Renal masses containing macroscopic fat traditionally are pathognomonic for angiomyolipoma, a benign tumour. We describe two cases contrary to this axiom, the first being initially referred for angioembolisation, but subsequently biopsied when it was angiographically occult, whilst the second case showed a small macroscopic fat component and arterial enhancement prompting biopsy. Neither of these two cases demonstrated calcification which would usually suggest a more sinister lesion requiring further workup. The results demonstrated renal cell carcinoma for both lesions. Our multidisciplinary meeting approach to renal masses with a small amount of macroscopic fat and no calcifications has now changed.