Ileal angiomyolipoma as an unusual cause of small-intestinal intussusception

Angiomyolipomas are benign mesenchymal tumors, but those that arise from the small intestine are exceedingly rare. We report on a 48-year-old woman who had an ileal angiomyolipoma, who presented clinically with vague abdominal pain and bloody stool. Small-bowel intussusception was shown on an abdominal computed tomography (CT) scan. We discuss the clinical manifestations and clinicopathological and immunohistochemical findings of this benign tumor which appeared in this rare location.

Pulmonary angiomyolipoma recurring 26 years after nephrectomy for angiomyolipoma: benign clinical course

Angiomyolipoma (AML), a benign renal tumor, has various clinical forms, and the nature of AML is not sufficiently understood because of few reports of long-term observation. We report a 57-year-old female without tuberous sclerosis who developed multiple pulmonary AML 26 years after a right nephrectomy for renal AML. A computed tomogram demonstrated multifocal round lesions with lipid-like density throughout both lung fields. An open lung biopsy revealed a histological diagnosis of pulmonary AML. An abdominal computed tomogram was also compatible with splenic AML. She has been in good health for 12 years since the lung biopsy over the 38 years since the nephrectomy. This case suggests that multicentric AML can recur at distant organs even after long-term silence in a patient who has a past history of renal AML.

Anterior Mediastinal Presentation of a Giant Angiomyolipoma

Angiomyolipomas are benign, solitary, noninvasive lesions that most often arise in the kidney. Extrarenal manifestations of these tumors include the skin, oropharynx, the abdominal wall, retroperitoneum, gastrointestinal tract, heart, lung, liver, uterus, penis, and spinal cord. We report a patient with a giant angiomyolipoma located in the anterior mediastinum. We believe this is the seventh reported case of mediastinal angiomyolipoma and the largest reported by size. It is the second reported lesion to arise in the anterior mediastinum. Distinction from other pulmonary or thoracic masses relies on the appreciation of the unique and characteristic histologic features of these mediastinal angiomyolipomas. We conclude that, although rare, angiomyolipoma should be considered in the differential diagnosis of a mediastinal tumor.

Bilateral giant angiomyolipoma of kidneys: a case report and review of literature

Angiomyolipoma is uncommon benign tumor of the kidney. Bilateral and multiple lesions are associated with tuberous sclerosis. We report a case with bilateral giant angiomyolipomas in a patient who had no other features of tuberous sclerosis. In this case, the involvement of the kidneys was diffuse rather than usual well-circumscribed lesions.

[Ruptured renal angiomyolipoma treated by transcatheter arterial embolization: report of two cases]

We report two cases of spontaneous rupture of renal angiomyolipoma (AML). In the first case, a 22-year-old woman was admitted with lower abdominal pain. She was diagnosed with rupture of left renal AML. Transcatheter arterial embolization (TAE) was performed for three times to preserve renal function, and the size of AML decreased to 6.5 cm from 10 cm. In the second case (74-year-old woman), the chief complaint was lower abdominal pain. The clinical diagnosis of this patient was rupture of right renal AML. The size of this AML markedly reduced due to TAE. TAE is an effective therapy for rupture of renal AML.

Sonographic mimics of renal calculi

OBJECTIVES

To review sonographic findings that can mimic renal calculi.

METHODS

We comment on a number of echoes that can mimic renal calculi.

RESULTS

There are a number of sonographic renal artifacts, vascular and nonvascular, that may confound a correct diagnosis.

CONCLUSIONS

Awareness of these potential artifacts will result in a more specific sonographic examination and will accurately guide the referring physician toward appropriate patient treatment. The importance of other imaging modalities is also emphasized to ensure that a correct diagnosis is obtained whenever the sonographic findings are inconclusive.

Masses and Pseudomasses of the Kidney

MR imaging is useful in differentiating and characterizing renal masses. A careful evaluation of the signal characteristics and morphology of a renal mass combined with the ancillary imaging findings and patient history should assist the radiologist in making the proper diagnosis or recommending the appropriate treatment in most cases. This pictorial essay demonstrates the typical MR imaging features of common renal masses including renal cell carcinoma (RCC), oncocytoma, angiomyolipoma, metastases, transitional cell carcinoma (TCC), lymphoma, and arteriovenous malformation (AVM), and highlights several potential diagnostic pitfalls in making the proper diagnosis.

Renal angiomyolipoma with calcification: CT–pathology correlation

Fat containing renal tumours are usually considered as angiomyolipomas on imaging modalities. Some cases of renal cell carcinoma have been reported. Although it has been previously reported, angiomyolipomas containing calcifications are very rare. We report a case of a fatty renal tumour with calcification which was an angiomyolipoma. The calcification within the tumour was secondary to osseous metaplasia.

Laparoscopic nephron-sparing surgery for two or more ipsilateral renal tumors

OBJECTIVES

To review our experience with laparoscopic nephron-sparing surgery in the management of two or more synchronous, ipsilateral renal masses. Minimally invasive nephron-sparing procedures are increasingly used for the treatment of select patients with a single, small renal tumor.

