Angiomyolipoma with Minimal Fat: Can It Be Differentiated from Clear Cell Renal Cell Carcinoma by Using Standard MR Techniques?

Hindman, Nicole; Ngo, Long; Genega, Elizabeth M.; Melamed, Jonathan; Wei, Jesse; Bráza, J; Rofsky, Neil M.; Pedrosa, Iván

doi:10.1148/radiol.12112087

Cited by 212 publications

(129 citation statements)

References 36 publications

(59 reference statements)

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“…This pattern of enhancement is atypical of tumors with a rich blood supply, including renal angiomas, renal angiomyolipomas with minimal fat and clear cell renal cell carcinomas, whose degree of enhancement is normally higher than that of the normal renal cortex (35). Therefore, these findings support the concept that distinguishing between RMCs and renal tumors with a rich blood supply based on their different enhancement on CT may be relatively easy.…”

Section: Discussionsupporting

confidence: 68%

Clinical and computed tomography imaging features of renal medullary carcinoma: A report of six cases

et al. 2015

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Abstract. Patients with renal medullary carcinoma (RMC) have a poor prognosis, usually due to late diagnosis. Computed tomography (CT) analysis may aid the differentiation between RMC and other types of renal cell carcinoma, in order to establish an accurate early diagnosis. There is a limited number of reports in the literature focusing on clinical and multi-slice CT (MSCT) imaging findings of RMC. Consequently, the present study aimed to characterize the clinical and MSCT imaging features of RMC. For this purpose, the MSCT imaging findings of 6 patients with RMC were retrospectively studied. The patients were subjected to MSCT in order to investigate the characteristics of the tumors, including location, size, density, calcification, cystic or solid appearance, capsule sign, enhancement pattern and presence of retroperitoneal lymph node metastasis. The tumors in the current study presented a mean diameter of 7.48±3.25 cm, and were observed to be solitary and heterogeneous with necrotic components. The majority of the tumors did not contain calcifications (5/6); displayed an ill-defined margin (4/6); were centered in the medulla; extended into the renal pelvis or peripelvic tissues (6/6); and did not exhibit a fibrous capsule. Localized caliectasis was observed in 3 of the 6 cases. The attenuation of the solid region of the RMC on unenhanced CT was equal to that of the renal cortex or medulla (42.3±2.7 vs. 40.7±3.6 and 41.2±3.9 Hounsfield units, respectively; P>0.05) while, on enhanced CT, the enhancement of the tumor was lower than that of the normal renal cortex and medulla during all phases (cortical phase, 52.6±4.8 vs. l99.5±9.7 and 72.7±6.4; medullary phase, 58.6±5.7 vs. 184.6±10.8 and 93.5±7.8; delayed phase, 56.8±6.1 vs. 175.7±8.5 and 96.5±7.9, respectively; P<0.05).In conclusion, RMC tends to be an infiltrative, ill-defined heterogeneous mass with intratumoral necrosis, which arises from the renal medulla, and displays lower enhancement than the renal cortex and medulla during all phases on enhanced CT. Despite its rarity in adults, RMC should be included in a differential diagnosis when CT imaging reveals these features.

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Section: Discussionsupporting

confidence: 68%

Clinical and computed tomography imaging features of renal medullary carcinoma: A report of six cases

et al. 2015

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“…Contrast-enhanced US can be helpful in specific cases (eg, chronic renal failure with a relative contraindication for iodinated or gadolinium contrast media, complex cystic masses, and differential diagnosis of peripheral vascular disorders such as infarction and cortical necrosis) (LE 3) [18]. However, CT and MRI features cannot reliably distinguish oncocytoma and fat-free angiomyolipoma from malignant renal neoplasms (LE 3) [19,20]. Advanced MRI techniques such as diffusionweighted and perfusion-weighted imaging are being explored in RM assessment [21].…”

Section: Imagingmentioning

confidence: 99%

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Ljungberg¹,

Bensalah²,

Canfield³

et al. 2015

European Urology

2,674

1,914

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Context: The European Association of Urology Guideline Panel for Renal Cell Carcinoma (RCC) has prepared evidence-based guidelines and recommendations for RCC management. Objectives: To provide an update of the 2010 RCC guideline based on a standardised methodology that is robust, transparent, reproducible, and reliable. Evidence acquisition: For the 2014 update, the panel prioritised the following topics: percutaneous biopsy of renal masses, treatment of localised RCC (including surgical and nonsurgical management), lymph node dissection, management of venous thrombus, systemic therapy, and local treatment of metastases, for which evidence synthesis was undertaken based on systematic reviews adhering to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant databases (Medline, Cochrane Library, trial registries, conference proceedings) were searched (January 2000 to November 2013) including randomised controlled trials (RCTs) and retrospective or controlled studies with a comparator arm. Risk of bias (RoB) assessment and qualitative and quantitative synthesis of the evidence were performed. The remaining sections of the document were updated following a structured literature assessment. Evidence synthesis: All chapters of the RCC guideline were updated. For the various systematic reviews, the search identified a total of 10 862 articles. A total of 151 studies reporting on 78 792 patients were eligible for inclusion; where applicable, data from RCTs were included and meta-analyses were performed. For RCTs, there was low RoB across studies; however, clinical and methodological heterogeneity prevented data pooling for most studies. The majority of studies included were retrospective with matched or unmatched cohorts based on single or multi-institutional data or national registries. The exception was for systemic treatment of metastatic RCC, in which several RCTs have been performed, resulting in recommendations based on higher levels of evidence.

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“…Low signal intensity on T2 weighted imaging compared to the signal intensity of the renal cortex favours a diagnosis of lipid-poor AML rather than clear cell RCC [11]. However, papillary RCCs can also have low T2 signal intensity but these lesions typically have a lower level enhancement which is less prolonged than AMLs [12].…”

Section: Discussionmentioning

confidence: 99%

Nephrectomy Avoided in a Patient with Lipid Poor Angiomylipoma with Radiological Features Suspicious for Renal Cell Carcinoma: A Case Report

Grice¹,

Ahmad²,

Khan³

2018

OJU

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Angiomyolipoma (AML) is a benign neoplasm that is easily mistaken for renal cell carcinoma (RCC) upon radiological investigation. The management of the two pathologies is significantly different, and so accurate diagnosis is vital. We report a case in which ultrasound guided biopsy saved the patient from an unnecessary nephrectomy when an AML had radiological appearances consistent with RCC. This case report also discusses the literature surrounding radiological features and novel imaging techniques of minimal-fat AML and RCC.

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Angiomyolipoma with Minimal Fat: Can It Be Differentiated from Clear Cell Renal Cell Carcinoma by Using Standard MR Techniques?

Cited by 212 publications

References 36 publications

Clinical and computed tomography imaging features of renal medullary carcinoma: A report of six cases

Clinical and computed tomography imaging features of renal medullary carcinoma: A report of six cases

EAU Guidelines on Renal Cell Carcinoma: 2014 Update

Nephrectomy Avoided in a Patient with Lipid Poor Angiomylipoma with Radiological Features Suspicious for Renal Cell Carcinoma: A Case Report

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