\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[ngerman,english]{babel}



\usepackage{float}








\begin{document}

\title{Imaging findings of succinate dehydrogenase-deficient renal cell
carcinoma}



\author[1]{Wenqin Liu}%
\author[1]{Gui-Wu Chen}%
\author[1]{Jiaxin Meng}%
\author[1]{Xiao-Min Liao}%
\author[1]{Yuhuan Xie}%
\affil[1]{Dongguan People's Hospital}%


\vspace{-1em}



  
  \date{May 18, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup








\sloppy


\textbf{Imaging findings of succinate dehydrogenase-deficient renal cell
carcinoma}

\textbf{Wenqin Liu\textsuperscript{1} \textbar{} Guiwu
Chen\textsuperscript{1} \textbar{} Jiaxin
Meng\textsuperscript{1}\textbar{} Xiaomin Liao\textsuperscript{2}
\textbar{} Yuhuan Xie\textsuperscript{1}}

Department of Ultrasound, The Tenth Affiliated Hospital of Southern
Medical University, Dongguan People's Hospital, Dongguan, China

Department of Pathology, The Tenth Affiliated Hospital of Southern
Medical University, Dongguan People's Hospital, Dongguan, China

\textbf{Corresponding Author}

Yuhuan Xie

Department of Ultrasound, The Tenth Affiliated Hospital of Southern
Medical University, Dongguan People's Hospital, 3 Wandao Road South,
Wanjiang District, Dongguan, Guangdong Province, China

Telephone Number: +86 13713130989

Fax Number: +86 076928636378

Email Address: xieyuhuan0989@126.com

\textbf{AUTHOR CONTRIBUTIONS}

Wenqin Liu wrote the original draft of this letter, and Guiwu Chen made
subsequent revisions. Jiaxin Meng participated in the image analysis and
interpretation. Xiaomin Liao participated in the pathology image
analysis and interpretation. Yuhuan Xie assisted in the revision and
supervised the overall production of this report.

\textbf{ACKNOWLEDGMENT}

Not applicable.

\textbf{FUNDING STATEMENT}

No funding was received for this study.

\textbf{CONFLICT OF INTEREST STATEMENT}

The authors declare no conflicts of interest.

\textbf{DATA AVAILABILITY STATEMENT}

The data used to support the findings of this study are available from
the corresponding author upon request.

\textbf{TRANSPARENCY STATEMENT}

We can confirm that this manuscript is an honest, accurate, and
transparent account of the case being reported and that no important
aspects of the case have been omitted.

\textbf{CONSENT FOR PUBLICATION}

Written informed consent was obtained from the patient to publish this
report in accordance with the journal's patient consent policy.

\textbf{Key Clinical Message}

A 50-year-old man with a mass located in the left kidney was described
by multimodal images, including ultrasonography, computed tomography,
and magnetic resonance imaging. After surgical resection of the mass,
pathological examination confirmed succinate dehydrogenase-deficient
renal cell carcinoma.

\textbf{Graphical Abstract Image}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{Graphical Abstract Text}

Succinate dehydrogenase-deficient renal cell carcinoma (SDH-deficient
RCC) is a malignant epithelial tumor that tends to occur in young males.
Here, we present a case of SDH-deficient RCC characterized by multimodal
images and confirmed by pathological examination.

\textbf{Abstract}

Succinate dehydrogenase-deficient renal cell carcinoma (SDH-deficient
RCC) is a malignant tumor associated with the loss of a mitochondrial
enzyme. Owing to its rarity and limited imaging, SDH-deficient RCC is
always misdiagnosed or escapes diagnosis. Here, we report a case of
SDH-deficient RCC in a 50-year-old male characterized by multimodal
images and confirmed by pathological examination.

\textbf{KEYWORDS}

Renal cell carcinoma, Succinate dehydrogenase, Ultrasonography, Computed
tomography, Magnetic resonance imaging, Pathology

Succinate dehydrogenase (SDH)-deficient renal cell carcinoma (RCC) is a
malignant epithelial tumor defined by the absence of immunohistochemical
expression of mitochondrial complex II. Due to its incidence accounting
for only 0.05\% to 0.2\% of all renal carcinomas, SDH-deficient RCCs are
always misdiagnosed or escape diagnosis.\textsuperscript{1} Here, we
report a case of SDH-deficient RCC characterized by ultrasonography,
computed tomography, and magnetic resonance imaging as well as confirmed
by pathological examination.