METHODS

Since 1998, we have performed laparoscopic nephron-sparing surgery in 288 consecutive patients, including laparoscopic partial nephrectomy (n = 200) and renal cryotherapy (n = 88). Of these, 13 patients (4.5%) were treated for synchronous ipsilateral renal masses.

RESULTS

A total of 27 renal tumors were treated in 13 patients. The patients were divided into four groups on the basis of the treatment. Group 1 (n = 3) underwent en-bloc laparoscopic partial nephrectomy encompassing both tumors; group 2 (n = 2) underwent individual laparoscopic partial nephrectomy of discrete masses during the same procedure; group 3 (n = 2) had one mass treated with partial nephrectomy and the other mass treated with cryotherapy; and group 4 (n = 6) had all tumors treated with cryotherapy. All cases were completed successfully without conversion to open surgery or laparoscopic nephrectomy. The mean overall operative time was 4.3 hours, and the mean blood loss was 169 mL. No intraoperative complications occurred. Three patients had postoperative complications, none requiring re-exploration. One patient in group 4 developed de novo tumors in the treated kidney, located distant from the cryoablated sites.

CONCLUSIONS

Laparoscopic partial nephrectomy is an emerging, efficacious laparoscopic treatment option for select patients. Laparoscopic cryotherapy is a useful alternative or adjunct to partial nephrectomy. The judicious combination of these complementary techniques further extends the scope of minimally invasive nephron-sparing surgery.

Epithelioid angiomyolipoma of the uterus: a case report

BACKGROUND

Epithelioid angiomyolipoma is a recently recognized pathologic entity. The occurrence of epithelioid angiomyolipoma in thefemale genital tract is rare.

CASE

A case of uterine epithelioid angiomyolipoma occurred in a young woman without tuberous sclerosis and underwent an early recurrence with lymph node metastasis.

CONCLUSION

Uterine epithelioid angiomyolipoma should be considered in young women with a tumor exhibiting high intratumoral linear vascularity and aneurysmal dilation.

Extrarenal retroperitoneal angiomyolipoma: case report and review of the literature

Angiomyolipomas are rare benign tumors that usually occur in the kidneys. Extrarenal angiomyolipomas are extremely uncommon. We describe a case of angiomyolipoma arising in the retroperitoneum that was successfully treated by arterial embolization and surgical excision. The literature on retroperitoneal extrarenal angiomyolipoma and its differential diagnoses is briefly reviewed.

Frequency and imaging appearance of hepatic angiomyolipomas in pediatric and adult patients with tuberous sclerosis

OBJECTIVE

This study evaluates the frequency and imaging appearance of hepatic angiomyolipomas in pediatric and adult patients with tuberous sclerosis.

CONCLUSION

Multiple hepatic angiomyolipomas are often found in patients with tuberous sclerosis, particularly in those with bilateral diffuse renal angiomyolipomas.

Primary angiomyolipoma of the pancreas

Angiomyolipoma (AML) is a rare tumor characterized histologically by a mixture of spindle cells, adipose tissue, epithelioid cells, and blood vessels. AML usually occurs in the kidney but can involve the liver and, rarely, other sites. We describe a 74-year-old woman without tuberous sclerosis who presented with spontaneous hemorrhage into a primary AML of the pancreas and underwent curative surgical resection. We are aware of only one previous report describing a clear cell "sugar" tumor of the pancreas, which probably represents a monotypic epithelioid variant of AML. The pancreas should be included among sites that can give rise to AML.

Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT

PURPOSE

To compare various computed tomographic (CT) features of angiomyolipoma (AML) with minimal fat with those of size-matched renal cell carcinoma (RCC).

MATERIALS AND METHODS

Eighty-one patients (19 with AML with minimal fat [mean diameter, 2.8 cm; range, 1.5-4.5 cm] and 62 with RCC [mean diameter, 3.1 cm; range, 1.8-4.5 cm]) who had undergone biphasic CT (ie, CT with unenhanced, corticomedullary, and early excretory phase scanning) were evaluated. Two reviewers who were unaware of the diagnosis retrospectively recorded tumor attenuation on unenhanced scans, enhancement characteristics (ie, homogeneity of enhancement, amount of enhancement, enhancement pattern over time), tumor margin, location of tumor center, intratumoral calcification, perinephric changes, and patient age and sex. The predictive value of each CT finding was determined by using multivariate logistic regression analysis.

RESULTS

Homogeneous enhancement (observed in 79% of AMLs vs 5% of RCCs; odds ratio, 37) and prolonged enhancement pattern (observed in 58% of AMLs vs 10% of RCCs; odds ratio, 42) were valuable predictors for differentiating AML with minimal fat from RCC at multivariate analysis (P <.05 for both). When both CT findings were used as a criterion for differentiating AML from RCC, positive and negative predictive values were 91% (10 of 11 tumors) and 87% (61 of 70 tumors), respectively. Fifty-three percent of AMLs versus 13% of RCCs showed high tumor attenuation on unenhanced scans (P =.04), whereas RCCs showed greater mean enhancement than AMLs (114 HU +/- 44 [SD] vs 73 HU +/- 30 in corticomedullary phase and 66 HU +/- 24 vs 49 HU +/- 20 in early excretory phase) and a male predominance (male-to-female ratio, 50:12 vs 8:11; P =.001).

