Fig. 2

A 9.6 * 8.9 * 13.9 cm heterogeneously enhancing lesion completely involving left renal parenchyma, perinephric fat stranding and nodularity, focal areas of extracapsular extension, involvement of renal pelvis and ureter, tumoral thrombus extending into infrahepatic IVC, no contrast excretion, enlarged L.N in preaortic and paraaortic, largest 2.1 * 1.4 cm, liver and lung lesions. B, C 21 * 12 * 10 cm gross kidney specimen, weighing 1103 gm. Diffusely infiltrative grayish pink tumors with areas of necrosis and focal calcification. D, E Low power and high power microscopic images showing predominantly papillary type 2 tumor composed of papillary fronds covered with eoisnophilic tumor cells. F CK 20 positive. G CK 7 negative. H CA 9 negative