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We present a case of renal medullary fibroma and various nuances associated with radiological identification of this lesion and its management related dilemmas.

Keywords: Benign, histopathology, imaging, renal cancer, renal medullary fibroma How to cite this URL: Kumar S, Choudhary GR, Nanjappa B, Bal A.

Renomedullary fibromas are very common benign tumors arising from the interstitial cells of the renal medulla and commonly present as an incidental finding.

The lesion localizes in the renal medulla and almost always measures less than 0.5 cm in diameter although tumors up to 8 cm have been reported.

More than 50% of patients are older than 20 years of age.

Few renal medullary fibromas are large enough to become clinically evident and cause symptoms due to torsion of the tumor about a pedicle causing venous stasis, infarction, vascular rupture, and subsequent hematuria.

Pre-operative diagnosis of renal medullary fibroma is difficult and the radiological spectrum of calcifications on plain X-rays, echogenicity on CT, neovascularity on arteriogram and filling defects on retrograde pyelogram, all simulate either renal cell carcinoma (RCC or transitional cell carcinoma.

On ultrasonography, renal medullary fibroma is seen as an echogenic mass.

J Clin Imaging Sci [serial online] 2013 [cited 2018 Jan 12];. 2013/3/1/43/120776 Clinical diagnosis of this entity on imaging is usually difficult.Contrast enhanced computed tomography reveals doubtful enhancement around the calcified partially exophytic mass with perirenal mild inflammatory stranding (arrow).On cut section, the right kidney contained a well-circumscribed 4 cm × 4 cm, grayish-yellow tumor with areas of calcification [Figure 3]. Figure 3: 32-year-old male with left flank pain and gross hematuria diagnosed with renal medullary fibroma.There was no evidence of renal vein or venacaval extension and no obvious lymphadenopathy. Right renal cell carcinoma (RCC) was suspected and patient underwent laparoscopic right radical nephrectomy.Figure 1: 32-year-old male with left flank pain and gross hematuria diagnosed with renal medullary fibroma.

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