Ipsilateral adrenal metastasis with adrenal and residual renal vein tumor thrombus from ESC-RCC 6 years post-nephrectomy: A case report

Figures

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  Fig. 1. Abdominal contrast-enhanced CT. (A) Axial and (B) coronal sections showing a heterogeneously enhanced left upper pole renal mass with a normal left adrenal gland.

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  Fig. 2. Pathological specimen showing tumor cells with abundant eosinophilic punctate cytoplasmic granules.

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  Fig. 3. Abdominal contrast‑enhanced CT at recurrence (March 2025). (A) Coronal section showing a 61×53×50 mm left adrenal mass with heterogeneous enhancement. (B) Tumor thrombus extending into the adrenal vein. (C) Tumor thrombus in the residual renal vein.

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  Fig. 4. Intraoperative and gross specimen photographs. (A) Exposure of the left adrenal mass. (B) Exposure of the left adrenal vein and left renal vein. (C) Exposure of the left renal vein and left ovarian vein. (D) Complete resection of the tumor and tumor thrombus. (E) Gross specimen – external view. (F) Gross specimen – cut section.

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  Fig. 5. Pathological and immunohistochemical examination of the adrenal metastasis. (A) Hematoxylin and eosin (HE) staining showing solid areas of tumor cells with abundant eosinophilic cytoplasm (×100). (B) Higher magnification demonstrating eosinophilic cytoplasmic granules and round to oval nuclei arranged in nests and sheets (HE, ×200). (C) Immunohistochemistry showing diffuse nuclear positivity for PAX‑8 (×100). (D) Higher magnification confirming PAX‑8 expression (×200), supporting renal origin. The tumor cells were negative for α‑inhibin, CgA, Melan‑A, and syn (not shown).