PMC10125746_01
(a) Coronal imaging of large multilobular solid and cystic mass involving most of the left mid to upper pole with a portion of the mass wall not well delineated possibly involving the renal pelvis measuring approximately 8.5 x 9.2 x 9.2 cm. (b) Axial view of high-density material within the posterior aspect of the urinary bladder. (c) Coronal imaging of right complex solid and cystic mass in the upper pole measuring 2.4 x 1.7 cm, large solid cystic mass at the lower pole measuring 8.6 x 9.1 x 7.8 cm, and an ill-defined cortical based mass like area in the lower pole measuring approximately 17 x 9 mm. (d) Axial view of aorto-caval adenopathy with arrow pointing to periaortic adenopathy.
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Additionally, paracaval adenopathy was appreciated (Figure 1).
PET scan with right mass demonstrating moderate metabolic activity and left renal mass irregular with hypermetabolic activity.
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There was no evidence of any additional disease outside of the patient's urinary tract, and the previously observed adenopathy did not enhance (Figure 2).
The histopathological findings of the radical cystectomy specimen showed a small focus of noninvasive high-grade urothelial carcinoma, composed of tumor cells with nuclear atypia, pleomorphism, and hyperchromasia ((a, b) hematoxylin and eosin, x100 and x400 magnification). The left radical nephrectomy specimen showed a clear cell renal cell carcinoma with nests of clear cells surrounded by intricately branching vascular septa and hyperchromatic nuclei ((c) hematoxylin and eosin, x400 magnification). These tumor cells demonstrated membranous staining pattern with carbonic anhydrase IX immunohistochemical stain ((d) x200 magnification). Histopathologic evaluation of the right nephrectomy specimen showed the typical nested pattern of a well-differentiated neuroendocrine tumor surrounded by fibrous stroma ((e) hematoxylin and eosin, x400 magnification). Chromogranin A immunohistochemical stain showed diffuse granular staining in the tumor cells ((f) x200 magnification). One out of three inter-aorto-caval lymph nodes showed metastatic neuroendocrine carcinoma ((g) hematoxylin and eosin, x100 magnification), confirmed by synaptophysin immunohistochemical stain ((h) x100 magnification).
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Final pathology was consistent with noninvasive high-grade papillary UC of the bladder (pTaN0), left renal clear cell RCC (pT2bN0), right renal well-differentiated NET, and a single paracaval lymph nodes positive for metastatic NET (pT2aN1) (Figure 3).