PMC5954322_01
Native right kidney, removed at the time of transplantation. (a) The kidney
was enlarged with an irregular cortical surface and numerous, variable sized
fluid-filled cysts. The cysts were compatible with polycystic kidney
disease. Although no distinct neoplastic masses were identified grossly,
abundant firm, white-tan tissue separated the cysts and regionally replaced
the renal parenchyma (*). (b) Despite intraoperative cytology suggestive of
inflammation, histology of the renal parenchyma identified an infiltrative
neoplasm composed of tubules and small islands of neoplastic epithelial
cells amid an abundant desmoplastic stroma. Cellular and nuclear
pleomorphism was marked, and mitoses were frequent. These features were
consistent with a renal cell carcinoma in the right native kidney
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These histologic features were consistent with a renal cell carcinoma (RCC) (Figure 1a,b).
Inguinal and perineal skin. (a) The skin was erythematous with multifocal
erosions and ulcers. (b) Histologically, there were large areas of epidermal
and dermal necrosis with suppurative inflammation extending throughout the
dermis into the subcutis. (c) Dermal and subcutaneous blood vessels
frequently contained fibrin thrombi
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Blood vessels in these sections often contained fibrin thrombi, exhibited fibrinoid vascular necrosis and occasionally necrotizing vasculitis (Figure 2a-c).
The digital and metatarsal pads of the left pelvic limb were erythematous (*)
and the skin distal to the tarsus was hyperemic
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Similar lesions were identified in the digital and metatarsal pads of the left pelvic limb during necropsy (Figure 3).
Caudal to the liver (L), there was an anomalous bifurcation (white arrow) of
the caudal vena cava (CVC) at the level of the adrenal glands. Distal to the
bifurcation, the right branch of the caudal vena cava was regionally
thickened and contained a luminal fibrin thrombus (black arrowhead) at
post-mortem examination. Hemoclips and sutures surrounded the right renal
vein, artery and anastomosing vessels at the site of nephrectomy of the
right native kidney (*)
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TE disease, multifocal acute intravascular fibrin thrombi were distributed throughout multiple other tissues, including the allograft kidney, heart, right adrenal gland and one of the anomalous branches of the caudal vena cava (Figure 4). The allograft kidney had multiple fibrin thrombi within the vessels of the renal cortex and corticomedullary junction and foci of segmental acute tubular necrosis with tubular casts (Figure 5a,b).
Left allograft kidney. (a) Multiple tubules were lined by necrotic epithelial
cells, which were often sloughed into the tubular lumen (*). (b)
Multifocally, blood vessels contained fibrin thrombi (*)
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TE disease, multifocal acute intravascular fibrin thrombi were distributed throughout multiple other tissues, including the allograft kidney, heart, right adrenal gland and one of the anomalous branches of the caudal vena cava (Figure 4). The allograft kidney had multiple fibrin thrombi within the vessels of the renal cortex and corticomedullary junction and foci of segmental acute tubular necrosis with tubular casts (Figure 5a,b).