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15 March 2020 : Case report  Japan

An Incidental Diagnosis of Microscopic Renal Angiomyolipoma Completely Excised on Renal Biopsy: A Case Report

Challenging differential diagnosis, Rare disease

Toshiki Hyodo1ABCEF, Keiji Kono2B, Shinichi Nishi2B, Tomoo Itoh1B, Shigeo Hara13ABCDEF*

DOI: 10.12659/AJCR.921353

Am J Case Rep 2020; 21:e921353

Abstract

BACKGROUND: Microscopic tumor foci have been detected incidentally on renal biopsy, including renal cell carcinoma and renomedullary interstitial cell tumor (medullary fibroma). A report is presented of a case of an incidental finding of microscopic renal angiomyolipoma that was diagnosed and completely excised on core needle biopsy.

CASE REPORT: A 44-year-old woman was referred to our hospital for evaluation of persistent mild proteinuria. Three years previously, she was diagnosed with Cushing’s syndrome associated with a right adrenal cortical adenoma, which was successfully treated with unilateral adrenalectomy. At the time of surgery, abdominal computed tomography (CT) showed no renal lesions. During the present admission, a renal biopsy was performed that showed minimal changes in the renal glomeruli and interstitium. Immunofluorescence showed weakly positive staining for IgM in the glomeruli and no dense deposits. A microscopic focus of a predominantly spindle-cell tumor was found in the corticomedullary region. Immunohistochemistry showed positive immunostaining for HMB-45, Melan-A, and alpha-smooth muscle actin (ASMA), which supported a diagnosis of angiomyolipoma. Abdominal ultrasound at one-year follow-up showed no evidence of residual renal tumor.

CONCLUSIONS: To our knowledge, this is the first reported case of a completely excised incidental microscopic renal angiomyolipoma. This case demonstrated that even when imaging findings are normal, renal biopsy may detect microscopic foci of primary renal tumors.

Keywords: Angiomyolipoma, Kidney Neoplasms, MART-1 Antigen, Actins, Biomarkers, Tumor, Biopsy, Large-Core Needle, Immunohistochemistry, Incidental Findings, Melanoma-Specific Antigens, gp100 Melanoma Antigen

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923