title: Calcified, minimally fat-contained angiomyolipoma clinically indistinguishable from a renal cell carcinoma.
abstract: BACKGROUND
  Angiomyolipomas are benign tumors of the kidney. Typical angiomyolipomas are usually recognized by identifying fat components before any intervention. On the contrary, solid renal masses without evident fatty components but containing calcifications on the computed tomography scan are suspicious for malignancy. However, as in this rare case, rules of diagnostic imaging are of exceptions.
  
  
  METHODS
  A 40-year-old man presented with left flank pain. The plain X-ray showed multiple coarse calcifications of 4.0x3.2 cm in diameter on the left upper quadrant abdomen. Computed tomography scan further revealed a solid renal mass and inside the mass there were calcifications. The size of the tumor was 5.6×5.5×6.3 cm. We performed a radical nephrectomy, and the histopathology showed a minimally fat-contained angiomyolipoma of multiple calcifications. The patient was free of recurrence or metastases after a follow-up period of 3 years.
  
  
  CONCLUSIONS
  An angiomyolipoma containing calcification is rare. An angiomyolipoma with minimal fat concomitant with calcifications is an even rarer presentation. It is very difficult to differentiate a minimal-fat angiomyolipoma with calcifications from a renal cell carcinoma preoperatively. In such a circumstance, a well-planned partial nephrectomy may be optimal for the patient, regardless of the tumor size.
authors.affiliation: Division of Urology, Department of Surgery, Tri-Service General Hospital, No325, Section 2, Cheng-Kung Road, Taipei 114, Taiwan, ROC.
authors.forename: Chin-Li
authors.initials: CL
authors.lastname: Chen
authors.forename: Shou-Hung
authors.initials: SH
authors.lastname: Tang
authors.forename: Sheng-Tang
authors.initials: ST
authors.lastname: Wu
authors.forename: En
authors.initials: E
authors.lastname: Meng
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Tsao
authors.forename: Guang-Huan
authors.initials: GH
authors.lastname: Sun
authors.forename: Dah-Shyong
authors.initials: DS
authors.lastname: Yu
authors.forename: Sun-Yran
authors.initials: SY
authors.lastname: Chang
authors.forename: Tai-Lung
authors.initials: TL
authors.lastname: Cha
mesh_terms: D000328:Adult; D018207:Angiomyolipoma / Q000175:diagnosis* / Q000601:surgery; D002114:Calcinosis / Q000175:diagnosis* / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000175:diagnosis* / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008297:Male