Association of angiomyolipoma and oncocytoma of the kidney: a case report and review of the literature

Abstract

Aim: The association between renal carcinoma and angiomyolipoma is rare. Only 14 cases have been reported in the literature. The purpose of this paper is to present an additional case and review the literature on this association.

Patient and methods: A healthy 42 year old woman was found to have a left flank mass incidentally when she presented for a Papanicolaou smear. The computerised tomography scan revealed a left lower pole renal mass consistent with a renal cell carcinoma. A nephrectomy was performed and the patient recovered uneventfully. The nephrectomy specimen was processed routinely. In addition to haematoxylin and eosin staining, immunohistochemistry for CAM 5.2, vimentin, CD34, antismooth muscle actin, and HMB45 was carried out. Transmission electron microscopy was also performed.

Results: Macroscopically, the lower pole of the kidney contained a well circumscribed, non-encapsulated, tan coloured tumour with a large area of central haemorrhage measuring 10.5 cm. In addition, there was a 0.4 cm poorly circumscribed unencapsulated yellow nodule adjacent to the tumour. Microscopically, the larger tumour showed characteristic features of an oncocytoma. Numerous mitochondria were seen on electron microscopy. The smaller yellow nodule was an angiomyolipoma.

Conclusions: This paper presents an additional case of oncocytoma associated with angiomyolipoma. Of the 15 cases described in the literature, three were associated with the tuberous sclerosis complex, all from a single study. In tuberous sclerosis, angiomyolipomas are more commonly associated with renal cell carcinoma. If angiomyolipomas are found incidentally in nephrectomy specimens together with other tumours, it is important to exclude tuberous sclerosis retrospectively.

Figure 1

Computed tomography scan of the abdomen showing a large left renal neoplasm.

Figure 2

Bisected nephrectomy specimen showing a large well circumscribed, tan coloured oncocytoma with a large area of central haemorrhage. A much smaller yellow nodule, the angiomyolipoma, is present superiorly (arrow).

Figure 3

Oncocytoma displaying compact tubules with polygonal cells showing eosinophilic cytoplasm and uniform nuclei (haematoxylin and eosin stain).

Figure 4

Angiomyolipoma showing an admixture of mature adipose tissue, smooth muscle, and vessels (haematoxylin and eosin stain).

Figure 5

Electron microscopy: oncocytoma showing abundant mitochondria within the cytoplasm of the cells (original magnification, ×5000).