Angiomyolipoma differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Angiomyolipoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Angiomyolipoma]]
{{CMG}} {{AE}}{{Faizan}}
{{CMG}} {{AE}}{{Faizan}},{{Rekha}}


==Overview==
==Overview==
[[Angiomyolipoma]] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
[[Angiomyolipoma]] must be differentiated from [[retroperitoneal liposarcoma]], [[adrenal myelolipoma]], and [[renal cell carcinoma]].<ref name="pmid25517956">{{Cite journal  | last1 = Patil | first1 = PA. | last2 = McKenney | first2 = JK. | last3 = Trpkov | first3 = K. | last4 = Hes | first4 = O. | last5 = Montironi | first5 = R. | last6 = Scarpelli | first6 = M. | last7 = Nesi | first7 = G. | last8 = Aron | first8 = M. | last9 = Sangoi | first9 = AR. | title = Renal Leiomyoma: A Contemporary Multi-institution Study of an Infrequent and Frequently Misclassified Neoplasm. | journal = Am J Surg Pathol | volume =  | issue =  | pages =  | month = Dec | year = 2014 | doi = 10.1097/PAS.0000000000000354 | PMID = 25517956 }}</ref><ref name="aaa"> Renal angiomyolipoma differential diagnosis. Dr Matt A. Morgan and Dr Behrang Amini et al. Radiopaedia 2015. http://radiopaedia.org/articles/renal-angiomyolipoma</ref>


==Differential Diagnosis==
==Differentiating Angiomyolipoma from other Diseases==
[[Angiomyolipoma]] must be differentiated from the following:<ref name="pmid25517956">{{Cite journal  | last1 = Patil | first1 = PA. | last2 = McKenney | first2 = JK. | last3 = Trpkov | first3 = K. | last4 = Hes | first4 = O. | last5 = Montironi | first5 = R. | last6 = Scarpelli | first6 = M. | last7 = Nesi | first7 = G. | last8 = Aron | first8 = M. | last9 = Sangoi | first9 = AR. | title = Renal Leiomyoma: A Contemporary Multi-institution Study of an Infrequent and Frequently Misclassified Neoplasm. | journal = Am J Surg Pathol | volume =  | issue =  | pages =  | month = Dec | year = 2014 | doi = 10.1097/PAS.0000000000000354 | PMID = 25517956 }}</ref><ref>{{Cite journal
| author = [[N. Azumi]], [[J. Curtis]], [[R. L. Kempson]] & [[M. R. Hendrickson]]
| title = Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases
| journal = [[The American journal of surgical pathology]]
| volume = 11
| issue = 3
| pages = 161–183
| year = 1987
| month = March
| pmid = 3826477
}}</ref><ref>{{Cite journal
| author = [[Emily Z. Keung]], [[Jason L. Hornick]], [[Monica M. Bertagnolli]], [[Elizabeth H. Baldini]] & [[Chandrajit P. Raut]]
| title = Predictors of outcomes in patients with primary retroperitoneal dedifferentiated liposarcoma undergoing surgery
| journal = [[Journal of the American College of Surgeons]]
| volume = 218
| issue = 2
| pages = 206–217
| year = 2014
| month = February
| doi = 10.1016/j.jamcollsurg.2013.10.009
| pmid = 24315890
}}</ref><ref>{{Cite journal
| author = [[Khin Thway]], [[Robin L. Jones]], [[Jonathan Noujaim]], [[Shane Zaidi]], [[Aisha B. Miah]] & [[Cyril Fisher]]
| title = Dedifferentiated Liposarcoma: Updates on Morphology, Genetics, and Therapeutic Strategies
| journal = [[Advances in anatomic pathology]]
| volume = 23
| issue = 1
| pages = 30–40
| year = 2016
| month = January
| doi = 10.1097/PAP.0000000000000101
| pmid = 26645460
}}</ref><ref name="pmid470981">{{cite journal| author=Cohen AJ, Li FP, Berg S, Marchetto DJ, Tsai S, Jacobs SC et al.| title=Hereditary renal-cell carcinoma associated with a chromosomal translocation. | journal=N Engl J Med | year= 1979 | volume= 301 | issue= 11 | pages= 592-5 | pmid=470981 | doi=10.1056/NEJM197909133011107 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=470981  }}</ref>
{| style="border: 0px; font-size: 90%; margin: 3px; width: 800px" align=center
|valign=top|
|+
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential diagnosis}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Characteristic features of the differential diagnosis}}
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:[[Retroperitoneal liposarcoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Presence of a large vessel extending into the renal cortex suggestive of [[angiomyolipoma]]; [[liposarcoma]] is hypovascular<ref>{{Cite journal
| author = [[Kate Lynn J. Bill]], [[Lucia Casadei]], [[Bethany C. Prudner]], [[Hans Iwenofu]], [[Anne M. Strohecker]] & [[Raphael E. Pollock]]
| title = Liposarcoma: molecular targets and therapeutic implications
| journal = [[Cellular and molecular life sciences : CMLS]]
| volume = 73
| issue = 19
| pages = 3711–3718
| year = 2016
| month = October
| doi = 10.1007/s00018-016-2266-2
| pmid = 27173057
}}</ref>
*Renal [[Parenchyma|parenchymal]] defect at the site of [[tumor]] contact favors exophytic [[angiomyolipoma]]- claw sign
*[[Calcification]]s suggest [[liposarcoma]]


