Pathologic quiz case: Hepatic mass in a patient with renal cell carcinoma.

Abstract

A white woman had a radical right nephrectomy for stage I renal cell carcinoma of clear cell type. She had yearly computed tomographic scans that showed no evidence of tumor. Seven years postnephrectomy, however, an abdominal computed tomographic scan identified a new 2.0-cm, hypodense, nonenhancing peripheral mass present in the posterior right lobe of her liver (Figure 1). There was no associated biliary dilatation or lymphadenopathy, and no recurrent mass was identified in the right renal surgical bed. Physical examination was unremarkable. Blood tests revealed a white blood cell count of 5.5 3 109/L; hemoglobin, 140 mmol/L; platelets, 146 3 109/L; and normal liver function tests with a prothrombin time of 13.1 seconds and international normalized ratio of 1.0. The patient’s carcinoembryonic antigen value was less than 1.0 mg/L, and CA19-9 was within the normal range. Viral hepatitis serology, a-fetoprotein levels, and antimitochondrial antibodies were unavailable. A chest radiograph and whole body bone scan showed no evidence of metastases. Fine-needle aspiration of the liver mass revealed polymorphous lymphoid cells, normal hepatocytes, and rare atypical spindle cells. A computed tomography–guided needle core biopsy revealed a chronic inflammatory infiltrate. The hepatic lesion was surgically resected, as metastatic re-