Presentation
Recent onset headaches.
Patient Data
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.
Histology
Paraffin sections show a densely hypercellular tumor within cerebral white matter. Tumor 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 tumor delimited by thin walled capillaries. An occasional mitotic figure is identified and there is focal tumor necrosis. The features are most consistent with metastatic renal cell carcinoma.
IMMUNOHISTOCHEMISTRY: Tumor cells sho strong staining for pancytokeratin AE1/AE3 and moderate staining for CAM5.2. No staining for CD10 or Inhibin is seen in tumor cells. This profile is consistent with a renal cell origin of tumor.
FINAL DIAGNOSIS: metastatic renal cell carcinoma.