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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

June 2010 - Presented by Nelson Velasco, M.D.

Clinical history:

The patient is a 56-year-old female with no significant past medical history who presented to her PMD with on going non-specific microscopic hematuria. A cystoscopy performed 10 years prior was negative. A CT ordered for further evaluation showed a 5 cm complex cyst in the right kidney at the upper pole and extending downward into the hilum. Upon referral to UC Davis Health System, an abdominal ultrasound showed a 4.5 cm isoechoic mass of the upper pole of the right kidney probably representing a hemorrhagic cyst.  A cystoscopy was also perfomed and was negative. The patient underwent a partial right nephrectomy.

Gross description:

The partial nephrectomy specimen measured 6.5 x 6 x 4 cm and was predominantly cystic. Upon sectioning a small yellow nodule measuring 1.2 x 1 x 1.2 cm was noted within a background of hemorrhagic and necrotic material. The nodule was grossly 0.8 cm from the parenchymal margin.

Microscopic photographs

COTM June 2010 Microscopic photographs: Figure 1 of 3 (20x) COTM June 2010 Microscopic photographs: Figure 2 of 3 (20x) COTM June 2010 Microscopic photographs: Figure 3 of 3 (40x)

Immunohistochemical stains:

AE1/AE3: Positive
Calretinin: Negative
CAM 5.2: Positive
CD31: Negative
Factor VIII: Negative
HMB-45: Positive
Vimentin: Positive

Figure 1: AE1/AE3 20x

COTM June 2010 Immunohistochemical stains: Figure 1 of 3 (AE1/AE3 20x) 

Figure 2: CAM 5.2 20x

COTM June 2010 Immunohistochemical stains: Figure 2 of 3 (CAM 5.2 20x)

Figure 3: VIM 20x

COTM June 2010 Immunohistochemical stains: Figure 3 of 3 (VIM 20x)