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Renal Tumour Angiomyolipoma - Bizarre Presentation

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Presented in Victoria Hospital, Seychelles in 2005

Presented in Victoria Hospital, Seychelles in 2005

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  • 1. Renal Tumor – Bizarre Presentation Dr Sanjoy Sanyal Consultant Surgeon, Victoria Hospital, Ministry of Health, Seychelles 2005
  • 2. Clinical presentation
    • 28 year old female
    • Term pregnancy – awaiting delivery
    • Past h/s/o recurrent Urinary Tract Infection
    • Fever with chills
    • 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
    • FTND / SVD
    • Breast-feeding normally
    • Advised to report to Surgical clinic with CT report
  • 4. CT Scan preoperative
  • 5. CT Scan preoperative – cont’d This is looking suspiciously like a liver abscess!
  • 6. CT Scan preoperative – cont’d But is it?
  • 7. CT Scan preoperative – cont’d Notice two things.
  • 8. CT Scan preoperative – cont’d
  • 9. CT Scan preoperative – cont’d 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
    • functional
    • Is it tumour with necrosis?
    • Abscess?
    Things are not always what they seem to be
  • 12. One and half litre of pus Ureterolysis
  • 13. Postoperative phase
  • 14. CT Scan postoperative
  • 15. CT Scan postoperative – cont’d
  • 16. IVP postoperative Notice two things
  • 17. Revised diagnosis Most probably a renal tumour
  • 18.  
  • 19. 2 nd postoperative 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
    • 3D-CT imaging
    • 3D CT angiography
      • 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
    • Spie R, Devevey JM, Ponnelle T, 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, Ohashi K, Funata N, 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- Covarrubias L, McGee J, Landes J, Florman SS, Slakey DP. 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.
    • MacLennan GT, Bostwick DG. Tubulocystic carcinoma, mucinous tubular and spindle cell carcinoma, and other recently described rare renal tumors. Clin Lab Med. 2005 Jun;25(2):393-416.
    • Quek ML, Soni RA, Hsu J, Skinner DG. Renal epithelioid angiomyolipoma associated with hyperprolactinemia . Urology. 2005 Apr;65(4):797.
  • 25. Literature review – PubMed
    • Obara W, Sato K, Owari Y, Nozawa T, Isurugi K, Ohmori S, Matsushita Y, Tanji S, Konda R, 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.
    • Toprak U, Erdogan A, Gulbay M, Karademir MA, Pasaoglu E, Akar OE. 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.
    • Svec A, Velenska Z. 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.