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research-article2013

IJSXXX10.1177/1066896913511526International Journal of Surgical PathologyNair et al

Images in Pathology

Large Exophytic Angiomyolipoma of the Kidney Mimicking Retroperitoneal Liposarcoma

International Journal of Surgical Pathology 2014, Vol. 22(3) 250­–251 © The Author(s) 2013 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896913511526 ijs.sagepub.com

Anila K. R., DNB1, P. P. Manjusha, DNB1, Madhu Muralee, DNB1, and K. Jayasree, MD1

Figure 1.  Computed tomography scan showing large fatcontaining mass with enlarged vessels abutting the right kidney with a sharp defect in the anterior renal cortex.

Figure 3.  (A) Neoplasm composed of areas showing adipose tissue intervened by vascular channels with perivascular epithelioid cells. (B) Perivascular epithelioid cells showing positivity for HMB-45.

Figure 2.  Large exophytic fatty mass arising from the lower pole of the kidney.

A 43-year-old woman presented with abdominal pain and distention. Imaging studies showed a large fatty mass

1

Regional Cancer Center, Thiruvananthapuram, India

Corresponding Author: Anila K. R. Department of Pathology, Regional Cancer Center, Thiruvananthapuram, 695011, India. Email: [email protected]

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Nair et al with enlarged vessels abutting the right kidney with sharp defect in anterior renal cortex at the lower pole (Figure 1). With a differential of retroperitoneal liposarcoma/angiomyolipoma, radical nephrectomy along with excision of the mass was done. The mass was exophytic, yellowish and measured 16 × 12 × 8 cm (Figure 2). Microscopy showed neoplasm composed of adipose tissue intervened by vascular channels, with perivascular epithelioid cells and spindle cells (Figure 3A). Spindle cells were SMA positive, and perivascular epithelioid cells were HMB-45 positive (Figure 3B). CD-31 highlighted the vascular channels. A diagnosis of exophytic renal angiomyolipoma (AML) was made. Follow-up scan showed 10 × 7 mm lesion in the left kidney, which was compatible with AML. The patient is on follow-up. AML is a benign tumor of the kidney, more prevalent in patients with tuberous sclerosis. AML can involve both kidneys synchronously or metachronously.1 Our patient had metachronous

bilateral disease with no associated tuberous sclerosis. AMLs usually have characteristic imaging findings.2 But exophytic AMLs, as in our case, and retroperitoneal liposarcomas may cause diagnostic difficulty on imaging. Current management options include observation, embolization, and partial or total nephrectomy depending on size of the tumor and symptoms of the patient.3 References 1.  Mantas D, Papachristodoulou A. Bilateral renal angiomyolipoma. Acta Chir Belg. 2006;106:707-709. 2.  Israel GM, Bosniak MA, Slywotzky CM, Rosen RJ. CT differentiation of large exophytic renal angiomyolipomas and perirenal liposarcomas. AJR Am J Roentgenol. 2002;179: 769-773. 3.  Hom D, Eiley D, Lumerman JH, Siegel DN, Goldfischer ER, Smith AD. Complete renal embolization as an alternative to nephrectomy. J Urol. 1999;161:24-27.

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Large exophytic angiomyolipoma of the kidney mimicking retroperitoneal liposarcoma.

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