Ultrasound and CT features of atypical renal angiomyolipoma
https://doi.org/10.17650/1726-9776-2008-4-2-26-30
Abstract
Research purpose: investigation of the features of the ultrasonography and computed tomography (CT) image of the uncharacteristic renal angiomyolipomata (AML) and the analysis of the diagnostic efficacy of these radiologic means.
Materials and methods: the data of the radiologic checkup of 12 patients with verified AML were investigated. For all the patients, multihelical computed tomography (MHCT) and ultrasonography (US) including perioperative in 5 observations were performed. A comparative evaluation of the opportunities of the given radiomethods in diagnosing atypical AML is executed.
Results: when in preoperative observation, CT image of tumor of the all patients was not characteristic of AML. All the tumors were solid, roundish formations, mainly extrarenal, with a density conforming to soft tissues, and in the native phase of the study didn't practically differ from unaffected renal parenchyma. In intravenous contrast enhancement, the uneven accumulation of the contrast medium occurred, at that their heterogeneity became more apparent. Thus, according to CT data all the patients were diagnosed with renal cancer. At that, the US image of the 11 patients was typical of AML. According to histology of the operational material, a change in ratio of the structural components of the AML, favoring significant predominance of the smooth muscle component, was revealed in all the tumors.
Conclusions: If the smooth muscle component predominated in the structure of the renal AML, the atypical CT image may be a cause of diagnostic errors, specifically, renal cancer hyperdiagnostics. In these cases especially when planning organ-sparing surgeries, the one should consider that sonographic signs of the majority of such tumors remain characteristic of AML.
About the Authors
A. I. GromovRussian Federation
V. I. Shirokorad
Russian Federation
V. V. Kapustin
Russian Federation
V. P. Sergeev
Russian Federation
References
1. Руководство по клинической урологии. Пер. с англ. Под ред. Ф.М. Ханко, С.Б. Манивича, А. Дж. Вейна. 3-е изд. М., ООО «Медицинское информационное агентство»; 2006. с. 306.
2. Самсонов В.А. Патоморфология опухолей почек и верхних мочевыводящих путей. М., Медицина; 1981.
3. Attyaoui F., Binous M.Y., Sallami S. et al. Renal angiomyolipoma. Tunis Med 2003;81(1):1–4.
4. Воронин Д.В. Лучевая диагностика ангиомиолипомы почки: Дис. … канд. мед. наук. М.; 1999. 110 с.
5. Справочник по онкологии. Под ред. акад. РАМН Н.Н. Трапезникова и проф. И.В. Поддубной. Онкоцентр РАМН. Справочная библиотека врача. Вып. 4. М., КАППА; 1996.
6. Bulto Monteverde J.A., Talens A., Navalon P. et al. Renal angiomyolipoma. Ultrasonography and computerized tomography findings. Arch Esp Urol 1999;52(10):1043–50.
7. Zebedin D., Kammerhuber F., Uggowitzer M.M. et al. Criteria for ultrasound differentiation of small angiomyolipomas (< or = 3 cm) and renal cell carcinomas. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 1998;69(6):627–32.
8. Ascenti G., Zimbaro G., Mazziotti S. et al. Usefulness of power Doppler and contrast-enhanced sonography in the differentiation of hyperechoic renal masses. Abdom Imaging. 2001;26(6):654–60.
9. Ikeda A.K., Korobkin M., Platt J.F. et al. Small echogenic renal masses: how often is computed tomography used to confirm the sonographic suspicion of angiomyolipoma? Urology 1995;46(3):311–5.
10. Nakai M., Nakamura N. A case report of spontaneous rupture of renal cell carcinoma difficult to be distinguished from angiomyolipoma. Hinyokika Kiyo 2003;49(2):99–101.
11. Esparza P.P., Sarasua M.A., de Andoin Barandiaran G.N. et al. Renal angiomyolipoma: a case with a difficult diagnosis. An Esp Pediatr 2002;57(5):495–7.
12. Matveev V.B., Volkova M.I., Kudashev B.V. et al. Diagnostic difficulties in rare variants of renal angiomyolipoma. Urologiia 2000;(4):22–6.
13. Obuz F., Karabay N., Secil M. et al. Various radiological appearances of angiomyolipomas in the same kidney. Eur Radiol 2000;10(6):897–9.
14. Pozzi Mucelli R., Locatelli M. Renal angiomyolipoma: typical and atypical features. Radiol Med 2002;103(5-6):474–87.
15. Pozzi-Mucelli F., Pozzi-Mucelli R.S., Melato M. et al. Renal angiomyolipomas: atypical aspects in ultrasonography and computerized tomography. Radiol Med 1993;86(6):856–64.
16. Bennett W.F., Bova J.G., Vaswani K. Case 2. Angiomyolipoma with minimal fat content. AJR Am J Roentgenol 2000;175(3):881;883–4.
17. Hosokawa Y., Kinouchi T., Sawai Y. et al. Renal angiomyolipoma with minimal fat. Int J Clin Oncol 2002;7(2):120–3.
18. Jinzaki M., Tanimoto A., Narimatsu Y. et al. Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology 1997;205(2):497–502.
19. Ohkawa M., Kadoya M., Nonomura A. Renal angiomyolipoma composed primarily of smooth muscle element: diagnostic considerations. Urol Int 1995;54(4):230–3.
20. Bernardini S., Chabannes E., Algros M.P. et al. Variants of renal angiomyolipoma closely simulating renal cell carcinoma: difficulties in the histological diagnosis. Urol Int 2002;69(1):78–81.
21. Jimenez R.E., Eble J.N., Reuter V.E. et al. Concurrent angiomyolipoma and renal cell neoplasia: a study of 36 cases. Mod Pathol 2001;14(3):157-63.
22. Tsujimura A., Miki T., Gotoh T. et al. Renal cell carcinoma with a fatty component mimicking angiomyolipoma on CT. Br J Radiol 1998;71(849):977-9.
23. Cibas E.S., Goss G.A., Kulke M.H. et al. Malignant epithelioid angiomyolipoma ('sarcoma ex angiomyolipoma') of the kidney: a case report and review of the literature. Am J Surg Pathol 2001;25(1):121–6.
Review
For citations:
Gromov A.I., Shirokorad V.I., Kapustin V.V., Sergeev V.P. Ultrasound and CT features of atypical renal angiomyolipoma. Cancer Urology. 2008;4(2):26-30. (In Russ.) https://doi.org/10.17650/1726-9776-2008-4-2-26-30