PMC3914176_01
(a) oral contrast and (b) IV and oral contrast: abdominal computerized tomography demonstrating an encapsulated fatty vascular mass (white arrows) lateral to the left kidney measuring 19.3 cm x 13.5 cm x 10.7 cm with prominent vascular dependence on the left renal vein and artery as well as a 2 cm posterior mid-pole homogeneous fatty density (yellow arrow). Left colon is laterally displaced (orange arrow).
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fig1
In addition, there was a 2 cm inferior midpole homogeneous fatty renal lesion consistent with a renal angiomyolipoma (Figures 1(a) and 1(b)).
Abdominal magnetic resonance imaging demonstrating a large fatty encapsulated mass (white asterisk) measuring 19.3 cm x 13.5 cm x 10.7 cm with prominent vascularity (white arrows). The anatomic relationship between the mass and the left kidney can be well seen in Figure 2(b).
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fig2
The mass tightly abutted the superior pole of the left kidney and a small 2 cm lesion inferiorly, most likely representing a renal angiomyolipoma, was also noted (Figures 2(a) and 2(b)).
Gross image of the en bloc resected mass including the left kidney (black arrow), demonstrating a well-encapsulated fatty mass attached to the upper pole of the kidney (white arrow) with a smooth outer surface measuring 23 cm x 14 cm x 9 cm.
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fig3
The kidney measured 11.5 cm x 4.5 cm x 3 cm, and the mass located near the superior renal pole measured 23 cm x 14 cm x 9 cm (Figure 3).
Extrarenal mass (Hematoxylin and Eosin). Photomicrograph of the mass demonstrate mature adipose tissue with a tortuous thick blood vessel (black arrow) ((a); x20) and bundles of smooth muscles lacking elastic tissue lamina ((b); x40), adipose tissue with small areas of smooth muscle with epithelioid features ((c); x40). Focal staining with HMB45 antibody was positive (blue star) ((d); x40), consistent with angiomyolipoma.
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fig4
HMB-45 staining performed on the larger lesion was positive, which is characteristic for an angiomyolipoma (Figure 4).