Rapidly progressive giant renin secreting tumor: a rare case report

Figures

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  Fig. 1. CT manifestations of the left renal tumor; (A) Enhanced CT arterial phase 8 years ago showed a low-density tumor of approximately 3.7 cm in diameter in the left kidney without obvious enhancement; (B) Enhanced CT excretory phase 8 years ago showed no obvious enhancement of the left renal tumor; (C) Enhanced CT arterial phase 3 months ago showed a huge tumor in the left kidney, approximately 13.3 cm in diameter, with enhancement at the tumor periphery and hypodense area in the center without enhancement; (D) Enhanced CT arterial phase 3 months ago showed a close relationship between the tumor and the branches of the left renal artery; (E) Coronal enhanced CT showed compression of the splenic artery and abdominal aorta by the left renal tumor; (F) Three-dimensional reconstruction showed the tumor compressed the left kidney, similar to “residual kidney sign”, “vine-like” vascular shadow, signs of Wilms tumor.

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  Fig. 2. MRI and 68Ga-NY104 PET/CT manifestations of the left renal tumor. (A) T2-weighted imaging of the left renal tumor showed hyperintensity in the center of the tumor; (B) Enhanced MRI showed enhancement at the tumor edge and no enhancement in the center; (C) Coronal T2-weighted imaging of the left renal tumor; (D) Enhanced MRI showed compression of the spleen and displacement of the abdominal aorta by the tumor; (E) The cross-section PET/CT shows that the tumor does not express CA IX. (F) The coronal PET/CT shows that the tumor does not express CA IX.

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  Fig. 3. Gross and pathological specimens. (A) Completely resected ex vivo specimen; (B) Cross-section of the ex vivo specimen; (C) Low-power HE staining showed tumor cells arranged in chords (×40); (D) High-power HE staining showed round or polygonal cells with pathological mitoses (4/50HP) (×400); (E) IHC staining showed a KI-67 value of 3%; (F) IHC staining showed CD34(+).

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  Fig. 4. IHC staining of the tumor. (A) Syn (weakly positive); (B) SMA (+); (C) Vimentin (+); (D) TFE3 (+). (E) CAIX (negative); (F) RCC (negative).