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Case of the Week

2021-02 / January 11

Contributors:  Aiswarya Irri, G. Kenneth Haines III, Li Li



A man in his 50s presented with significant debilitating left flank pain and was found to have an asymmetrically-enlarged left kidney (16.5 cm) with a soft tissue mass involving the pararenal fascia and hilum concerning for malignancy.


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Quiz

1. What is the correct diagnosis?


A. Papillary renal cell carcinoma with sarcomatoid features

B. High-grade urothelial cell carcinoma

C. Chromophobe renal cell carcinoma with sarcomatoid features

D. Clear cell papillary renal cell carcinoma

E. Clear cell renal cell carcinoma with sarcomatoid features



2.  Which immunohistochemical phenotype is most consistent with this diagnosis?


A. Positive for CA IX and CK7; negative for AMACR or CD10

B. Positive for vimentin, CA IX, and PAX8; negative  for CK7, desmin, or uroplakin

C. Positive for CK7, GATA3, and uroplakin; negative for PAX8, CD10, or CD117

D. Positive for CK7 and CD117; negative for CA IX or vimentin

E. Positive for CK7 and AMACR; negative for CD117, PAX8, or CA IX





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