When an AML has typical appearances there is essentially no differential. If atypical, especially when fat-poor other lesions to consider include:
[[file:Retroperitoneal-liposarcoma-3.jpg | 200px]]
*[[Retroperitoneal liposarcoma]] invading the kidney:  
|-
**Presence of a large vessel extending into the renal cortex suggestive of AML; liposarcoma is hypovascular
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
**Renal parenchymal defect at the site of tumour contact favours exophytic angiomyolipoma- claw sign
:[[Renal cell carcinoma]]
**[[Calcification]]s suggest liposarcoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Adrenal myelolipoma]]
*May contain fat<ref name="pmid16339096">{{cite journal| author=Cohen HT, McGovern FJ| title=Renal-cell carcinoma. | journal=N Engl J Med | year= 2005 | volume= 353 | issue= 23 | pages= 2477-90 | pmid=16339096 | doi=10.1056/NEJMra043172 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16339096  }}</ref>
*[[Renal cell carcinoma]] ([[RCC]])
*Lipid [[necrosis]]
**May contain fat: lipid necrosis or osseous metaplasia
*Osseous [[metaplasia]]
*[[Oncocytoma]]: may contain fat
|-
*[[Wilm's tumor]]: may contain fat
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
*Perirenal fat entrapment / renal junctional parenchymal defect
:[[Oncocytoma]]
*Retroperitoneal [[sarcoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
**[[Liposarcoma]]
*May contain fat
**[[Leiomyosarcoma]]
|-
*[[Renal cell carcinoma]] with sarcomatoid differentiation
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
*Renal leiomyoma<ref name=pmid25517956>{{Cite journal  | last1 = Patil | first1 = PA. | last2 = McKenney | first2 = JK. | last3 = Trpkov | first3 = K. | last4 = Hes | first4 = O. | last5 = Montironi | first5 = R. | last6 = Scarpelli | first6 = M. | last7 = Nesi | first7 = G. | last8 = Aron | first8 = M. | last9 = Sangoi | first9 = AR. | title = Renal Leiomyoma: A Contemporary Multi-institution Study of an Infrequent and Frequently Misclassified Neoplasm. | journal = Am J Surg Pathol | volume =  | issue =  | pages =  | month = Dec | year = 2014 | doi = 10.1097/PAS.0000000000000354 | PMID = 25517956 }}</ref>
:[[Wilm's tumor]]
**very rare
| style="padding: 5px 5px; background: #F5F5F5;" |
**desmin +ve
*May contain fat
**HMB-45 -ve
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Retroperitoneal [[sarcoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Liposarcoma]]
*[[Leiomyosarcoma]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:[[Renal cell carcinoma]]
| style="padding: 5px 5px; background: #F5F5F5;" |
*Sarcomatoid differentiation
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Renal leiomyoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Very rare
*[[Desmin]] +ve
*[[HMB-45]] -ve
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Perirenal fat entrapment
| style="padding: 5px 5px; background: #F5F5F5;" |
*Renal junctional parenchymal defect
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Adrenal myelolipoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Fat in renal parenchyma
[[file:Adrenal-myelolipoma.jpg | 200px]]
|-
|}


==References==
==References==
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Latest revision as of 13:17, 6 November 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Faizan Sheraz, M.D. [2],Rekha, M.D.

