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Presented by Pedram Argani, M.D. and prepared by Safia Salaria, M.B.B.S.
Case 2: This is a 67 year old female with a fatty renal mass.
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Question 1 of 1
1. Question
Week 486: Case 2
This is a 67 year old female with a fatty renal mass.images/1Alex/071811case2image1.jpg
images/1Alex/071811case2image2.jpg
images/1Alex/071811case2image3.jpg
images/1Alex/071811case2image6.jpgCorrect
Answer: Mixed epithelial stromal tumor
Histology: The majority of this neoplasm is composed of adipose tissue, which yielded a yellow gross appearance. However, at the periphery of the lesion, one can see entrapped tubules with associated smooth muscle. This stroma is diffusely positive for estrogen receptor, and the muscular component is strongly immunoreactive for desmin. Melanocytic markers HMB45 and Melan A are completely negative. The fatty component demonstrates no evidence of cytologic atypia. These findings indicate that fat predominant mixed epithelial stromal tumor is the best diagnosis for the lesion
Discussion: Angiomyolipomas are frequently fat predominant, and most fatty lesions in the kidney prove to the angiomyolipoma, a fact that radiologists are well aware of. However, the current lesion lacks the dysplastic blood vessels of angiomyolipoma, and does not label at all for melanocytic markers. Lipoma-like liposarcoma would demonstrate pleomorphic lipoblasts in its fibrous septa, which are not present within this lesion. A lipoma would not contain estrogen receptor positive smooth muscle and entrapped tubules like the current lesion.
Reference(s):
– International Journal of Surgical Pathology 2008; 16:73-77.Incorrect
Answer: Mixed epithelial stromal tumor
Histology: The majority of this neoplasm is composed of adipose tissue, which yielded a yellow gross appearance. However, at the periphery of the lesion, one can see entrapped tubules with associated smooth muscle. This stroma is diffusely positive for estrogen receptor, and the muscular component is strongly immunoreactive for desmin. Melanocytic markers HMB45 and Melan A are completely negative. The fatty component demonstrates no evidence of cytologic atypia. These findings indicate that fat predominant mixed epithelial stromal tumor is the best diagnosis for the lesion
Discussion: Angiomyolipomas are frequently fat predominant, and most fatty lesions in the kidney prove to the angiomyolipoma, a fact that radiologists are well aware of. However, the current lesion lacks the dysplastic blood vessels of angiomyolipoma, and does not label at all for melanocytic markers. Lipoma-like liposarcoma would demonstrate pleomorphic lipoblasts in its fibrous septa, which are not present within this lesion. A lipoma would not contain estrogen receptor positive smooth muscle and entrapped tubules like the current lesion.
Reference(s):
– International Journal of Surgical Pathology 2008; 16:73-77.
