PMC5192326_01
Axial (a) and coronal (b) views of abdominal CT showing massive perinephric AML.
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She subsequently developed hemodynamic instability from a retroperitoneal bleed secondary to hemorrhage of a massive left lower pole perinephric mass containing few small vessels, as well as mixed fatty and soft tissue elements as seen on computerized tomography (Figure 1).
Macroscopic image showing a large circumscribed tumor with extensive hemorrhage (a). Photomicrographs show, arising from the kidney (lower left), an unencapsulated triphasic tumor (upper right) composed of mature adipose tissue (arrow), dystrophic vasculature (arrow head), and smooth muscle (clear arrow) (b). The smooth muscle cells appear to emanate from the wall of an irregular, thick-walled blood vessel (arrow) (c) and are characterized by oval to spindle cells with pale eosinophilic cytoplasm and regular nuclei with small nucleoli (perivascular epithelioid cells) (d).
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They appeared to be emanating from the wall of the blood vessels, characteristic of the PEComa family of tumors (Figure 2).
Axial (a) and coronal (b) views of abdominal CT showing recovered left kidney, ten months after partial nephrectomy for removal of a giant AML.
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Ten-month postoperative radiological surveillance revealed no evidence of recurrent mass lesion or other postoperative complications (Figure 3).