CONCLUSION

Biphasic helical CT may be useful in differentiating AML with minimal fat from RCC, with homogeneous tumor enhancement and prolonged enhancement pattern being the most valuable CT findings.

Renal angiomyolipoma with contrast-enhancing elements mimicking renal malignancy: radiographic and pathologic evaluation

The diagnosis of angiomyolipoma can typically be made on the basis of characteristic computed tomography findings. Varying tissue compositions within an angiomyolipoma can create difficulty in pathologically differentiating benign from malignant lesions. Epithelioid angiomyolipoma is a variant of angiomyolipoma characterized by the presence of epithelioid cells. We report a case of two discrete contrast-enhancing lesions within an enlarging angiomyolipoma that radiographically mimicked malignant elements. This finding presented a diagnostic challenge in terms of selecting medical versus surgical intervention. Surgical excision of the lesions was performed and the pathologic examination revealed a benign angiomyolipoma with epithelioid features.

Nontraumatic Emergent Abdominal Vascular Conditions: Advantages of Multi–Detector Row CT and Three-Dimensional Imaging

In the past decade, great strides have been made in the development of helical computed tomography (CT) that have led to shorter scanning time and higher spatial resolution. A wide range of traumatic and nontraumatic emergent conditions may be quickly and accurately diagnosed with multi-detector row CT. Multi-detector row CT angiography is the preferred method for imaging in emergent abdominal vascular conditions because it enables the acquisition of high-spatial-resolution volumetric image data during a single breath hold. Unlike catheter angiography, multi-detector row CT angiography not only depicts the vessels but also allows assessment of perfusion in adjacent organs. To make the most effective diagnostic use of multi-detector row CT angiography and three-dimensional image postprocessing, radiologists must be familiar with the optimal CT angiographic protocols and with the typical CT findings in various emergent vascular conditions. This article describes the protocols used in 11 patients with conditions including ruptured abdominal aortic aneurysm, secondary aortoduodenal fistula, splanchnic segmental arterial mediolysis, and Wegener-type vasculitis with visceral involvement. All of the diagnoses in these 11 cases were made in the emergency department, and the delay between imaging and diagnosis was decreased considerably by avoiding the transfer of patients for catheter angiography.

[Bleeding renal angiomyolipomas. CT findings]

PURPOSE

To describe our experience in three cases of abdominal haemorrhage caused by bleeding renal angiomyolipomas, which were studied with Computed Tomography (CT).

MATERIALS AND METHODS

A retrospective study carried out at our archives identified 3 patients (aged 58.6 on average) with renal angiomyolipomas clinically manifested with acute abdomen and haemorrhage. The patients underwent an emergency CT scan of the abdomen. One patient also under-went a subsequent renal angiography. All patients had surgery and histological characterizations of the renal lesions.

RESULTS

The CT study on all three patients allowed detection of a lesion in the kidneys with inhomogeneous density due to haemorrhage. Areas with fat-density values (-60 -80 UH) were always observable within the lesions. The lesions, measuring 5-9 cm, were located in the right kidney in two patients and in the left kidney in one.

CONCLUSIONS

In 40% of patients, renal angiomyolipoma may account for a picture of hypovolemic shock, so a correct diagnostic approach is important to guide the surgical approach. CT allows detection of the angiomyolipoma as the cause of the haemorrhage in most cases. The diagnosis is relatively simple when the lesion has typical features such as adipose content, whereas it may be difficult with non-typical aspects. Furthermore the fat content may also be detected in varying quantities in other renal lesions responsible for bleeding.

Exploration de l’appareil urinaire en IRM : développements actuels et perspectives futures

New fast MR imaging sequences obtained with high power gradients allow dynamic analysis of parenchymal enhancement by contrast media in order to improve characterization of masses as well as a functional analysis. Phased - array coils have greatly improved spatial resolution. MR Urography is a new valuable modality to study the collecting system. Numerous acronyms are proposed with a wide range of variations between different machines. But basic principles for sequences are similar. MR can be performed in patients with renal insufficiency, iodine allergy or any other contra-indication to the use of ionizing radiation. MRI of the kidney is becoming a major imaging modality to diagnose diseases of the kidney. It provides in a rather short time a "all-in-one approach" of the pathological process.

[Atypical presentation of angiomiolypoma in a patient with peritoneal metastases from ovarian cancer: a case report]

A renal mass with not typical instrumental characteristic in patient in follow-up for ovarian neoplasia sets to the surgeon serious doubts about proper surgical strategy. Achieve of the conservative renal surgery assisted by the intraoperative use of the radiofrequency energy has allowed to preserve the renal function and the diagnosis of unknown angiomyolipoma.