI. (A) Transverse and (B) coronal views demonstrating a large intra-cardiac tumor occupying the majority of the right atrium extending through the myocardium into the epicardial space and through the tricuspid valve into the right ventricle.
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F3
MRI confirmed an intra-cardiac tumor occupying the entire right atrium with extension through the myocardium into the epicardial space and through the tricuspid valve into the right ventricle (Figure 3). MRI brain revealed three lesions consistent with metastatic disease.
(A) Tumor cells from cytology with Papanicolaou stain (400x magnification); (B) Tumor cells from cytology with quick diff stain (400x magnification); (C-D) Tumor with featured rhabdoid cells (insert C) (C-200x magnification, insert 400x magnification; D-400x magnification); (E) Myogenin stain positive rhabdoid cells; (F) PAX 8 stain positive tumor cells.. Surgical Pathology description: Cytology specimen shows groups of cells featured with large pleomorphic appearances of high nuclear-cytoplasm ratio, irregular nuclear membrane, and unevenly distributed chromatin. Core biopsy shows sheets of large pleomorphic cells with similar previously described features and abnormal mitosis. Scattered high-grade malignant cells with rhabdoid morphology are noted. The cells have large eccentric vesicular nuclei, prominent nucleoli, and abundant eosinophilic cytoplasm. Overall morphology is consistent with sarcomatoid-type renal cell carcinoma (RCC) with focal rhabdoid features.
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F4
Renal biopsy was consistent with clear cell RCC with sarcomatoid features (Figure 4).