Overview

Angiomyolipoma must be differentiated from retroperitoneal liposarcoma, adrenal myelolipoma, and renal cell carcinoma.[1][2]

Differentiating Angiomyolipoma from other Diseases

Angiomyolipoma must be differentiated from the following:[1][3][4][5][6]

Differential diagnosis Characteristic features of the differential diagnosis
Retroperitoneal liposarcoma

Renal cell carcinoma
Oncocytoma
  • May contain fat
Wilm's tumor
  • May contain fat
Retroperitoneal sarcoma
Renal cell carcinoma
  • Sarcomatoid differentiation
Renal leiomyoma
Perirenal fat entrapment
  • Renal junctional parenchymal defect
Adrenal myelolipoma
  • Fat in renal parenchyma

References

  1. ↑ 1.0 1.1 Patil, PA.; McKenney, JK.; Trpkov, K.; Hes, O.; Montironi, R.; Scarpelli, M.; Nesi, G.; Aron, M.; Sangoi, AR. (2014). "Renal Leiomyoma: A Contemporary Multi-institution Study of an Infrequent and Frequently Misclassified Neoplasm". Am J Surg Pathol. doi:10.1097/PAS.0000000000000354. PMID 25517956. Unknown parameter |month= ignored (help)
  2. ↑ Renal angiomyolipoma differential diagnosis. Dr Matt A. Morgan and Dr Behrang Amini et al. Radiopaedia 2015. http://radiopaedia.org/articles/renal-angiomyolipoma
  3. ↑ N. Azumi, J. Curtis, R. L. Kempson & M. R. Hendrickson (1987). "Atypical and malignant neoplasms showing lipomatous differentiation. A study of 111 cases". The American journal of surgical pathology. 11 (3): 161–183. PMID 3826477. Unknown parameter |month= ignored (help)
  4. ↑ Emily Z. Keung, Jason L. Hornick, Monica M. Bertagnolli, Elizabeth H. Baldini & Chandrajit P. Raut (2014). "Predictors of outcomes in patients with primary retroperitoneal dedifferentiated liposarcoma undergoing surgery". Journal of the American College of Surgeons. 218 (2): 206–217. doi:10.1016/j.jamcollsurg.2013.10.009. PMID 24315890. Unknown parameter |month= ignored (help)
  5. ↑ Khin Thway, Robin L. Jones, Jonathan Noujaim, Shane Zaidi, Aisha B. Miah & Cyril Fisher (2016). "Dedifferentiated Liposarcoma: Updates on Morphology, Genetics, and Therapeutic Strategies". Advances in anatomic pathology. 23 (1): 30–40. doi:10.1097/PAP.0000000000000101. PMID 26645460. Unknown parameter |month= ignored (help)
  6. ↑ Cohen AJ, Li FP, Berg S, Marchetto DJ, Tsai S, Jacobs SC; et al. (1979). "Hereditary renal-cell carcinoma associated with a chromosomal translocation". N Engl J Med. 301 (11): 592–5. doi:10.1056/NEJM197909133011107. PMID 470981.
  7. ↑ Kate Lynn J. Bill, Lucia Casadei, Bethany C. Prudner, Hans Iwenofu, Anne M. Strohecker & Raphael E. Pollock (2016). "Liposarcoma: molecular targets and therapeutic implications". Cellular and molecular life sciences : CMLS. 73 (19): 3711–3718. doi:10.1007/s00018-016-2266-2. PMID 27173057. Unknown parameter |month= ignored (help)
  8. ↑ Cohen HT, McGovern FJ (2005). "Renal-cell carcinoma". N Engl J Med. 353 (23): 2477–90. doi:10.1056/NEJMra043172. PMID 16339096.

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