PMC6535833_01
(a), (b) Computed tomography scan showing symmetric enlargement and hypoattenuation of bilateral kidneys with associated fat stranding involving the renal sinuses and perinephric fat. Left sided urinary stent in in place. No hydronephrosis or nephrolithiasis.
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fig1
Imaging at that time was unchanged from prior imaging, showing symmetric kidney enlargement (Figure 1).
Fine needle aspiration of the kidney. Top left: H&E stain shows blue tumor cells infiltrating the kidney, pushing the tubules and glomeruli apart. Top right: CD20 marker positivity, which is associated with B-cells. Bottom left: CD79 marker positivity, which is associated with B-cells. Bottom right: Terminal deoxynucleotidyl transferase (TdT) positivity, often seen in acute lymphoblastic leukemia.
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fig2
TdT stains consistent with renal invasion by ALL (Figure 2).