Year : 2002 | Volume
: 19 | Issue : 1 | Page : 79--80
Renal angiomyolipoma (AML) - an unusual CT presentation
M Raghavendran, A Srivastava, A Kumar, W Zaman
Department of Urology, SGPGIMS, Lucknow, India
Department of Urology, SGPGIMS, Lucknow - 226014
|How to cite this article:|
Raghavendran M, Srivastava A, Kumar A, Zaman W. Renal angiomyolipoma (AML) - an unusual CT presentation.Indian J Urol 2002;19:79-80
|How to cite this URL:|
Raghavendran M, Srivastava A, Kumar A, Zaman W. Renal angiomyolipoma (AML) - an unusual CT presentation. Indian J Urol [serial online] 2002 [cited 2020 Nov 25 ];19:79-80
Available from: https://www.indianjurol.com/text.asp?2002/19/1/79/20297
A 32-year-old male presented with abdominal pain and fever of 2-weeks' duration. He had no history of either irritative or obstructive voiding symptoms. Physical examination did not reveal any significant abnormality. Ultrasound examination revealed a heterogenous echotexture mass consistent with the diagnosis of renal cell carcinoma. CT scan revealed a large heterogeneously attenuated mass arising from the right kidney. His left kidney was normal. There was no nodal enlargement nor was the renal vein or IVC involved. Patient underwent preoperative FNAC, which was inconclusive. Patient underwent left radical nephrectomy. The histopathological examination revealed a huge angiomyolipoma.
Renal angiomyolipoma, an uncommon benign tumour of the kidney classically referred to as hamartoma, consists of smooth muscle, thick-walled blood vessels and mature adipose tissue. These were originally described by Morgan and associates in 1951.
This patient presented with pain and fever of 2-weeks' duration, without any evidence of UTI. Fever as a mode of presentation has been reported by Chen et al in cases with AML. 
According to Yip et al the CT accuracy in diagnosis was 87%.  The 13% tumours which were missed were small tumours with low fat content. Jinzaki et al concluded that homogenously high attenuated lesions in unenhanced CT with homogenous enhancement in contrast enhanced CT and homogenous isoechogenicity on sonograms are suggestive of angiomyolipoma containing minimal fat. 
Our case is unusual, as this despite being a large angiomyolipoma did not correspond to any of the above CT criteria.
Regarding the role of FNAC Sant et al had opined that FNAC may help but it is not always successful and can cause complications.  In the present patient also FNAC could not establish the diagnosis.
Frozen section was not planned in our patient, but Chen et al had reported that frozen section has its own limitations and 2 of their 3 patients underwent nephrectomy even after frozen analysis. 
Though Oesterling and his associates advocated conservative surgery, their nephrectomy rates exceeded that of conservative surgery. In this present patient, nephrectomy was the only option as preoperative diagnosis was more in favour of renal cell carcinoma. 
|1||Chen et al. Renal Angiomyolipoma: Experience of 20 years in Taiwan. Eur Urol 1997: 32: 175-178.|
|2||Yip SKH et al. Partial nephrectomy for tumours : the Singapore General hospital experience. Jour Royal College Surgeons, Edinburg 1999 (in press).|
|3||Jinzaki et al. Angiomyolipoma : Imaging findings in lesions with minimal fat. Radiology 1997: 205: 497-502.|
|4||Sant GR et al. FNAB in the diagnosis of renal angiomyolipoma. J Urol 1990; 143: 999-1001.|
|5||Oesterling JE et al. The management of renal angiomyolipoma. J Urol 1986; 135: 1121-1124.|