Fig. 3

A 37-year-old female patient presented with right loin pain for 4 months. She was diagnosed with a large upper zonal renal AML with direct tumor extension into renal vein and infra-hepatic part of IVC on CECT. She underwent preoperative SAE using absolute alcohol and 2 microcoils followed by total nephrectomy with no intra-operative blood loss. Resected lesion was sent to pathologic analysis which revealed epithelioid renal AML. CECT scan (axial images): a large upper zonal right renal AML with multiple abnormal vascularities and direct tumor extension into renal vein (a) and infra-hepatic part of IVC (yellow arrow), b Arterial phase of CECT scan (coronal MIP images): c Double right renal arteries; main artery and higher accessory one supplying lower renal pole. d Upper segmental branch of the main renal artery supplying large upper zonal right renal AML with multiple abnormal vascularity. Right renal digital subtraction angiography (e, f, g): e Pre-embolization angiography of the right renal artery using cobra catheter showing large upper zonal lesion with multiple abnormal feeders. f Superselective catheterization of the arterial feeder of the lesion. g Post-embolization control angiogram showing no further opacification of the lesion after SAE using absolute alcohol and 2 microcoils. h Histopathologic image: Epithelioid renal AML that is formed of a mixture of polygonal and spindle cells of variable size where inflammatory cells are mingled with neoplastic cells. The resected specimens of renal vein and IVC show the same microscopic findings with no mural infiltration