PMC2698105_01
A. Sonogram of 12 cm-mass component located on top of the tumor shows variable echogenity with heterogeneous hyperechoic areas mixed with less echoic areas or small cysts presenting cystic necrosis (arrowheads).. B. Transverse sonogram of urinary bladder reveals a small tumor (arrow) arising from the left postero-lateral bladder wall.. C-E. Sequential enhanced CT scans through pancreas (C), at the level of the lower abdominal region (D) and the bladder (E).. C. Relatively well-defined, heterogeneous tumor seems to originate from the left kidney without any normal tissue apparently preserved from invasion. Obliteration of the fat plane (arrowhead) is seen between the upper-medial portion of the tumor (arrow) and the pancreatic tail corresponding to invasion that was pathologically proven.. D. Giant tumor extends caudally as a smoothly marginated mass with considerable displacement of the aorta and the inferior vena cava (arrowhead) at the midline. The tumor displays peripheral and nodular enhancement (arrows), which delineates large, hypodense zone of necrosis. The center has an attenuation value of between 20-25 HU.. E. A soft tissue sessile mass (arrow) extends into the bladder lumen. The perivesical fat planes are intact.. F. Photograph of resected kidney demonstrates that the tumor involves the entire renal parenchyma and pelvocaliceal system.. G. Photomicrograph of histological specimen obtained from renal neoplasm shows nest of transitional cell carcinoma (arrow) in a sarcomatous stroma (H and E, x100).
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F1
The largest component of the tumor located at the upper margin had multiple, small hypoechoic areas thought to be corresponding to necrosis (Figs. 1A, B). It has an extension into the pelvic inlet and a focal compression of the main vascular structures (Figs. 1C-E). The tumor had occupied the renal collecting system and extended into the renal capsule without leaving any cortical tissue (Fig. 1F). The sarcomatous component comprised nests of invasive transitional cell carcinoma (Fig. 1G).