Case 476 -- A 60 year-old woman with breast cancer and a left renal mass

Contributed by Craig Horbinski, MD, PhD and Federico Monzon-Bordonaba, MD
Published on line in August 2006


The patient was a 60 year-old woman who had inflammatory ductal carcinoma of the left breast diagnosed on a core biopsy in January 2005. An axillary lymph node was positive for metastatic disease on a concurrent FNA. The tumor was found to be ER-positive, PR-negative, and Her2-Neu weakly positive. Workup for further metastatic disease found multiple lesions in the liver and spine [images 1 and 2] as well as a 5 cm mass in the upper pole of the left kidney [image 3].

She received neoadjuvant chemotherapy and then underwent a modified radical mastectomy in October 2005 that found extensive primary tumor [image 4] as well as metastases in 14 of 14 axillary lymph nodes [image 5]. Two months later she had a left nephrectomy:


The specimen was a 280-gram nephrectomy measuring 12 cm superior to inferior, 6.0 cm anterior to posterior, and 7.0 cm medial to lateral. There was a 4.5 x 3 x 3 cm well circumscribed heterogeneous soft orange-yellow tumor protruding out of the superior pole with cystic changes and hemorrhage [image 6]. There was also a 0.2 cm well-defined white nodule near the renal papillae in the inferior pole [image 7].


Sections of the tumor showed tubules and solid nests containing large clear cells with sharp cytoplasmic borders, dark pleomorphic nuclei, and occasionally prominent nucleoli [images 8, 9 and 10]. Further examination of the tumor showed a large focus of cells arranged in solid nests that had eosinophilic cytoplasm, larger nuclei, open chromatin, and prominent nucleoli [images 11, 12 and 13]. Occasional glandular/ductular structures were seen [image 14]. Similar-appearing cells were seen in the inferior pole nodule [images 15 and 16].

The immunohistochemical profile of these cells is summarized in Table 1 and image 17.

Table 1:


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