PMC8040600_01
CT abdomen and pelvis showing (A) soft tissue lesions in the left posterior pararenal/perinephric space (lobulated like structures, blue arrows) (B) obstruction of fat visualization by the lesions around the left kidney as compared to the right kidney (red circle). Yellow arrows show the black space representing fat around the right kidney.. CT indicates computed tomography.
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CT) showed multiple fluorodeoxyglucose (FDG)-avid soft tissue nodules in the left perinephric space, consistent with local recurrence, and new FDG-avid left retrocrural soft tissue nodule likely metastatic adenopathy. Computed tomography abdomen and pelvis done 2 months after onset of symptoms showed soft tissue lesions in the left posterior pararenal/perinephric space (Figure 1).
CT abdomen and pelvis showing (A) complete resolution of nodular soft tissue thickening in the left posterior pararenal/perinephric space and disappearance of the lesions seen in the previous image with better visualization of the left kidney (orange arrows) and (B) better visualization of the fat surrounding the left kidney along with better overall visualization of the kidney (yellow circle).. CT indicates computed tomography.
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After 4 cycles of pembrolizumab, imaging done showed complete resolution of metastatic perinephric soft tissue (Figure 2).
Regulatory T-cells detected within the adrenocortical tumor using CD3, CD4, and CD25 immunostains at 60x (area within the circle, one of the cells pinpointed with the arrow). Tregs are CD3+, CD4+, CD25+, and FoxP3+ T-cells. Tregs were found to constitute less than 5% of the white blood cells within the tumor, favoring a good prognosis.
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Using CD3, CD8, and CD25 immunostains, we were able to stain for regulatory T-cells, which were found to represent only 5% of total lymphocytes (<10/mm2) (Figure 3).