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Extra-Kidney Mass

  • Qinwen Liu
    Affiliations
    Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Nephropathy Clinical Medical Research Center of Sichuan Province, China
    Search for articles by this author
  • Ge Li
    Affiliations
    Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Nephropathy Clinical Medical Research Center of Sichuan Province, China
    Search for articles by this author
  • Zhihui Yang
    Affiliations
    Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
    Search for articles by this author
  • Yong Cheng
    Affiliations
    Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Nephropathy Clinical Medical Research Center of Sichuan Province, China
    Search for articles by this author
  • Xiangjun Kong
    Affiliations
    Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Nephropathy Clinical Medical Research Center of Sichuan Province, China
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  • Rui Jiang
    Correspondence
    Address correspondence to: Rui Jiang, Ph.D., M.D., Department of Urology, Nephropathy Clinical Medical Research Center of Sichuan Province, Affiliated Hospital, Southwest medical University, Taiping Road, Luzhou, Sichuan 646000, China.
    Affiliations
    Department of Urology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China

    Nephropathy Clinical Medical Research Center of Sichuan Province, China
    Search for articles by this author
Published:September 30, 2022DOI:https://doi.org/10.1016/j.urology.2022.09.011
      A 64-year-old man with hypertension (156/76 mm Hg) without associated tachycardia was admitted to our hospital for a 1-week history of left-sided loin pain. Routine blood work indicated that hemoglobin was 10.3 g/dL and the ratio of neutrophil-to-lymphocyte (NLR) was 4.9. Complete metabolic panel and serum catecholamines were normal. Computed tomography (CT) revealed a round soft tissue mass measuring 55 × 45 × 35 mm located beside the left renal hilum and 10 mm away from the celiac trunk. 2 renal hilum lymph nodes were visible. The lesions showed enhancement in contrast-enhanced CT (52  Hounsfield unit) compared to that in plain CT (37  Hounsfield unit) (Fig. 1). The patient was treated by laparoscopic radical resection of lesion. The mass was a gray-white cut surface (Fig. 2). Histologically, the tumor cells were cuboidal and arranged in irregular tubular or glandular formations. Immunohistochemical staining showed positive expression of CK7, CK8, CK19, 34BE12, Vimentin, Pax8, and Integrase Interactor 1 (INI-1), and negative expression of CK20, P63, GATA3, CD117, P504S, S100P, Pax2 and OCT3/4. Two lymph nodes were positive for malignant cells (Fig. 3). The patient's left-sided loin pain was relieved, and the postoperative blood pressure had no significant change compared with the preoperative one after 3 month of follow-up.
      Figure 1
      Figure 1(A) Abdominal CT showed a round soft tissue mass with a maximum diameter of 55mm located besidethe left side of the abdominal aorta. The enhanced scan showed mild-to-moderate heterogeneous enhancement (white arrows). (B) Both kidneys were morphologically intact. The mass was located outside the kidney (white arrows). 2 lymph nodes were visible around the renal hilum (red arrows). (C) The upper pole of the mass was adjacent to the left renal artery (white arrows).
      Figure 2
      Figure 2The mass was about 6.0 × 4.8 × 3.7cm lobulated solid tumor, with a gray-white cut surface. Focal hemorrhage and necrosis in the mass were visible.
      Figure 3
      Figure 3(A) Cuboidal tumor cells with conspicuous nucleoli, high-grade nuclear atypia and acidophilic cytoplasm (H&E x 200). (B-F) Positive immunohistochemical staining of Pax8 (x 200), CK7 (x 100), CK19 (x 100), INI-1 (x 100), and Vimentin (x 100), respectively. (G) Negative immunohistochemical staining of OCT3/4 (x 100). (H) Malignant tumor cells can be seen in the lymph node sent for pathological examination (x 40) (white arrows).
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