Recent onset headaches.
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There is a well-defined, vividly contrast enhancing mass identified in the right frontal lobe measuring 25 x 20 x 18 mm (AP x lat x cc). The mass demonstrates a thick contrast-enhancing rim and a 6 x 6 mm focus of central hypodensity/necrosis. There is extensive surrounding vasogenic edema resulting in mass-effect with sulcal effacement, effacement of the right lateral ventricle and 3 mm left-sided midline shift.
No other mass, focal abnormality, intra or extra-axial collection is identified.
Ventricles and basal cisterns are within normal limits and age appropriate.
The patient went on to have a resection.
Paraffin sections show a densely hypercellular tumour within cerebral white matter. Tumour is sharply demarcated from adjacent brain parenchyma and is composed of cells with pleomorphic round, oval and angulated hyperchromatic nuclei and a variable amount of pale to clear cytoplasm. These are dispersed in an intensely vascular stroma with lobules of tumour delimited by thin walled capillaries. An occasional mitotic figure is identified and there is focal tumour necrosis. The features are most consistent with metastatic renal cell carcinoma.
IMMUNOHISTOCHEMISTRY: Tumour cells sho strong staining for pancytokeratin AE1/AE3 and moderate staining for CAM5.2. No staining for CD10 or Inhibin is seen in tumour cells. This profile is consistent with a renal cell origin of tumour.
FINAL DIAGNOSIS: metastatic renal cell carcinoma.