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I have been asked to give an opinion on the following images. I'm keen to get others viewpoints too. The images are of a 65 year old lady with a fatty mass displacing the right kidney. It is vascular and shows enhancement on CT. I am told it has been stable in size for at least 18 months. An attempt at embolisation was made and abandoned. It had been assumed to be an AML.

Do you think this is an AML or retroperitoneal liposarcoma ?

I have also posted this on my own site at:


(You are also able to place a vote for your opinion here)

Thanks in advance!

Views: 260


Replies to This Discussion

I Phil... sorry for the late answer but i was in spain untill the last week.... well, your case is very challenging.....the question sounds like "to be or not to be".....
My first impression was that the lesion has the appearance of a well differentiated liposarcoma...in my limited experience i never encontered a liposarcoma in a such location but i had seen some liposarcomas in other places and they have a similar morphologic appearance:
1) slow growing
2) compressing rather than infiltrating

I read an article in radiographics about the AML originating from the subcapsular cortex and i know that the differential diagnosis with liposarcoma is very challenging.

My reasons for AML esclusion:
1) I can't see a clear notch in the cortical profile of the right kidney as i would expect from lesions that originate from renal parenchima...
2) hypothetically, if the mas lies in the subcapsular location i would expect a greater degree of imprintig and dislocation of the renal cortex.
3) The patient's age (65y)....usually AML greter than 4 cm are discovered earlier because they are symptomatic.

Finally I suppose that we are in front to a well differentiated liposarcoma.....
I think that further investigation with US and MRI should help to gain other information for a correct diagnosis.

Thank you Phil.. this is a very interesting case.... please let me know how it will end!!!!!!

Thanks Gipo, hope Spain was good for you.
yes a difficult case. I have more images on WhichInterventionaldevice forum if you need any.
I have just heard today that the patient is going for surgery at the end of Sept, so we should hear then.

Heading to CIRSE next week.
Hi Phil, Giuseppe again........
I read an article in AJR about the differential diagnosis between AML an Liposarcoma...it's very interesting......
CT Differentiation of Large Exophytic Renal Angiomyolipomas and Perirenal Liposarcomas
Gary M. Israel1, Morton A. Bosniak, Chrystia M. Slywotzky and Robert J. Rosen. AJR 2002; 179:769-773
Thanks Gipo, will have a read if i get a minute !
Are you going to CIRSE ?
Thanks for the article, v good. I now am coming down more in favour of an AML as there is a small cortical defect and some larger vessels. Its being removed end of this month, so will let you know!
Phil I have seen the other images in Whickiinterventional and i'm agree with you; there is a clear nocth in the cortical profile of the right kidney, so according to the AJR article there are two major findigs for AML......Very interesting case...thank you......
I' m sorry but i will not attend to CIRSE! Probably i will be in chicago on decenber for RSNA.....
Thanks Gipo, yes I am going to RSNA, maybe catch up there.


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