Loss of intratumoral macroscopic fat in renal angiomyolipoma following chemoradiation therapy for pancreatic cancer

Angiomyolipoma (AML) is the most common benign mesenchymal tumour of the kidney. Classically, AML can readily be diagnosed by identifying the negatively attenuating intratumoral macroscopic fat component on non-enhanced CT scans. However, intratumoral macroscopic fat may not be visible on CT scans, mimicking renal cell carcinoma. We report a case of renal AML with CT scan evidence of macroscopic intratumoral fat that was not readily visible on subsequent CT or MRI, presumably owing to a generalized rapid loss of adipose tissue due to cachexia in a patient with pancreatic adenocarcinoma. Radiologists should be aware that AML may lose its intratumoral fat on follow-up imaging and may simulate renal cell carcinoma.