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Renal angiomyolipoma with aggressive features and inferior vena cava extension

Case contributed by Lea Aina Abrazaldo
Diagnosis almost certain

Presentation

Intermittent abdominal pain for 2 months

Patient Data

Age: 60 years
Gender: Female

Predominantly endophytic fat-attenuating mass in the interpolar region, extending into the renal sinus, with an exophytic component medially to the renal hilum of the right kidney. A small portion of the mass extends into the main renal vein, and into the infrahepatic inferior vena cava, minimally occluding its lumen. The mass shows minimal contrast enhancement in some of its portions with some visible vessels. The mass is measuring approximately 6.3 x 4.7 x 6.0 cm (CCx ML x AP). It is intimately related to and compresses the superior and middle calyces and renal pelvis, with no intraluminal extension.

Case Discussion

Renal angiomyolipomas typically present as benign lesions without local invasion. However, they may occasionally exhibit aggressive behavior. Intravascular extension into the inferior vena cava (IVC) and hemorrhagic aneurysm formation associated with AML has rarely been reported in the past. 

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