- 1. Renal Tumor Bizarre Presentation Dr Sanjoy Sanyal Consultant
Surgeon, Victoria Hospital, Ministry of Health, Seychelles
2005
2. Clinical presentation
- Term pregnancy awaiting delivery
- Past h/s/o recurrent Urinary Tract Infection
- Pain in right flank and hypochondrium
- Tenderness in same region
- USG : 12 x 13 cm liver SOL (? Tumour ? Abscess)
3. Clinical progress
- Broad spectrum antibiotics x 2 weeks
- Complete subsidence of clinical signs and symptoms
- Advised to report to Surgical clinic with CT report
4. CT Scan preoperative 5. CT Scan preoperative contd This is
looking suspiciously like a liver abscess! 6. CT Scan preoperative
contd But is it? 7. CT Scan preoperative contd Notice two things.
8. CT Scan preoperative contd 9. CT Scan preoperative contd Notice
something more! 10. IVP findings preoperative 11.
Recapitulation
- Definitely not a liver SOL, primarily
- Most probably retroperitoneal and /or renal in origin
- Related to upper pole of right kidney and behind it.
- Secondarily involving the liver right lobe
- Lower portion of right kidney is
- Is it tumour with necrosis?
Things are not always what they seem to be 12. One and half
litre ofpus Ureterolysis 13. Postoperative phase 14. CT Scan
postoperative 15. CT Scan postoperative contd 16. IVP postoperative
Notice two things 17. Revised diagnosis Most probably a renal
tumour 18. 19. 2 ndpostoperative phase 20. Histopathology report
ANGIOMYOLIPOMA of kidney 21.
- Renal Angiomyolipoma is considered among the rare renal
tumours; yet
- PubMed search revealed >11,000 results
- It constitutes a preoperative diagnostic conundrum
Discussion and literature review 22. Radiological preoperative
diagnosis
- Opposed-phase chemical shift MRI
- Multiphasic helical CT scan
-
- The 3D images are reconstructed by using the axial images of
the multiphasic helical CT, and by using embedded software of the
CT equipment
-
- Three-dimensional volume rendering method is generally
preferred.
-
- Once the 3D reconstructions are achieved, two dimensional cut
planes are applied to determine extensions of the masses.
23. Literature review PubMed
- SpieR,DeveveyJM,PonnelleT, Michel F. Angiomyolipoma with
epithelioid contingent mimicking renal cell carcinoma . Prog Urol.
2005 Apr;15(2):322-5; discussion 325.
- El-Hashemite N, Kwiatkowski DJ. IFN{gamma}-Jak-Stat Signaling
in Pulmonary LAM and Renal AML: A Potential Therapeutic Target.Am J
Respir Cell Mol Biol. 2005 Jun 30;
- Kida Y, Yamaguchi K, Suzuki H, Kanda E, Ando M,OhashiK,FunataN,
Saito H. Tuberous sclerosis, associated with renal cell carcinoma
and angiomyolipoma, in a patient who developed endstage renal
failure after nephrectomy . Clin Exp Nephrol. 2005
Jun;9(2):179-82.
- Garcia- CovarrubiasL, McGee J,LandesJ,FlormanSS,SlakeyDP.
Cadaveric kidney transplant complicated by rupture of native kidney
angiomyolipoma: a case report and review of the literature.Am Surg.
2005 Apr;71(4):286-8.
24. Literature review PubMed
- Israel GM, Hindman N, Hecht E, Krinsky G. The use of
opposed-phase chemical shift MRI in the diagnosis of renal
angiomyolipomas.AJR Am J Roentgenol. 2005 Jun;184(6):1868-72.
- Ma L, Kowalski D, Javed K, Hui P. Atypical angiomyolipoma of
kidney in a patient with tuberous sclerosis: a case report with p53
gene mutation analysis.Arch Pathol Lab Med. 2005
May;129(5):676-9.
- MacLennanGT,BostwickDG. Tubulocystic carcinoma, mucinous
tubular and spindle cell carcinoma, and other recently described
rare renal tumors.Clin Lab Med. 2005 Jun;25(2):393-416.
- QuekML,SoniRA, Hsu J, Skinner DG. Renal epithelioid
angiomyolipoma associated withhyperprolactinemia . Urology. 2005
Apr;65(4):797.
25. Literature review PubMed
- ObaraW, Sato K,OwariY,NozawaT,IsurugiK,OhmoriS, Matsushita
Y,TanjiS,KondaR, Fujioka T. Perinephric angiomyolipoma: a unique
development pattern surrounding the kidney.Int J Urol. 2005
Mar;12(3):305-7.
- Zhu J, Liu RB, Zhou XP, Wu ZF, Lu CY, Wang N. CT
differentiation of renal angiomyolipoma and renal cell carcinoma
Sichuan Da Xue Xue Bao Yi Xue Ban. 2005 Mar;36(2):257-60.
Chinese.
- ToprakU,ErdoganA,GulbayM,KarademirMA,PasaogluE,AkarOE.
Preoperative evaluation of renal anatomy and renal masses with
helical CT, 3D-CT and 3D-CT angiography.Diagn Interv Radiol. 2005
Mar;11(1):35-40.
- SvecA,VelenskaZ. Renal epithelioid angiomyolipoma--a close
mimic of renal cell carcinoma. Report of a case and review of the
literature.Pathol Res Pract. 2005;200(11-12):851-6.
26.