Wunderlich Syndrome in a Patient With Coexisting Giant Angiomyolipoma and Multicystic Clear Cell Renal Cell Carcinoma: A Case Report.

Angiomyolipoma (AML) is a benign mesenchymal renal neoplasm composed of dysmorphic blood vessels, smooth muscle cells, and adipose tissue. Although most AMLs are asymptomatic and incidentally detected, large tumors may present with spontaneous hemorrhage resulting in Wunderlich syndrome (WS), a rare urological emergency characterized by spontaneous nontraumatic renal bleeding. Renal cell carcinoma (RCC), on the other hand, is the most common malignant epithelial tumor of the kidney. The synchronous occurrence of AML and RCC within the same kidney is rare. We report the case of a 64-year-old woman who presented with acute left flank pain, hypotension, anemia, and a palpable abdominal mass. Imaging revealed a giant hemorrhagic AML arising from the upper pole of the left kidney with associated hemoperitoneum. Following resuscitation, the patient underwent emergency radical left nephrectomy. Histopathological examination demonstrated a ruptured giant AML along with an incidentally detected multicystic clear cell RCC. Immunohistochemistry confirmed the diagnoses with HMB45 positivity in AML and CD10, CK7, and PAX8 positivity in RCC. This case highlights the rare coexistence of AML and RCC in the same kidney and emphasizes the importance of careful pathological evaluation in patients presenting with hemorrhagic renal masses. Early recognition and prompt surgical intervention are essential for favorable outcomes in WS.