A histopathologic and immunohistochemical study of small nodules of renal angiomyolipoma: a comparison of small nodules with angiomyolipoma.

Small mesenchymal nodules (SNs) are observed in some cases of renal angiomyolipoma (AML), with or without tuberous sclerosis. They are composed of blood vessels and/or nonvascular smooth muscle cells (SMCs) and/or fat cells. We examined 20 cases of AML, performed detailed histopathologic and immunohistochemical studies of SNs, verified the histologic relationship between SNs and AMLs, and compared the SNs of the tuberous/nontuberous sclerosis groups. Seventy-seven SNs were observed in five cases of AML. The SNs were 0.11 mm to 20.0 mm in diameter. The location of small-sized SNs in the kidney was variable; almost all of the SNs larger than 3.25 mm were in the renal capsule. The small-sized SNs contained mainly epithelioid-type nonvascular SMCs. Blood vessels and fat cells were not observed in the small-sized SNs but appeared gradually in the large-sized SNs. Almost all of the SNs were rounded lesions, and no fusion was observed between the SNs. Nonvascular SMCs of all of the SNs and AMLs were positive for vimentin, alpha-SM actin, and S-100 protein. The SNs less than 1.13 mm in diameter were negative for HMB-45; the nonvascular SMCs of AMLs and of SNs greater than 1.13 mm in diameter were positive for HMB-45. Nonvascular SMCs of SNs and AMLs showed a neurogenic phenotype. The SNs of the nontuberous sclerosis group contained only SMC components, whereas the same-size SNs of the tuberous sclerosis group contained SMCs, fat cells, and blood vessels. The SNs of the nontuberous sclerosis group may not increase in size or may grow slowly. Some of the SNs of patients with tuberous sclerosis grow to become AML. Although the SNs in patients with nontuberous sclerosis do not contain any blood vessels or fat cells, their SMCs show the histologic and immunohistochemical characteristics of AMLs; this indicates that SNs are the "buds" of AML.