Angiomyolipoma other diagnostic studies: Difference between revisions

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__NOTOC__
__NOTOC__
{{Angiomyolipoma}}
{{Angiomyolipoma}}
{{CMG}} {{AE}}{{Faizan}}
{{CMG}} {{AE}}{{Faizan}},{{Rekha}}
==Overview==
==Overview==
[[CT]] guided biopsy is diagnostic of angiomyolipoma.
[[CT]] guided [[biopsy]] is diagnostic of [[angiomyolipoma]]. However it is used to established the [[diagnosis]],when imaging modalities fails to establish the [[diagnosis]] especially in cases of fat poor [[Angiomyolipoma]] that is difficult to distinguish from the [[Renal cell carcinoma]]. In case of presence of [[Tumor|tumour]] [[necrosis]] or [[calcification]], that is highly suggestive of the [[malignancy]], many clinicians prefers elective surgical removal instead of undergoing diagnosing [[biopsy]].


==Biopsy Findings==
==Biopsy Findings==
Biopsy findings of angiomyolipoma include:
[[Biopsy]] findings of [[angiomyolipoma]] include:<ref name="pmid25468637">{{cite journal| author=Schieda N, Kielar AZ, Al Dandan O, McInnes MD, Flood TA| title=Ten uncommon and unusual variants of renal angiomyolipoma (AML): radiologic-pathologic correlation. | journal=Clin Radiol | year= 2015 | volume= 70 | issue= 2 | pages= 206-20 | pmid=25468637 | doi=10.1016/j.crad.2014.10.001 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25468637  }}</ref>
===Microscopic Features===
===Microscopic Features===
Microscopic features of angiomyolipoma are:
[[Microscopic]] features of [[angiomyolipoma]] are:<ref name="pmid15584043">{{Cite journal  | last1 = Crapanzano | first1 = JP. | title = Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases. | journal = Diagn Cytopathol | volume = 32 | issue = 1 | pages = 53-7 | month = Jan | year = 2005 | doi = 10.1002/dc.20179 | PMID = 15584043 }}</ref>
*[[Smooth muscle]]
*[[Smooth muscle]]
*Adipose tissue - not always present<ref name=pmid15584043>{{Cite journal  | last1 = Crapanzano | first1 = JP. | title = Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases. | journal = Diagn Cytopathol | volume = 32 | issue = 1 | pages = 53-7 | month = Jan | year = 2005 | doi = 10.1002/dc.20179 | PMID = 15584043 }}</ref> - '''key feature'''
*[[Adipose]] tissue
*Abundant [[blood vessel]]s
*Abundant [[blood vessel]]s
<gallery>
<gallery>
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===Cytologic===
===Cytologic===
Cytologic features of angiomyolipoma include:<ref name=pmid15584043>{{Cite journal  | last1 = Crapanzano | first1 = JP. | title = Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases. | journal = Diagn Cytopathol | volume = 32 | issue = 1 | pages = 53-7 | month = Jan | year = 2005 | doi = 10.1002/dc.20179 | PMID = 15584043 }}</ref>
Cytologic features of angiomyolipoma include:<ref name="pmid15584043">{{Cite journal  | last1 = Crapanzano | first1 = JP. | title = Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases. | journal = Diagn Cytopathol | volume = 32 | issue = 1 | pages = 53-7 | month = Jan | year = 2005 | doi = 10.1002/dc.20179 | PMID = 15584043 }}</ref>
*[[Nuclei]] - round/ovoid
*[[Nuclei]] - round/ovoid
*[[Chromatin]] - bland
*[[Chromatin]] - bland
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===Immunohistochemistry===
===Immunohistochemistry===
[[Immunohistochemistry]] markers of angiomyolipoma include:
[[Immunohistochemistry]] markers of angiomyolipoma include:
*Melanocytic markers positive<ref name=Ref_GUP324>{{Ref GUP|324}}</ref>
*Melanocytic markers positive<ref name="Ref_GUP324">{{Ref GUP|324}}</ref>
**HMB-45 positive in all cases (15/15)<ref name=pmid23932749>{{Cite journal  | last1 = Esheba | first1 = Gel S. | last2 = Esheba | first2 = Nel S. | title = Angiomyolipoma of the kidney: clinicopathological and immunohistochemical study. | journal = J Egypt Natl Canc Inst | volume = 25 | issue = 3 | pages = 125-34 | month = Sep | year = 2013 | doi = 10.1016/j.jnci.2013.05.002 | PMID = 23932749 }}
**HMB-45 positive in all cases (15/15)<ref name="pmid23932749">{{Cite journal  | last1 = Esheba | first1 = Gel S. | last2 = Esheba | first2 = Nel S. | title = Angiomyolipoma of the kidney: clinicopathological and immunohistochemical study. | journal = J Egypt Natl Canc Inst | volume = 25 | issue = 3 | pages = 125-34 | month = Sep | year = 2013 | doi = 10.1016/j.jnci.2013.05.002 | PMID = 23932749 }}
</ref>
</ref>
**Melan A positive in ~87% of cases (13/15)
**Melan A positive in ~87% of cases (13/15)
*Epithelial markers negative<ref name=Ref_GUP324>{{Ref GUP|324}}</ref>
*Epithelial markers negative<ref name="Ref_GUP324">{{Ref GUP|324}}</ref>
**EMA
**EMA
**AE1/AE3
**AE1/AE3
*SMA positive
*SMA positive
*CD117 positive/negative
*CD117 positive/negative
*Ki-67:<ref name=pmid18839327>{{Cite journal  | last1 = Ooi | first1 = SM. | last2 = Vivian | first2 = JB. | last3 = Cohen | first3 = RJ. | title = The use of the Ki-67 marker in the pathological diagnosis of the epithelioid variant of renal angiomyolipoma. | journal = Int Urol Nephrol | volume = 41 | issue = 3 | pages = 559-65 | month =  | year = 2009 | doi = 10.1007/s11255-008-9473-1 | PMID = 18839327 }}</ref>
*Ki-67:<ref name="pmid18839327">{{Cite journal  | last1 = Ooi | first1 = SM. | last2 = Vivian | first2 = JB. | last3 = Cohen | first3 = RJ. | title = The use of the Ki-67 marker in the pathological diagnosis of the epithelioid variant of renal angiomyolipoma. | journal = Int Urol Nephrol | volume = 41 | issue = 3 | pages = 559-65 | month =  | year = 2009 | doi = 10.1007/s11255-008-9473-1 | PMID = 18839327 }}</ref>
**Epithelioid variant of [[angiomyolipoma]] positive
**Epithelioid variant of [[angiomyolipoma]] positive
**Conventional angiomyolipoma negative
**Conventional angiomyolipoma negative
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Latest revision as of 16:17, 8 November 2019

