PMC4251875_01
(a-d) E-AML both contains fatty and nonadipose components. T1W axial in-phase (a) and out-phase images (b) reveal mass lesion involving renal sinus and subcapsular region. No apparent fat is seen in some portion (thin arrows). However, due to pure fat content of subcapsular tumor component, no signal reduction is seen in dual echo imaging (thick arrow). TruFISP coronal image (c) shows subcapsular extension and maximum diameter. Axial T2W fat-saturated image (d) shows solid infiltrative renal mass with renal sinus and pelvicalyceal extension; note that pure fatty portion of subcapsular component demonstrates signal reduction (arrowheads).
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fig1
On MRI, a 7 cm kidney mass with infiltrative characteristics, originating from central part of the left kidney with the involvement of the pelvicalyceal system, was revealed (Figures 1 and 2).
(a-d) Precontrast axial T1W fat-saturated (a), early arterial (b), late arterial (c), and portal venous phase (d) images show slightly increased enhancement in fatty areas of subcapsular portion in portal phase (thin arrow). However, nonadipose component of E-AML is not avidly enhancing in the postcontrast images (thick arrows).
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fig2
On MRI, a 7 cm kidney mass with infiltrative characteristics, originating from central part of the left kidney with the involvement of the pelvicalyceal system, was revealed (Figures 1 and 2).
Hematoxylin-eosin staining of the same lesion is depicted. Large epithelioid cells show pleomorphism with large hyperchromatic nuclei and abundant eosinophilic cytoplasm in epithelioid angiomyolipoma are demonstrated. Same image also contains fatty tissue that corresponds with subcapsular adipose component of the E-AML.
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fig3
The specimens were proved to be E-AML upon detection of large epithelioid cells (Figure 3) as well as positive immunohistochemical stains with melanosome associated proteins (HMB-45 and Melan-A).
PMC4251875_02
(a, b) Axial venous phase postcontrast CT images (a, b) from the mid-portion of the kidneys. There is a hypoattenuating mass lesion involving the right central part of the kidney with sinus extension (arrows). Hypodense thrombus materials are seen in both right renal vein and inferior vena cava (arrowheads).
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fig4
CT scan was performed. CT revealed a kidney mass measuring 8.5 cm with involvement of RV and IVC at the central part of the right kidney (Figure 4).