Genito-Urinary Tumors

Episode 2

Genito-Urinary Tumors

• Renal tumors.

• Tumors of the ureter.

• Bladder tumors.

• Prostate tumors.

• Testicular tumors.

Angiomyolipoma

• Benign.• Vessel + Smooth Muscle + Fat.• 2 Types:

Pathology:

1. Isolated.2. Associated with

syndromes (as Tuberous Sclerosis)

Angiomyolipoma

• 80% of AMLs.• Solitary.• 20-70 years of age.• Female/Male = 4/1.• 80% in the Right Kidney !!

Isolated AML

Angiomyolipoma

• 20% of AMLs.• Bilateral and multiple.• 1-20 years of age.• Female/Male = Near equal.• AML occurs in 80% patients with tuberous

sclerosis.

AML with Tuberous Sclerosis

Angiomyolipoma

Clinical:

• 60% asymptomatic.• 40% are symptomatic; these can cause a

palpable abdominal mass, hematuria, or flank pain.

• The solitary sporadic tumors may cause acute abdomen and shock as a result of spontaneous hemorrhage in the tumor.

Angiomyolipoma

I. Plain X-Ray:

• Radiolucent mass.

Angiomyolipoma

II. IVU:

• Single or multiple lucent defects.

• Distortion of the calyces.

Angiomyolipoma

III.US:

• Round or oval cortical masses.

• Intensely echogenic. • Well circumscribed.

Angiomyolipoma

III.US:

• Round or oval cortical masses.

• Intensely echogenic. • Well circumscribed.

Angiomyolipoma

IV.CT:

NECT: • Well circumscribed round or

oval cortical masses.

• Fat.

Angiomyolipoma

IV.CT:

CECT: • Early/CTA → +/- Aneurysm.

• Fat.

Angiomyolipoma

IV.CT:

CECT: • Nephrographic Phase → +/-Heterogeneous

enhancement.

• Fat.

Angiomyolipoma

IV.CT:

Angiomyolipoma

IV.CT:

Angiomyolipoma

IV.CT:

Angiomyolipoma

V.MRI:

Variable areas of high signal intensity within

the tumor on both T1-weighted and T2-

weighted images

Angiomyolipoma

V.MRI:

T1W:

Pre → High signal intensity is present because of the fat content.

Post → Heterogeneous enhancement.

Angiomyolipoma

V.MRI:

Angiomyolipoma

V.MRI:

T2W:

Isointense relative to that of perinephric fat.

Angiomyolipoma

V.MRI:

Fat-Suppression:

Signal intensity dropout of fat .

Angiomyolipoma

V. Angiography:

• 95% of AMLs are hypervascular.• Enlarged interlobar and interlobular arteries.

• Intratumoral arteries are tortuous, irregular, and aneurysmal.

• Venous pooling exists, with a sunburst, whorled, and onion-peel appearance.

• No arteriovenous (AV) shunting is present.

Angiomyolipoma

VI.Angiography:

Angiomyolipoma

VI.Angiography:

Angiomyolipoma

VI.Angiography:

Angiomyolipoma

VI.Angiography:

• The presence of multisacculated pseudoaneurysms, the

absence of AV shunting, a sunburst appearance of the

capillary nephrogram, and an onion-skin appearance of

the peripheral vessels in the venous phase suggest AML.