Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 10, 2018; 9(7): 162-166
Published online Nov 10, 2018. doi: 10.5306/wjco.v9.i7.162
Giant exophytic renal angiomyolipoma masquerading as a retroperitoneal liposarcoma: A case report and review of literature
Gopal Sharma, Ayush Jain, Prerit Sharma, Sonal Sharma, Vinita Rathi, Pankaj Kumar Garg
Gopal Sharma, Ayush Jain, Prerit Sharma, Pankaj Kumar Garg, Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
Sonal Sharma, Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
Vinita Rathi, Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi 110095, India
Author contributions: Sharma G, Jain A, and Garg PK designed the report; all the authors actively managed the patient; Sharma G, Jain A, and Garg PK collected the patient’s clinical data; Sharma S provided the histopathological images; Rathi V provided the radiological images. All the authors analyzed the case, drafted the manuscript and finally approved it.
Informed consent statement: Consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Pankaj Kumar Garg, MS, DNB, MCh, FACS, Associate Professor, Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Dilshad Garden, Delhi 110095, India. dr.pankajgarg@gmail.com
Telephone: +91-11-22692400 Fax: +91-11-22590495
Received: July 6, 2018
Peer-review started: July 6, 2018
First decision: August 21, 2018
Revised: August 12, 2018
Accepted: October 23, 2018
Article in press: October 23, 2018
Published online: November 10, 2018
Processing time: 126 Days and 3.2 Hours
ARTICLE HIGHLIGHTS
Case characteristics

A 42-years-old lady came to our hospital with complaints of abdominal pain and distension of two months duration. The physical examination of the patient revealed large retroperitoneal lump present on the left side of the abdomen.

Clinical diagnosis

The clinical diagnosis was a retroperitoneal mass, likely to be malignant in nature.

Differential diagnosis

The differential diagnosis included retroperitoneal sarcoma, renal neoplasm, multicystic kidney, cold abscess, or hydatid cyst.

Laboratory diagnosis

Routine blood investigations did not reveal any abnormality.

Imaging diagnosis

Abdominal computed tomography revealed a large perirenal mass lesion displaying prominent vessels. There were also two fairly well defined, predominantly fat density rounded lesions in the left kidney; the smaller lesion was continuous with the large perirenal mass.

Pathological diagnosis

Preoperative image guided biopsy of the retroperitoneal mass suggested liposarcoma.

Treatment

In view of preoperative pathological diagnosis of liposarcoma, the patient underwent a margin-negative resection of the retroperitoneal mass (multi visceral resection - enbloc excision of retroperitoneal mass with left nephrectomy and segmental descending colectomy).

Related reports

The final histopathological report of the resected specimen confirmed angiomyolipoma.

Term explanation

AML is a tumor of tri-phasic morphology - blood vessels, smooth muscles, and fat cells. Majority of the AML tumors are benign in nature with almost no malignant potential.

Experiences and lessons

A large exophytic renal AML may be confused with a retroperitoneal sarcoma on a small biopsy specimen. A discordance of the radiological and core biopsy findings in a suspected case of exophytic renal AML must alert the surgeon and a re-evaluation of the case with repeat biopsies may clarify the diagnosis.