PMC2934590_01
a) A panel figure showing the large right renal tumor abutting the IVC (Figure 1a) with the intraoperative view showing the wedge excision of the IVC (Figure 1b) with its repair completed (Figure 1c) and the gross tumor on cut section (Figure 1d). An H and E stained slide showing a monotonous population of spindle cells on low power (Figure 1e) with elongated pleomorphic nuclei in an eosinophilic cytoplasm on high power (Figure 1f). Immuno-histochemical staining with antibodies to cytokeratin (-CK, Figure 1g), HMB-45 (Figure 1h) and smooth muscle actin (+SMA, Figure 1i)
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Computerized tomography confirmed a large homogenous mass lesion involving the right kidney, encasing the infra-hepatic segment of the IVC closely abutting the liver [Figure 1a]. On exploration, the right renal mass was found to be adherent to and encasing a 5 cm length of infra-hepatic IVC [Figure 1b]. Right radical nephrectomy with excision and repair of the involved anterior wall of IVC was performed [Figure 1c]. Gross tumor [Figure 1d] and histopathology revealed right renal capsular LMS involving the renal capsule and pelvis, encircling the renal hilar vessels. The H and E stained slide showed a uniform pattern of interlacing closely packed spindle cells on low power (10x - Figure 1e) with pleomorphic hyperchromatic elongated nuclei amidst an eosinophilic cytoplasm (HP-40x - Figure 1f), which suggested LMS. Immunohistochemistry revealed a negative (HMB-45 - Figure 1g) and cytokeratin (CK - Figure 1h) staining and an intensely positive cytoplasmic staining for smooth muscle actin (SMA - Figure 1i), confirming the diagnosis of LMS.