We suggest that a general definition of fat poor angiomyolipoma should be the failure of imaging to reveal fat within a lesion, thus, making it unsuspected at surgery. A pathological definition should be less than 25% fat per high power field, which to our knowledge is a formerly undefined quantity. Not all cases are hyperdense on nonenhanced computerized tomography. These lesions cannot be reliably identified by imaging and they should be managed like all enhancing renal masses.
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