PMC5264199_01
(a and b) Contrast-enhanced computed tomography scan images in the axial plane showing a large heterogeneous mass lesion arising from the left side of retroperitoneum replacing the entire left kidney. The mass was displacing the bowel loops, aorta (outlined arrow), and inferior vena cava (arrow) to the opposite side. There was no evidence of thrombus seen in the inferior vena cava. The right kidney (*) was normal and located in the right renal fossa
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F1
We repeated the CECT abdomen and chest which revealed a 21 cm x 17 cm x 12 cm solid mass with necrosis within it and this was arising from the left kidney [Figure 1].
(a) Intra-operative image showing the lump occupying almost the entire abdominal cavity with colon stretched over it and pushed to the right of the patient (b) The excised specimen showing that it arose predominantly from the middle and lower pole of the left kidney
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F2
The operative findings confirmed that the mass was arising from the lower pole of the left kidney, and it was occupying the entire abdomen and pushing the peritoneal contents to the right paracolic gutter [Figure 2a]. The specimen measured 27 cm x 22 cm x 18 cm and weighed 5.5 kg [Figure 2b].
Photomicrograph of the tumor shows features of anangiomyolipoma with a variable mixture of smooth muscle bundles (thin arrow), blood vessels (bold arrow), and adipose tissue (star) (a and b: H and E, x40 and c: H and E, x200). Focal immunopositivity for hydroxy beta-methyl butyric acid-45 was also noted (parentheses) (d: HMB 45, x200)
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F3
There was a positive reaction towards HMB45 [Figure 3] and trace positivity towards vimentin.