Concurrent angiomyolipoma and two oncocytomas in the same kidney

Concurrent angiomyolipomas and renal cell neoplasms in patients without tuberous sclerosis: a retrospective study

Synchronous renal cell neoplasms (RCNs) and angiomyolipomas (AML) occurring in the same kidney are rare. The aim of this retrospective study is to investigate the incidence and clinicopathological features of concurrent AML and RCN in patients without tuberous sclerosis complex (TSC). Partial and radical nephrectomy specimens with a diagnosis of RCN and AML from 1995 to May 2013 were reviewed. Cases were assessed for histological subtype of AML and RCN, topographic relationship between the AML and the RCN, and clinical characteristics. A total of 565 RCNs and 19 AMLs were identified. Of 19 cases of AML, 9 (47%) were associated with renal tumors. Clear-cell renal cell carcinoma (RCC) was the most common malignancy associated with AML (56%). The mean age of patients with concomitant AML and RCN was higher than the mean age of patients with only AML (58.6 vs 55.5 years). The majority of patients with concomitant AML and RCN were female (78%). All concurrent sporadic AMLs were benign. We identified one case of bilateral clear-cell RCC with concomitant multiple bilateral AMLs in a patient with TSC.

Coexistence of Renal Epithelioid Angiomyolipoma and Clear Cell Carcinoma in Patients Without Tuberous Sclerosis

Renal epithelioid angiomyolipoma (EAML) is a rare but distinct variant of angiomyolipoma, closely simulating renal cell carcinoma or sarcoma both clinically and histopathologically. This report presents an unusual case of unilateral simultaneous renal EAML and renal clear cell carcinoma. A 52-year-old man without any sign of tuberous sclerosis had a complaint of 6-month history of pain in left renal area and had macroscopic hematuria twice within the recent 1 month. Computed tomography showed the presence of 2 masses in the upper and lower portion of the left kidney. The patient underwent left radical nephrectomy. Histological examination revealed the upper mass was composed of medium to large epithelioid cells with clear or eosinophilic cytoplasm and numerous giant multinucleated cells. Adult-appearing adipose tissue and coagulative necrosis could also be observed focally in the mass. Immunohistochemically, the tumor cells in the upper mass showed positive reactions to actin, HMB-45, Melan-A, and CD68 but negative reactions to pan-cytokeratin (pan-CK), epithelial membrane antigen, and CD10. However, the lower mass was composed of diffusely monomorphic clear cells with strongly immunoreactive for pan-CK, vimentin, and CD10, whereas without expression for HMB-45 and actin. The patient showed no evidence of recurrence or metastasis during 1-year postoperative following-up period. To the authors’ knowledge, this is the first report of coincidental renal EAML and clear cell carcinoma in the same kidney. Unlike classic triphasic angiomyolipoma, adjuvant therapy after resection should be considered for renal EAML because of its malignant potential, more aggressive behavior and poor prognosis.

Trends of presentation and clinical outcome of treated renal angiomyolipoma

PURPOSE

The purpose of this study is to set guidelines for the management of renal angiomyolipoma (AML), clinical prognosis according to tumor size, in association with tuberous sclerosis complex (TSC), multiplicity, radiographic finding, and treatment modality.

MATERIALS AND METHODS

Between March 1998 and October 2008, 129 out of 254 patients with AML who underwent surgical intervention or angioembolization were enrolled. Diagnosis of AML was determined by the presence of a low attenuated component on CT imaging or by pathological confirmation. Indications of treatment were intractable pain, hematuria, suspicion of malignancy, large tumor size, spontaneous rupture, and radiographically equivocal tumors in which a differential diagnosis was needed to rule out malignancy. Parameters including age, sex, tumor size, multiplicity, radiographic characteristics, association with TSC, and treatment modality were reviewed.

RESULTS

Age at presentation was 50.6 years and mean tumor size was 3.5 cm. Presentation symptoms were flank pain, hematuria, spontaneous rupture, and fatigue. 97 (75.2%) patients were incidentally discovered. 100 (77.5%) were females. 68 (52.7%) underwent nephron-sparing surgery (NSS), 35 (27.1%) radical nephrectomy, and 26 (20.2%) angioembolization. TSC was accompanied in 12 (9.3%) patients. No patient developed renal function impairment during the mean follow-up period of 64.8 months. Patients with TSC presented at a younger age, along with larger, bilateral, and multiple lesions.

