Fig. 4.

Clear cell RCC (ISUP grade 2) in a 50-year-old female patient. Coronal T1-weighted spoiled gradient echo images acquired during the corticomedulary (A) and delayed nephrographic (B) phases of a dynamic contrast enhanced examination show a heterogeneous mass at the upper pole of right kidney exhibiting a hypervascular component peripherally (arrowheads). A central stellate area with intense delayed enhancement (*) is present. Coronal perfusion map (C) generated with a 2D ASL acquisition shows high perfusion in the periphery of the mass inferiorly (arrowheads) with areas of decreased tumor perfusion centrally (*). Bivalved gross specimen confirms the presence of a rim of viable tumor tissue (arrowhead) around a central scar (*) (D). E) Histopathology in viable tumor showed prototypic clear cell renal cell carcinoma, ISUP nucleolar grade 2, with nests of clear cells surrounded by intricate branching vascular network (F). Sections from the central scar show hyalinization and fibrosis with branching capillary network. No viable tumor cells or necrosis is identified. (G).