PMC5328934_01
Ultrasound study, both in B and Color-Doppler modes.
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It was requested an abdominal ultrasound (Fig. 1) that showed the existence of a heterogeneous mass, mostly isoechoic to muscle with some hypoechoic areas, between the right kidney and the vertebral body, posteriorly to the renal artery and vein.
Abdominal CT, from left to right, top to bottom: unenhanced scan, contrast-enhanced scan in portal phase on the coronal plane, arterial phase, portal phase. A hypervascular mass is seen displacing the right kidney, with a hypodense center (*), compatible with necrosis.
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The abdominal CT was performed two days later, showing a solid and heterogeneous mass in the retroperitoneum, with lobulated contours, resulting in lateral shift of the right kidney and anterior shift of the renal vasculature (Fig. 2).
MIBG I123 scintigraphic scan with SPECT-CT. The lesion is marked with the yellow arrow, not showing any kind of uptake of MIBG I123.
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It was also performed a SPECT/CT examination for better anatomical correlation with the scintigraphic scan (Fig. 3).
MR study, on the left T2WI acquired in singleshot, on the right top to bottom: T2 with fat saturation, DWI-b1000, ADC map. As with the CT images, a mass is seen displacing the right kidney, with very hyperintense center (necrosis) and very high diffusion restriction in the solid portion of the mass.
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Although abdominal MRI didn't contribute much in terms of lesion characterization, it reinforced the probable necrotic center and showed high diffusion restriction in the hypervascular areas (Fig. 4).
Left: Hematoxilin-Eosin: multiple polymorphous cells showing no atypia; right: Intense reaction to actin.
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The immunochemistry tests showed reaction to actin in the fusiform cells and lymphoid markers (Fig. 5).