案例報告: 電腦斷層下不同表現之同側腎臟多發性血管平滑肌脂肪瘤

案例報告及文獻討論

陳忠佐、王世鋒

國泰綜合醫院 外科部 泌尿科

Different Appearance of Multiple Angiomyolipoma in the Same Kidney of Patient in Computed Tomography Image: Case Report and Literature Review

Chung-Tso Chen, Shih-Feng Wang

Divisions of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract:

Renal angiomyolipoma (AML) is the most common type of benign mesenchymal tumor of the kidney, which composed of blood vessels, smooth muscles and adipose tissues. They are usually detected on ultrasound or computed tomography (CT) incidentally due to fat-containing lesions. In most cases, renal AML can be confidently diagnosed, because the fat component presents negative attenuation on CT and increased echogenicity on sonography. However, rare AML may contain poor amount of fat to make a deferential diagnosis between AML and renal cell carcinoma (RCC) difficult on CT or sonography.

We present a case of 66-years-old female with an incidentally detected left renal tumor on health examination. Further abdominal contrast enhanced CT revealed two renal tumors at left kidney, one with a mainly fat component located at upper portion, another one with soft tissue density at lower pole. Due to difficult diagnosis between AML and RCC to the tumor at lower pole of kidney, partial nephrectomy was still performed. Pathological examinations revealed well-defined lesion composed of mature adipose tissue, spindled smooth muscle fascicles, and dispersed dysmorphic blood vessels. No cytological atypia or mitotic activity is present. An angiomyolipoma was diagnosed. Here is the case report of the patient with coexist of fat-containing and fat-poor AML in the same kidney.