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Presented by Pedram Argani, M.D. and prepared by Jeremy Vincent M.D.
Case 1: This is a 55 year old male with a renal mass.
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Question 1 of 1
1. Question
Week 537: Case 1
This is a 55 year old male with a renal mass.images/vincent/5569_01.jpg
images/vincent/5569_02.jpg
images/vincent/5569_03.jpgCorrect
Answer: Angiomyolipoma
Histology: This lesion has a predominance of spindle cells and epithelioid areas. The spindle cells resemble smooth muscle, except that the cells have clearer cytoplasm and fascicles are less well formed. The epithelioid cells suggest carcinoma; however, they lack significant atypia and have eosinophilic cytoplasm. Other areas include foci of fat within the lesion, as well as abnormally formed dysplastic blood vessels. These are the typical features angiomyolipoma.
Discussion: Leiomyoma would lack the fat and dysplastic vessels of the current lesion, and would not label for melanocytic markers like HMB45. Sarcomatoid renal cell carcinoma would demonstrate greater atypia, lack fat and dysplastic vessels, and label for cytokeratins. Mixed epithelial stromal tumor would not label for melanocytic markers, and would have a prominent epithelial component.
Incorrect
Answer: Angiomyolipoma
Histology: This lesion has a predominance of spindle cells and epithelioid areas. The spindle cells resemble smooth muscle, except that the cells have clearer cytoplasm and fascicles are less well formed. The epithelioid cells suggest carcinoma; however, they lack significant atypia and have eosinophilic cytoplasm. Other areas include foci of fat within the lesion, as well as abnormally formed dysplastic blood vessels. These are the typical features angiomyolipoma.
Discussion: Leiomyoma would lack the fat and dysplastic vessels of the current lesion, and would not label for melanocytic markers like HMB45. Sarcomatoid renal cell carcinoma would demonstrate greater atypia, lack fat and dysplastic vessels, and label for cytokeratins. Mixed epithelial stromal tumor would not label for melanocytic markers, and would have a prominent epithelial component.
