Fat necrosis mimicking recurrent kidney cancer

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Abstract

Fat necrosis is a benign inflammation of adipose tissue, which is associated with sterile saponification, due to impaired blood supply. At the same time, differential diagnostics with malignant neoplasms and tumor relapses is extremely difficult due to the similar features according to imaging studies (ultrasound, CT, MRI, PET/CT).

We present a clinical case of fat necrosis, confirmed by the immunohistochemical study, simulating recurrent kidney cancer. The patient underwent partial nephrectomy for renal cell carcinoma. After 6 months, radiological signs of tumor recurrence were detected in the resection area, due to which patient underwent laparoscopic nephrectomy. Immunohistochemical study indicated fat necrosis.

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About the authors

Vladimir A. Chernorotov

Vernadsky Crimean Federal University

Email: v-kostenich@mail.ru
ORCID iD: 0000-0002-3111-9747

professor, Head of Department of Radiation Diagnostics and Radiation Therapy of Order of the Red Banner of Labor Medical Institute named after S.I. Georgievsky

Russian Federation, 295051, Republic of Crimea, Simferopol, blvd. Lenin, 5/7

Viktor S. Kostenich

Vernadsky Crimean Federal University

Author for correspondence.
Email: v-kostenich@mail.ru
ORCID iD: 0000-0001-5733-6953

Ph.D. student at the Department of Radiation Diagnostics and Radiation Therapy of Order of the Red Banner of Labor Medical Institute named after S.I. Georgievsky

Russian Federation, 295051, Republic of Crimea, Simferopol, blvd. Lenin, 5/7

Alexey N. Eremenko

Vernadsky Crimean Federal University

Email: v-kostenich@mail.ru
ORCID iD: 0000-0002-5318-6561

Ph.D., urologist at the Department of Oncology of Clinical Medical Multidisciplinary Center named after Saint Luke's

Russian Federation, 295051, Republic of Crimea, Simferopol, Lenin Blvd., 5, building 11

References

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2. Fig. 1. MSCT data: Irregularly shaped soft tissue area (A) measuring 35x35x33 mm after i.v. enhancement intensively accumulates CF up to 85 HU in the arterial phase (B); the formation is adjacent with its wide base to the large lumbar mouse (C, figure), closely adjacent to the descending colon (D, arrows). HU – Hounsfield unit; Mean – average value; SD – standard deviation; Max – maximum value; Min – minimum value.

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3. Fig. 2. Microscopic preparations of the removed infiltrate (stained with hematoxylin and eosin, 40x): A – abundant infiltration by lymphocytes; B – necrotic adipose tissue; C – numerous foam cells; D – numerous cystic cells. No tumor cells were detected during pathohistological examination.

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4. Fig. 3. Results of immunohistochemical study: A - negative reaction of MSC in cells lining cystic structures; B - negative reaction with MSC antibodies in areas of gastrointestinal tract; C - negative reaction with S100 antibodies in areas of gastrointestinal tract; D - positive reaction with SD68 antibodies in cells lining cystic structures.

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