PMC6362795_01
On MRI (a) Tumor shows heterogenous signal; intensity on Axial T2 -Weighted image (b) coronal Recostruction on gadolinium enhanced T2- weighted image the tumor thrombus invading right renal vein and inferior vena cava up to junction of inferior vena cava with hepatic vein
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F1
Magnetic resonance imaging (MRI) abdomen demonstrated the extension of tumor thrombus up to the junction of hepatic vein and IVC [Figure 1a and 1b].
High power vision of smear shows lobules made of all round cells with indistinct cytoplasm, round nuclei with vesicular chromatin arranged around eosinophilic fibrillary materials and cells were arranged in clusters. (H and E, x400)
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F2
Histopathology demonstrated small round to oval cells with scanty cytoplasm and cells were arranged in clusters [Figure 2].
An immunohistochemical stain for CD99 was positive in the tumor cells. (Immunohistochemistry, x400)
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F3
Immunohistochemical staining showed a highly specific cluster of differentiation (CD99) [Figure 3], thus confirmed the diagnosis of a PNET.
After completion of four cycle of neoadjuvant chemotherapy (IVAD regimen) MRI shows (a) bright signal intensities on T1-weighted and T2-weighted imaging (b); (c) No extension of tumor thrombus seen in right renal vein and inferior vena cava, and on gadolinium contrast no abnormal enhancement seen
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F4
MRI abdomen demonstrated hemorrhagic cystic mass (bright signal intensities on T1 and T2 image) and no tumor thrombus extension visualized renal vein or IVC [Figure 4a-c].