Case ReportCASE REPORTS AND CLINICAL OBSERVATIONS
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Collision Tumor of the Kidney: Renal Cell Carcinoma Hidden in a Giant Angiomyolipoma in a Patient With Tuberous Sclerosis Complex

José Iván Robles-Torres, José Gustavo Arrambide-Herrera, Max Molina-Ayala, Sergio Alan Dávila-Martínez, Pedro Antonio Madero-Morales and Lauro Salvador Gómez-Guerra
Ochsner Journal September 2021, 21 (3) 287-290; DOI: https://doi.org/10.31486/toj.20.0075

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Computed tomography scan in coronal view shows a large right perinephric hematoma, left kidney with multiple angiomyolipomas, and abundant free fluid in the peritoneal cavity.

  • Figure 2.
    Figure 2.

    (A) Macroscopic view of the kidney. (B) Cross-section of the kidney shows visible tumor with a tan, whorled appearance and admixed fat tissue (asterisk). The ureter was identified (arrow).

  • Figure 3.
    Figure 3.

    Hematoxylin and eosin stained sections of the patient's kidney. (A) The arrangement of adipocytes, spindle cells, and enlarged thick-walled vessels with irregular walls is mostly haphazard (×100). (B) A clear transition to a different tumor is observed in nests within a collagenous stroma (×100). (C) In detail (×400), pleomorphic nuclei and prominent nucleoli are observed, with a finely granular eosinophilic cytoplasm and a fine capillary network, compatible with renal cell carcinoma. The entire area with these characteristics was surrounded by angiomyolipoma. Immunohistochemistry was performed to further identify this foci, with CD117 negativity (D), HMB45 positivity only in the angiomyolipoma component (E), and PAX8 nuclear positivity in the renal cell carcinoma (F).

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