angiomyolipoma
TRANSCRIPT
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Genito-Urinary Tumors
Episode 2
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Genito-Urinary Tumors
• Renal tumors.
• Tumors of the ureter.
• Bladder tumors.
• Prostate tumors.
• Testicular tumors.
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Angiomyolipoma
• Benign.• Vessel + Smooth Muscle + Fat.• 2 Types:
Pathology:
1. Isolated.2. Associated with
syndromes (as Tuberous Sclerosis)
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Angiomyolipoma
• 80% of AMLs.• Solitary.• 20-70 years of age.• Female/Male = 4/1.• 80% in the Right Kidney !!
Isolated AML
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Angiomyolipoma
• 20% of AMLs.• Bilateral and multiple.• 1-20 years of age.• Female/Male = Near equal.• AML occurs in 80% patients with tuberous
sclerosis.
AML with Tuberous Sclerosis
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Angiomyolipoma
Clinical:
• 60% asymptomatic.• 40% are symptomatic; these can cause a
palpable abdominal mass, hematuria, or flank pain.
• The solitary sporadic tumors may cause acute abdomen and shock as a result of spontaneous hemorrhage in the tumor.
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Angiomyolipoma
I. Plain X-Ray:
• Radiolucent mass.
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Angiomyolipoma
II. IVU:
• Single or multiple lucent defects.
• Distortion of the calyces.
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Angiomyolipoma
III.US:
• Round or oval cortical masses.
• Intensely echogenic. • Well circumscribed.
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Angiomyolipoma
III.US:
• Round or oval cortical masses.
• Intensely echogenic. • Well circumscribed.
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Angiomyolipoma
IV.CT:
NECT: • Well circumscribed round or
oval cortical masses.
• Fat.
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Angiomyolipoma
IV.CT:
CECT: • Early/CTA → +/- Aneurysm.
• Fat.
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Angiomyolipoma
IV.CT:
CECT: • Nephrographic Phase → +/-Heterogeneous
enhancement.
• Fat.
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Angiomyolipoma
IV.CT:
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Angiomyolipoma
IV.CT:
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Angiomyolipoma
IV.CT:
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Angiomyolipoma
V.MRI:
Variable areas of high signal intensity within
the tumor on both T1-weighted and T2-
weighted images
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Angiomyolipoma
V.MRI:
T1W:
Pre → High signal intensity is present because of the fat content.
Post → Heterogeneous enhancement.
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Angiomyolipoma
V.MRI:
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Angiomyolipoma
V.MRI:
T2W:
Isointense relative to that of perinephric fat.
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Angiomyolipoma
V.MRI:
Fat-Suppression:
Signal intensity dropout of fat .
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Angiomyolipoma
V. Angiography:
• 95% of AMLs are hypervascular.• Enlarged interlobar and interlobular arteries.
• Intratumoral arteries are tortuous, irregular, and aneurysmal.
• Venous pooling exists, with a sunburst, whorled, and onion-peel appearance.
• No arteriovenous (AV) shunting is present.
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Angiomyolipoma
VI.Angiography:
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Angiomyolipoma
VI.Angiography:
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Angiomyolipoma
VI.Angiography:
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Angiomyolipoma
VI.Angiography:
• The presence of multisacculated pseudoaneurysms, the
absence of AV shunting, a sunburst appearance of the
capillary nephrogram, and an onion-skin appearance of
the peripheral vessels in the venous phase suggest AML.