RESUMEN
Primary adrenal angiosarcoma is an extremely rare malignant tumor with challenging diagnosis. A 66-year-old woman had a 4.3 cm right adrenal mass suspicious for adrenal cortical carcinoma. Pathological examination demonstrated a hemorrhagic adrenal cyst with numerous irregularly shaped anastomosing vascular channels lined by atypical endothelial cells that had frequent atypical mitotic figures (12/10 HPF, Ki67 10%). The tumor cells were positive for CD31, ERG, and FLI-1, but negative for adrenal and other tumor lineage markers by immunohistochemistry. NGS fusion gene testing ruled out epithelioid hemangioendothelioma. Accurate diagnosis and differential inclusion are important for appropriate treatment of this rare tumor.
RESUMEN
Emphysematous pyelonephritis (EPN) is a severe, acute necrotizing infection of the kidney with gas accumulation in the renal parenchyma, collecting ducts, and/or perirenal tissue. We report a case of EPN in a 66 year-old male with uncontrolled diabetes mellitus (DM), urinary tract infection and septic shock necessitating emergent bilateral radical nephrectomy. Morphologically, the kidney parenchyma revealed severe acute bacterial pyelonephritis with extensive abscesses, gas cysts, necrosis and foci of infarctions. The uninvolved background cortex parenchyma exhibited diabetic nephropathy (DN), Class IIB. Post-operatively, the patient remained dialysis-dependent with multiple re-admissions for recurrent multi-drug resistant E. coli pyocystitis, anemia and urinary retention.