PMC6159275_01
Contrast-enhanced CT scan of the abdomen and pelvis following treatment for pancreatic adenocarcinoma showing an enhancing lesion at the lower pole of the left kidney measuring 2.5 cm (large arrow). Evidence of macroscopic fat suggesting angiomyolipoma is not readily identified, likely owing to significant loss of fat (small arrowhead).
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The contrast-enhanced CT scan revealed an incidental solid enhancing mass measuring 2.5 cm in diameter in the lower pole of the left kidney, which was suspicious for renal cell carcinoma (RCC; Figure 1).
() Unenhanced and (b) contrast-enhanced CT scans of the abdomen and pelvis before treatment for pancreatic adenocarcinoma shows an incidental 3.0 cm lesion at the lower pole of the left kidney with areas of fat attenuation (large white arrows), consistent with angiomyolipoma. The contrast-enhanced CT scan shows the pancreatic head mass from adenocarcinoma (black arrowhead). A noteworthy feature is the abundance of subcutaneous fat compared with imaging done after treatment (small white arrowheads).
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On comparison with pre-treatment imaging performed 9 months earlier, the mass corresponded to a 3.0 cm lesion (Figure 2) that demonstrated regions of negative attenuation (-39 Hounsfield units), characteristic of intratumoral fat and consistent with angiomyolipoma (AML).
An MR examination more than 2 years after the initial CT scan shows the angiomyolipoma (arrows) with lack of microscopic intratumoral fat on the in-phase (a) and opposed-phase images (b). A small focus of low signal intensity seen on both images may relate to haemosiderin. In addition, T2 weighted images without (c) and with fat suppression (d) demonstrate the lack of macroscopic intratumoral fat.
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The intratumoral fat component remained imperceptible on imaging, including an MR of the abdomen performed more than 2 years after the initial CT (Figure 3) and an unenhanced CT that had shown minimal hyperattenuation of the mass compared with the surrounding parenchyma (Figure 4).
An unenhanced CT scan performed almost 2 years after the initial CT scan shows that the mass has homogeneous attenuation (arrow), with minimal hyperattenuation of the lesion (35 Hounsfield units) compared with the surrounding renal parenchyma (32 Hounsfield units), with attenuation ratio of 1.09.
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The intratumoral fat component remained imperceptible on imaging, including an MR of the abdomen performed more than 2 years after the initial CT (Figure 3) and an unenhanced CT that had shown minimal hyperattenuation of the mass compared with the surrounding parenchyma (Figure 4).