Surgical pathology

Impression

Kidney and adrenal, right, radical nephrectomy

  • Clear cell sarcoma of kidney, 19.8 cm
  • tumors invades through capsule into perinephric fat and renal sinus lymphvascular spaces (stage ii)
  • renal vein, ureteric and parenchymal resection margins free of tumor

Lymph nodes, paraaortic, excision

  • No evidence of malignancy in two lymph nodes

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Microscopic description

  • sections of renal mass show a monomorphic population of rounded cells arranged in a diffuse-to-corded pattern consisting of ovoid-to-round nuclei, vesicular chromatin, inconspicuous nucleoli. Cytoplasm is moderate, and mostly clear-to-eosinophilic. A delicate arborizing-to-parallel vascular network separates groups of tumor cells
  • tumor-renal parenchymal interface is well-demarcated, focally infiltrating without pseudocapsule
  • limited panel of immunostains show WT-1 to be negative in the tumor cells. INI-1 is retained. Cytokeratin fails to identify tubular cell rests and is negative
  • overall, histomorphology is consistent with a clear cell sarcoma of the kidney, supported by its immunophenotype. By invasion through the capsule into the perinephric fat, as well as by invasion into the renal sinus lymphovascular spaces, this is stage II. Tumor is not seen present at ink, on multiple sections, therefore, presumed to be completely resected

Gross description

  • first specimen labeled "right kidney and adrenal" consists of a previously inked and bivalved kidney and adrenal gland
  • adrenal gland measures 6.5 x 1.5 x 0.1 cm. The gland is compressed on the surface of the kidney, but tumor does not grossly appear to invade it
  • [right kidney] external surface is intact and glistening and not grossly disrupted. Cut surface appears heterogenous with tan-pink area mixed with regions of yellow-white friable parenchyma with regions of necrosis. Overall architecture is lobulated with regions of white-tan tissue having a glistening, mucoid appearance
  •  a green cassette labeled "ureter margin" and holds a tan-brown fragment of tissue measuring 1.6 x 0.6 x 0.7 cm and is compressed at one end
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