Presentation
Asymptomatic patient. An incidentally discovered large retroperitoneal soft tissue mass lesion on check-up ultrasound abdomen.
Patient Data
A large fairly well-defined fat-rich mass lesion, arising from the right lower pole of the right kidney, causing splaying and compression of the rest renal parenchyma and pelvicalyceal system (the lesion predominantly contains fat density component (mean HU: minus 60-80). Few soft tissue components are also seen. No calcification.
On contrast studies, the lesion shows heterogeneous enhancement. Multiple Intratumoral and peritumoral tubular vascularity are seen. Good contrast excretion is seen from the right kidney.
The lesion closely abuts the inferior margin of the right lobe of the Liver. No focal lesion is seen in hepatic parenchyma. The lesion displaces and compressesIVC. Bowel loops are displaced anteromedially by the lesion.
CT features are strongly suggestive of fat-rich renal angiomyolipoma (AML).
The rest of the scanned organs are showing no definite suspicious lesion.
Case Discussion
This case came for a check-up by Ultrasound and incidentally, discovered a predominantly hyperechoic mass, mostly related to the right kidney, then the CT showed a classic type of renal angiomyolipoma (AML) and the mass was excised ( subjected to total nephrectomy ) to prevent the risk of bleeding and to exclude other possibilities such as retroperitoneal liposarcoma. The histopathology showed typical (triphasic) renal angiomyolipoma (AML). Follow-up has also shown it almost stable for 10 years.
Renal AML is the most prevalent benign neoplasm of the kidney. It has a variable and heterogeneous nature, with the potential to pose serious diagnostic challenges in clinical practice. The characteristics of classic AMLs are well described. Knowledge of the different types, their classification, and their radiologic appearance will help radiologists in making a correct diagnosis.
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