Synchronous Occurrence of Papillary Urothelial Carcinoma, Cystic Clear Cell Carcinoma, Multiple Papillary Renal Cell Carcinomas of Unknown Malignant Potential and Multiple Cortical Cysts in Same Kidney: A Rare Case Report
Bibliographic record
Abstract
Synchronous occurrence of dual pathology is known to occur, but triple pathology in the kidney is an extraordinarily rare phenomenon. Our unique case showed incidental triple pathologies in the same kidney. A left nephroureterectomy specimen received in our anatomic pathology department revealed a high-grade papillary urothelial carcinoma, cystic clear cell carcinoma, and multiple nodules of papillary renal cell carcinoma of unknown malignant potential (former papillary renal cell carcinoma, according to size criteria of 0.5-2.0 cm, WHO classification). A 61-year-old man came to the urology department. His medical history was significant for smoking, hypertension, sleep apnea, and coronary heart disease. No family history or genetic history was given in his chart. Gross examination revealed the kidney weighed 220 g and measured 15 × 7 × 5 cm. Serial sectioning of the specimen revealed a single papillary lesion in the renal pelvis measuring 5 × 5 × 3 cm without any areas of hemorrhage or necrosis. Incidental findings covering the entire surface of kidney included multiple cystic and solid golden yellow nodules ranging from 1 to 12 mm. Microscopic examination showed a high-grade papillary urothelial carcinoma, cystic clear cell carcinoma, and papillary neoplasm of uncertain malignant potential (former papillary renal cell carcinoma). Additional findings included multiple renal cell papillomatosis, cortical cysts, and arterial arteriosclerosis. Immunohistochemistry showed positive staining for CD10 and p63 and negativity for P504S. Our case is unique in that 3 distinct pathologies were present in the same kidney. we have not come across any literature describing multiple entities including high-grade papillary urothelial carcinoma, cystic clear cell carcinoma, papillary renal cell carcinoma, cortical cysts, and other chronic changes in 1 kidney. This unusual constellation of papillary renal neoplasms raises the question of genomic alterations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.003 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.003 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".