Angiomyolipoma of the Kidneys: Current Perspectives and Challenges in Diagnostic Imaging and Image-Guided Therapy

Publication date: Available online 20 March 2018
Source:Current Problems in Diagnostic Radiology
Author(s): Abdul Razik, Chandan J. Das, Sanjay Sharma
Angiomyolipomas (AML) are benign tumors of the kidneys frequently encountered in radiologic practice in large tertiary centers. In comparison to renal cell carcinomas (RCC), AML are seldom treated unless they are large, undergo malignant transformation or develop complications like acute hemorrhage. The common garden triphasic (classic) AML is an easy diagnosis, however some variants lack macroscopic fat in which case the radiologic differentiation from RCC becomes challenging. Several imaging features, both qualitative and quantitative, have been described in differentiating the two entities. Although minimal fat AML is not entirely a radiologic diagnosis, the suspicion raised on imaging necessitates sampling and potentially avoids an unwanted surgery. Recently a new variant, epitheloid AML has been described which often has atypical imaging features and is at a higher risk for malignant transformation. Apart from the diagnosis, the radiologist also needs to convey information regarding nephrometric scores which help in surgical decision making. Recently, more and more AMLs are managed with selective arterial embolization and percutaneous ablation, both of which lack the amount of morbidity associated with surgery. The purpose of this article is to review the imaging and pathologic features of classic AML as well as the differentiation of minimal fat AML from RCC. In addition, an overview of nephrometric scoring and image-guided interventions is also provided.



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