Centrally Thrombosed Renal Angiomyolipoma: A COVID-Induced Pathology?

Abstract

Renal Angiomyolipomas (AMLs) are benign neoplastic entities paradigmatically composed of smooth muscle, blood vessels, and adipose tissue. The cornerstone of renal AML identification fundamentally entails imaging; however, findings may rarely resemble malignancy and subsequently obfuscate diagnosis. Compellingly, the comorbid effect of viral diseases such as COVID-19 on neoplasm integrity and morphology remains incompletely understood. The following case reports a 46-year-old female presenting with intermittent right flank pain persisting for three weeks. Preliminary sonographic studies revealed a predominantly echogenic, space-occupying lesion with well-defined margins in the right renal cortex undergoing angiogenesis. Shortly thereafter, the patient contracted COVID-19, and the right flank pain progressed to a debilitatingly constant nature described as sharp, stabbing, and aggravating to an eight on a scale of ten. Recovery was uncomplicated; however, the patient presented with mild thrombocytopenia. Contrast-enhanced CT scans elucidated a compelling hypodense mass center suggesting the presence of an encapsulated thrombus accompanied by further invasion of Morison’s pouch 25 days post-initial identification. Histopathological examination of the surgically excised specimen confirmed the likely diagnosis of a centrally thrombosed renal angiomyolipoma. Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2) infection may have ostensibly contributed to neoplasm morphology alterations and subsequent thrombosis, as intrinsic renal cell damage is welldocumented in the literature. Consequently, clinicians must remain vigilant that radiographic abnormalities may emerge secondary to comorbid viral diseases such as COVID-19 via incompletely understood mechanism(s).