Case 66

Surgical Pathology Case
 
Clinical Information
 

An 82-year-old gentleman has a history of hypertension, benign prostate hyperplasia and essential thrombocytopenia. In 2007, he came to the clinic with a complaint of weight loss and fatigue for the past four months, and he also felt a lump in the abdomen without constipation, diarrhea or bloody stool. A subsequent CT scan shows multiple large simple cysts in bilateral kidneys that have a thin wall with uniform low attenuation. An enhancing exophytic mass in the lower pole of the right kidney is identified, which is solid with heterogeneous attenuation and measures up to 6.0 cm in maximal dimension. The liver, lung and pancreas are free of mass or cyst, and no pelvic mass or lymphadenopathy is present. The patient has no familial history of cystic renal. A malignant tumor was highly suspicious and the patient then underwent an open nephrectomy.

Gross Description
 

Grossly, the renal specimen weights 373 grams and the surface is distorted by multiple thin-wall cysts from 1.0 cm to 5.0 cm in diameter.  Upon bisecting the kidney, the renal parenchyma and pelvis are distorted by these cysts. The cysts contain clear-yellow to dark-brown fluid and the inner walls of the cysts are smooth. A well-demarcated mass is noted in the lower pole of the kidney with a solid brown, tan cut surface. The tumor measures 5.05.55.0 cm and is restricted within the renal capsule with a pushing margin. The renal artery, vein and ureter are unremarkable.

     
     
 
     
 
  HE, 10 HE, 10
 
  HE, 40 HE, 10
   
  HE, 10  
     
 

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Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Discussion: Zenggang Pan