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Volume 54, Issue 3 , Pages A41-A44 , September 2009

Quiz Page September 2009: Long-standing High-Renin Hypertension and Hypokalemia

Upper abdomen computed tomographic scan with contrast injection. A 2 x 2-cm round lesion is visible at the corticomedullary junction in the middle third of the left kidney. (A) The lesion is isodense

Upper abdomen computed tomographic scan with contrast injection. A 2 x 2-cm round lesion is visible at the corticomedullary junction in the middle third of the left kidney. (A) The lesion is isodense to the renal parenchyma (thin arrows), with (B) weak peripheral contrast enhancement in the late parenchymal phase (thick arrow).
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Light microscopy of hematoxylin and eosin staining. Branching vascular lacunae (thin arrows) with hemangiopericytoma-like aspects show an organoid cell growth pattern (original magnification x10).

Light microscopy of hematoxylin and eosin staining. Branching vascular lacunae (thin arrows) with hemangiopericytoma-like aspects show an organoid cell growth pattern (original magnification x10).
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Light microscopy of toluidine blue staining. Eosinophilic granular cytoplasm is shown (original magnification x20).

Light microscopy of toluidine blue staining. Eosinophilic granular cytoplasm is shown (original magnification x20).
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Immunohistochemical staining is positive for (A) vimentin and (B) CD34.

Immunohistochemical staining is positive for (A) vimentin and (B) CD34.
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Transmission electron microscopy, (A) lower and (B) higher magnification, shows electron-dense cytoplasmic secretory granules of different shapes.

Transmission electron microscopy, (A) lower and (B) higher magnification, shows electron-dense cytoplasmic secretory granules of different shapes.
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Case provided and authored by Giuseppe Regolisti, MD,¹ Aderville Cabassi, MD,¹ Elisabetta Parenti, MD,¹ Paolo Greco, MD,¹ Caterina Maccari, MD,¹ Letizia Gnetti, MD,² Massimo Melissari, MD, PhD,² Domenico Potenzoni, MD,³ and Enrico Fiaccadori, MD, PhD,¹ ¹Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, and ²Sezione di Anatomia Patologica, Dipartimento di Medicina di Laboratorio, Università di Parma; and ³Divisione di Urologia, Ospedale di Vaio, AUSL di Parma, Parma, Italy.Address correspondence to Giuseppe Regolisti, MD, Terapia Intensiva, Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, Università di Parma, Via Gramsci, 14 - 43100 Parma, Italy. E-mail: gregolisti@ao.pr.it