Abstract
Giant renal angiomyolipomas have been reported, but typically have the pathognomonic finding of fat density on CT scan. We present the case of a 53-year-old male with a symptomatic, 35-cm, predominantly cystic renal mass without fat density on CT that on nephrectomy was found to be a fat-poor angiomyolipoma with predominantly epithelioid morphology weighing 17.9 kg. Giant renal angiomyolipoma without macroscopic fat density on CT scan is an exceedingly rare occurrence.
Highlights
Large, solid, enhancing renal masses are most frequently renal cell carcinoma (RCC), but can be less common entities, including angiomyolipoma (AML), oncocytoma, urothelial carcinoma, sarcoma, or metastatic tumor
We present the unusual case of a giant cystic renal mass suspected to be RCC that was subsequently discovered to be fat-poor AML with predominantly epithelioid morphology
AML can be diagnosed on CT imaging based on the pathognomonic finding of even a small amount of fat within a renal mass that virtually excludes the diagnosis of RCC[3,4]
Summary
Solid, enhancing renal masses are most frequently renal cell carcinoma (RCC), but can be less common entities, including angiomyolipoma (AML), oncocytoma, urothelial carcinoma, sarcoma, or metastatic tumor. We present the unusual case of a giant cystic renal mass suspected to be RCC that was subsequently discovered to be fat-poor AML with predominantly epithelioid morphology. CT scan with contrast demonstrated a primarily cystic right renal mass, 35 cm in greatest dimension, with a thin rim of enhancing tissue around the margins of the mass (Fig. 1).
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