CONCLUSION

Significant differences in clinical manifestations and treatment outcomes were noted in respect to tumor characteristics, association with TSC, and treatment modality. Considering the benign nature of AML, these parameters ought to be considered when deciding upon active surveillance or prophylactic intervention.

Unilateral simultaneous renal oncocytoma and angiomyolipoma: case report

A rare case of synchronous angiomyolipoma and oncocytoma in the same kidney of a 70 year old man is presented. A left renal mass was found incidentally by ultrasound. Computerized tomography and magnetic resonance imaging revealed a 1,3 cm mass in the mid-portion of the left kidney, whereas on the lower pole of the same kidney, a 3,3 cm mass was also revealed, consistent with angiomyolipoma. A working diagnosis of renal cell carcinoma was made. A radical nephrectomy was performed. Microscopically, the tumor of the lower pole was found to be an angiomyolipoma, whereas the mid-portion tumor was an oncocytoma. Until now, only 16 cases of unilateral simultaneous presence of renal angiomyolipoma and oncocytoma have been reported. Of these cases, all except one were female and three were associated with the tuberous sclerosis complex. It is well worth remarking, that renal oncocytoma overlap with other renal neoplasms, therefore nephrectomy remains the treatment of choice.Renal angiomyolipoma and oncocytoma are uncommon neoplasms and their simultaneous presence in the same kidney is rare. Only 16 cases have been reported until now in the literature. The purpose of this paper is to present an additional case without evidence of tuberous sclerosis.

Coexistence of Different Histotypes of Renal Carcinoma: Our Experience and Literature Review

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney.

Materials and Methods

We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies.

Results

Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect.

Conclusions

The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.

Bilateral massive renal angiomyolipoma concurrent with oncocytoma in tuberous sclerosis complex associated with pulmonary lymphangioleiomyomatosis

We describe a patient with tuberous sclerosis complex and massive bilateral renal angiomyolipomas (AMLs) in association with pulmonary lymphangioleiomatosis, who experienced hemorrhagic shock because of rupture of the left renal AML. She was treated with transarterial embolization, followed by bilateral nephrectomy. The total tumor burden weighed 5800 g, making it the largest AML by weight in published reports. The histopathologic examination revealed concurrent oncocytomas with AMLs in the right kidney, indicating a possible shared mechanism in the pathogenesis of these two disorders. This case also represents a rare, but significant, overlap between renal AML, pulmonary lymphangioleiomatosis, and tuberous sclerosis complex.

Renal oncocytoma: clinical experience of Taipei Veterans General Hospital

BACKGROUND

Renal oncocytoma has been reported mostly in the Western literature, and only a few cases have been reported in Eastern populations. In the present study, we review the clinical course of renal oncocytoma in our institution.

METHODS

We obtained the files of 13 cases of renal oncocytoma between 1988 and 2006 from the pathological archives of Taipei Veterans General Hospital. We retrospectively analyzed the patients' characteristics, clinical manifestations, surgical technique and clinical outcome.

RESULTS

The study population comprised 10 men and 3 women, and the mean age at diagnosis was 59.6 years (range, 37-75 years). Twelve patients (92%) were asymptomatic at presentation and were incidentally diagnosed to have renal tumor by sonography (9 patients), computed tomography (1 patient) or magnetic resonance imaging (2 patients), and 1 presented with hematuria. The clinical impression of oncocytoma was made preoperatively in only 3 patients by imaging studies, and most of the patients (76.9%) were diagnosed with renal cell carcinoma before surgery. Ten were treated with radical nephrectomy, 2 with partial nephrectomy, and 1 received excisional biopsy. All patients had unilateral solitary renal tumor; the right kidney was involved in 7 cases (54%) and the left in 6 (46%). Mean tumor size was 5.3 cm (range, 2.7-8.5 cm). Three patients were lost to follow-up in our series, and there was no recurrence or death (100% disease-specific survival) in the remaining 10 patients (77%) who were followed-up for a mean duration of 53.2 months (range, 10-117 months).

CONCLUSION

Renal oncocytoma has a benign clinical course with excellent long-term outcomes. Currently, nephron-sparing surgery is the mainstay of treatment, especially in patients with small tumors. However, accurate preoperative diagnosis based only on imaging studies is difficult, and radical nephrectomy was performed for most of the patients in our series.