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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

CT guided biopsy is diagnostic of angiomyolipoma. However it is used to established the diagnosis,when imaging modalities fails to establish the diagnosis especially in cases of fat poor Angiomyolipoma that is difficult to distinguish from the Renal cell carcinoma. In case of presence of tumour necrosis or calcification, that is highly suggestive of the malignancy, many clinicians prefers elective surgical removal instead of undergoing diagnosing biopsy.

Biopsy Findings

Biopsy findings of angiomyolipoma include:[1]

Microscopic Features

Microscopic features of angiomyolipoma are:[2]

  • Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. H & E stain.[3]

    Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. H & E stain.[3]

  • Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. H & E stain.[3]

    Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. H & E stain.[3]

  • Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. H & E stain.[3]

    Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. H & E stain.[3]

  • Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. HMB-45 immunostain.[3]

    Histopathologic image of renal angiomyolipoma. Nephrectomy specimen. HMB-45 immunostain.[3]

Cytologic

Cytologic features of angiomyolipoma include:[2]

Immunohistochemistry

Immunohistochemistry markers of angiomyolipoma include:

  • Melanocytic markers positive[4]
    • HMB-45 positive in all cases (15/15)[5]
    • Melan A positive in ~87% of cases (13/15)
  • Epithelial markers negative[4]
    • EMA
    • AE1/AE3
  • SMA positive
  • CD117 positive/negative
  • Ki-67:[6]
    • Epithelioid variant of angiomyolipoma positive
    • Conventional angiomyolipoma negative

References

  1. ↑ Schieda N, Kielar AZ, Al Dandan O, McInnes MD, Flood TA (2015). "Ten uncommon and unusual variants of renal angiomyolipoma (AML): radiologic-pathologic correlation". Clin Radiol. 70 (2): 206–20. doi:10.1016/j.crad.2014.10.001. PMID 25468637.
  2. ↑ 2.0 2.1 Crapanzano, JP. (2005). "Fine-needle aspiration of renal angiomyolipoma: cytological findings and diagnostic pitfalls in a series of five cases". Diagn Cytopathol. 32 (1): 53–7. doi:10.1002/dc.20179. PMID 15584043. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 3.2 3.3 http://librepathology.org/wiki/index.php/Angiomyolipoma
  4. ↑ 4.0 4.1 Template:Ref GUP
  5. ↑ Esheba, Gel S.; Esheba, Nel S. (2013). "Angiomyolipoma of the kidney: clinicopathological and immunohistochemical study". J Egypt Natl Canc Inst. 25 (3): 125–34. doi:10.1016/j.jnci.2013.05.002. PMID 23932749. Unknown parameter |month= ignored (help)
  6. ↑ Ooi, SM.; Vivian, JB.; Cohen, RJ. (2009). "The use of the Ki-67 marker in the pathological diagnosis of the epithelioid variant of renal angiomyolipoma". Int Urol Nephrol. 41 (3): 559–65. doi:10.1007/s11255-008-9473-1. PMID 18839327.

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