low power, moderately cellular, haphazard solid growth in this field, diagonsis not immediately apparent Image

actually some pleomorphism and some hyperchromasia Image

other aresa with vessels with prominent eosiophilic thickened walls and mature fat Image

cellular areas merge with these funny thick walled vessels of various sizes/calibre Image

another area with the myoid component which predominantes, gives it the "epithleioid"look Image

vessel amongst the myxoid stuff Image

embedded within the fatty areas are these vessels with prominent walls Image

the myoid area and SMA immunostain Image

Pax 8 Immunoreactivity for HMB45, HMB50, CD117, CD63, and negativity for epithelial markers and cytokeratins confirm the diagnosis Image

Clonal

Originate from PEComa cell?

accumulating evidence that this is a malignant neoplasm

associated with tuberous sclerosis

Unlike typical angiomyolipoma for which resection alone is adequate, resection perhaps adjuvant therapy should be considered for this tumor.

Unlike classic renal angiomyolipoma, commonly benign, renal epithelioid angiomyolipoma can behave in an aggressive manner.

- need to recognize so as to not misdiagnose as renal cell carcinoma