PMC6100120_01
Computed tomography (CT) of (A) abdomen and (B) thorax at the time of diagnosis. CT of patient 1 showed (A) a large right-sided renal tumor 7.5 cm x 5 cm x 5 cm in the kidneys upper and middle parts (see arrow) and (B) bilateral multiple rounded suspect metastases in the lungs, up to 2.5 cm in diameter (see arrow).
10.1177_1177271918792246-fig1.jpg
PMC6100120_01_10.1177_1177271918792246-fig1.jpg
fig1-1177271918792246
Whereas a gastroscopy was normal, the planned CT scan showed in the upper and middle part of the right kidney a large renal tumor, 7.5 cm x 5 cm x 5 cm (Figure 1A), with overgrowth into the perirenal fat, possibly the right liver lobe, around the inferior vena cava and aorta, and with continuity to enlarged necrotic lymph nodes along major retroperitoneal vessels. Bilateral multiple rounded suspect metastases were seen in the lungs, up to 2.5 cm in diameter (Figure 1B).
Leukocyte counts related to time from hematological presentation and treatment with hydroxyurea (patient 1). The X-axis represents time in days and the Y-axis represents leukocyte counts (/muL). The blue line represents the trend in the leukocyte count. The red line represents the upper limit of the reference interval for the leukocyte count (8800/muL). The initial dose of hydroxyurea was 500 mg daily, later increased to 1000 mg daily (see arrows).
10.1177_1177271918792246-fig2.jpg
PMC6100120_01_10.1177_1177271918792246-fig2.jpg
fig2-1177271918792246
Thereafter, the dose was incremented to 1000 mg daily when the leukocyte count had risen to 139 000/muL, soon after which monitoring of laboratory values was stopped due to a generally worsened condition (Figure 2).
Renal biopsy immunohistochemistry results by microscopy. (A) G-CSF expression (brown) and (B) CXCL8 expression (brown) in the renal carcinoma cells. Original magnification x100, patient 1.
10.1177_1177271918792246-fig3.jpg
PMC6100120_01_10.1177_1177271918792246-fig3.jpg
fig3-1177271918792246
The G-CSF and CXCL8 expressions of the renal carcinoma cells were later confirmed by IHC (Figure 3A and B, with method descriptions below).