BENIGN FOCAL RENAL TUMORS
Category: Diagnostic Radiology
Abstract : BENIGN FOCAL RENAL TUMOURS - Angiomyolipoma This is a homogeneous, highly
echogenic, usually rounded lesion in the renal parenchyma containing blood
vessels, muscle tissue and fat, as the name suggests. They are usually solitary,
asymptomatic lesions, found incidentally on the scan, although the larger
lesions can haemorrhage, causing haematuria and pain. Angiomyolipomas are also
asso
BENIGN FOCAL RENAL TUMOURS - Angiomyolipoma
This is a homogeneous, highly
echogenic, usually rounded lesion in the renal parenchyma containing blood
vessels, muscle tissue and fat, as the name suggests. They are usually solitary,
asymptomatic lesions, found incidentally on the scan, although the larger
lesions can haemorrhage, causing haematuria and pain.
Angiomyolipomas are also
associated with tuberose sclerosis, when they are often multiple and bilateral.
Because the contrast between the hypoechoic renal parenchyma and the hyperechoic
angiomyolipoma is so great, very small lesions in the order of a few millimetres
can easily be recognized. It may be difficult confidently to differentiate an
angiomyolipoma from a malignant renal neoplasm, particularly in a patient with
haematuria.
Angiomyolipomas tend to be smaller and more echogenic than
renal cell carcinomas, and sometimes demonstrate shadowing, which is not
normally seen in small carcinomas. When doubt persists, CT is often able to
differentiate in these cases by identifying the fat content of the
lesion.
Adenoma
The renal adenoma is usually a small, well-defined
hyperechoic lesion, similar in appearance to the angiomyolipoma. It is felt that
adenomas are frequently early manifestations of renal carcinoma as distinct from
a benign lesion6 and the two may be histologically indistinguishable. Renal
adenomas are often found in association with a renal cell carcinoma in the same
or contralateral kidney, although these are radiologically indistinguishable
from metastases.
Because of the controversy surrounding the distinction
between adenomas and small renal cell carcinomas, the management of patients
with these masses is uncertain. Most incidentally discovered, small (less than 3
cm), parenchymal renal masses are slow-growing and may be safely monitored with
CT or ultrasound, particularly in the elderly.
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