Triple Threat: Three Primary Malignancies Simultaneously Involving Three Genitourinary Organs

Figure 3

The histopathological findings of the radical cystectomy specimen showed a small focus of noninvasive high-grade urothelial carcinoma, composed of tumor cells with nuclear atypia, pleomorphism, and hyperchromasia ((a, b) hematoxylin and eosin, ×100 and ×400 magnification). The left radical nephrectomy specimen showed a clear cell renal cell carcinoma with nests of clear cells surrounded by intricately branching vascular septa and hyperchromatic nuclei ((c) hematoxylin and eosin, ×400 magnification). These tumor cells demonstrated membranous staining pattern with carbonic anhydrase IX immunohistochemical stain ((d) ×200 magnification). Histopathologic evaluation of the right nephrectomy specimen showed the typical nested pattern of a well-differentiated neuroendocrine tumor surrounded by fibrous stroma ((e) hematoxylin and eosin, ×400 magnification). Chromogranin A immunohistochemical stain showed diffuse granular staining in the tumor cells ((f) ×200 magnification). One out of three inter-aorto-caval lymph nodes showed metastatic neuroendocrine carcinoma ((g) hematoxylin and eosin, ×100 magnification), confirmed by synaptophysin immunohistochemical stain ((h) ×100 magnification).

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