Epithelioid angiomyolipoma of the kidney: Pathological features and clinical outcome in a series of consecutively resected tumors

Wenlei He, John C. Cheville, Peter M. Sadow, Anuradha Gopalan, Samson W. Fine, Hikmat A. Al-Ahmadie, Ying Bei Chen, Esther Oliva, Paul Russo, Victor E. Reuter, Satish K. Tickoo

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54 Scopus citations

Abstract

The 2004 World Health Organization classification of tumors defines epithelioid angiomyolipoma of kidney as a potentially malignant mesenchymal neoplasm with reported metastasis in approximately one-third of the cases. However, this conclusion was based primarily on individual case reports and small retrospective series. More recently reported larger series have shown varying results. We reviewed 437 consecutive renal angiomyolipomas with primary resection at three tertiary-care institutions with high nephrectomy volumes. Only tumors showing >80% epithelioid histology were included in this study. Tumors resected elsewhere and reviewed in consultation were not included. Twenty of these 437 (4.6%) were classified as epithelioid angiomyolipoma. The female to male ratio was 11:9, mean age 49.7 (range, 30-80) years, and mean tumor size 8.7 (range, 1-25) cm. Microscopic tumor necrosis was present in 10 (50%) tumors and mitotic activity (range, <1-5/10 high power fields) in 8 (40%); atypical mitoses were seen in only 1 (5%) tumor. Pleomorphic ganglion-like or multinucleated giant cells were seen in 18 (90%) tumors. With a mean follow-up of 82.5 (range, 1-356) months, seventeen patients were alive with no-evidence-of-disease at the time of last follow-up; two patients died of unrelated causes with no-evidence-of-disease, and one patient (5%) developed distant metastases. Our data, based on consecutively resected angiomyolipomas with long clinical follow-up, suggests that epithelioid angiomyolipomas constitute a small proportion of all angiomyolipomas, and the rate of aggressive behavior among epithelioid angiomyolipomas, even when showing morphologic features previously reported to portend aggressive clinical behavior, is very low.

Original languageEnglish (US)
Pages (from-to)1355-1364
Number of pages10
JournalModern Pathology
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2013

Keywords

  • Epithelioid angiomyolipoma
  • PEComa
  • Renal angiomyolipoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    He, W., Cheville, J. C., Sadow, P. M., Gopalan, A., Fine, S. W., Al-Ahmadie, H. A., Chen, Y. B., Oliva, E., Russo, P., Reuter, V. E., & Tickoo, S. K. (2013). Epithelioid angiomyolipoma of the kidney: Pathological features and clinical outcome in a series of consecutively resected tumors. Modern Pathology, 26(10), 1355-1364. https://doi.org/10.1038/modpathol.2013.72