A 50-year-old man was admitted to our hospital with polypnea for 1 month
and smoking for 30 years. He had a history of hypertension and hepatitis
B confirmed recently. After admission, abdominal ultrasonography
revealed a cystic-solid mass located in the left kidney (Figure 1).
Then, computed tomography of the abdomen was performed to describe the
mass (Figure 2). Furthermore, magnetic resonance imaging provided more
characteristics of this mass (Figure 3). Eventually, the patient
underwent surgical resection, and a pathological diagnosis of
SDH-deficient RCC was confirmed (Figure 4). Immunohistochemical staining
showed that CK, CK8/18, Vim, PAX-8, GATA3, HNF1 Beta were positive and
AMACR, TFE-3, E-Cad were partly positive as well as CK7, CK20, RCC, CA,
IX, CD10, CD117, 34BetaE12, SDHB were negative. Ki-67 was approximately
30\%.

SDH-deficient RCCs tend to occur in relatively young adults with a mean
age of 38 years and the male-to-female ratio is 1.8. Most of them were
unilateral or bilateral, while others could be combined with
paragangliomas, gastrointestinal stromal tumors, or pituitary
adenomas.\textsuperscript{2} Regarding the imaging of SDH-deficient
RCCs, abdominal ultrasound shows that the masses are oval, well-defined,
and mix-echoic with or without blood flow signals. Computed tomography
and magnetic resonance imaging revealed that the masses could be cystic,
cystic--solid, or solid with obvious
enhancement.\textsuperscript{1}Fortunately, most SDH-deficient RCCs have
a favorable prognosis for low metastatic risk with low nuclear grade
after nephron-sparing surgery. However, others have more aggressive
progression for a higher metastatic rate with coagulative necrosis, high
nuclear grade, or sarcomatoid dedifferentiation, and radical nephrectomy
should be performed.\textsuperscript{3}

\textbf{REFERENCES}

\begin{enumerate}
\tightlist
\item
  Kumar R, Bonert M, Naqvi A, et al. SDH-deficient renal cell carcinoma
  - clinical, pathologic and genetic correlates: a case report.\emph{BMC
  Urol} , 2018, 18(1): 109.
\item
  Milionis V, Goutas D, Vlachodimitropoulos D, et al. SDH - deficient
  renal cell carcinoma: A case report associated with a novel germline
  mutation. \emph{Clin Case Rep} , 9(10): e04605.
\item
  Sun A, Liu Z, Wang T, et al. Succinate dehydrogenase-deficient renal
  cell carcinoma: A case report and review of the literature.\emph{Asian
  J Surg} , 2021, 44(4): 692-693.
\end{enumerate}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image2/image2}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image3/image3}

\end{center}
\end{figure}

\textbf{FIGURE 1} Ultrasonography of succinate dehydrogenase-deficient
renal cell carcinoma. (A) Grayscale ultrasound showed that the
cystic-solid mass was oval, well-defined, and approximately 41 mm\selectlanguage{ngerman}×40 mm
in size. (B) Color Doppler flow imaging showed that the solid component
of the mass was isoechoic and approximately 16 mm×9 mm in size without
any blood flow signals.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image4/image4}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image5/image5}

\end{center}
\end{figure}

\textbf{FIGURE 2} Computed tomography of succinate
dehydrogenase-deficient renal cell carcinoma. (A) Plain computed
tomography showed that the cystic-solid mass was low-density and the
solid component of the mass was approximately 37 HU. (B) Enhanced
computed tomography showed that the solid component of the mass was
obviously enhanced with 99 HU.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image6/image6}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image7/image7}

\end{center}
\end{figure}

\textbf{FIGURE 3} Magnetic resonance imaging of succinate
dehydrogenase-deficient renal cell carcinoma. (A) T1-weighted imaging
showed that the cystic-solid mass had short signals and the solid
component of the mass had long signals. (B) T2-weighted imaging showed
that the mass had long signals and the solid component of the mass had
short signals.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image8/image8}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image9/image9}

\end{center}
\end{figure}

\textbf{FIGURE 4} Pathology of succinate dehydrogenase-deficient renal
cell carcinoma. (A) The gross specimen showed that the cystic-solid mass
was grayish white and the solid component of the mass was papillary. (B)
Hematoxylin-eosin staining showed the cells of the mass with abundant
vessels presented in a nest or duct shape, the nucleus was enlarged and
oval as well as the cytoplasm was eosinophilic and transparent.\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Graphical-Abstract-Image/Graphical-Abstract-Image}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1A/Figure-1A}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-1B/Figure-1B}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2A/Figure-2A}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-2B/Figure-2B}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-3A/Figure-3A}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-3B/Figure-3B}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-4A/Figure-4A}

\end{center}
\end{figure}\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/Figure-4B/Figure-4B}

\end{center}
\end{figure}

\selectlanguage{english}
\FloatBarrier
\end{document}

