AML or liposarcoma

Replies to This Discussion

Permalink Reply by Giuseppe Pelle on September 7, 2008 at 10:19am

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!!!!!!

GIPO

Permalink Reply by Phil Haslam on September 7, 2008 at 12:51pm

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.

Permalink Reply by Giuseppe Pelle on September 10, 2008 at 5:32am

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

Permalink Reply by Phil Haslam on September 10, 2008 at 5:38am

Thanks Gipo, will have a read if i get a minute !
Are you going to CIRSE ?

Permalink Reply by Phil Haslam on September 10, 2008 at 7:10am

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

Permalink Reply by Giuseppe Pelle on September 10, 2008 at 9:28am

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......

Permalink Reply by Giuseppe Pelle on September 10, 2008 at 9:33am

I' m sorry but i will not attend to CIRSE! Probably i will be in chicago on decenber for RSNA.....

Permalink Reply by Phil Haslam on September 10, 2008 at 9:39am

Thanks Gipo, yes I am going to RSNA, maybe catch up there.