Bilateral massive renal angiomyolipoma concurrent with oncocytoma in tuberous sclerosis complex associated with pulmonary lymphangioleiomyomatosis

High-Resolution Ultrasonography of Renal Oncocytoma Presenting with Symptomatic Hematuria and Urinary Bladder Clot Retention-A Rare Occurrence

Renal oncocytomas are asymptomatic, benign tumors often encountered incidentally on various imaging modalities. Renal oncocytomas comprise 5–7% of primary renal neoplasms and are derived from cells of the distal renal tubule. We present a case report of renal oncocytoma in a 22-year-old male having right-sided flank pain and symptomatic gross hematuria with a giant urinary bladder clot retention. The tumor was excised, and the patient underwent laparoscopic partial nephrectomy. Typical features of renal oncocytoma were observed upon histopathological examination of the resected specimen. The patient was catheterized, and bladder irrigation with clot retraction was performed.

Clinical features of lymphangioleiomyomatosis complicated by renal angiomyolipomas

OBJECTIVE

Renal angiomyolipomas (R-AMLs) are major complications of lymphangioleiomyomatosis (LAM). The objective of this study was to better understand the influence of R-AMLs in patients with LAM on the prognosis and other clinical factors related to respiration, and to investigate the management of R-AMLs in patients with LAM.

PATIENTS AND METHODS

We retrospectively investigated the clinical features of 7 patients with LAM [4 were TSC (Tuberous sclerosis complex)-LAM and 3 were S (sporadic)-LAM] complicated by R-AMLs admitted to our hospital from 1997 to 2008.

RESULTS

All patients were females and the mean age at diagnosis of LAM was 40.7 years (31.7 years for TSC-LAM and 52.7 years for S-LAM). Although 5 patients had symptoms related to R-AMLs, only 1 patient experienced symptoms related to R-AMLs at the time of diagnosis. Five patients had bilateral and 2 patients had unilateral R-AMLs. R-AMLs ruptured in 4 cases (3 patients were TSC-LAM) including 2 patients in whom they ruptured bilaterally, and who underwent bilateral nephrectomy. In 1 case, unilateral R-AMLs grew larger and appeared on the other side during the follow-up period.

CONCLUSION

Although only rare cases of LAM show symptoms related to R-AMLs initially, R-AMLs are a notable complication. To avoid nephrectomy, R-AMLs should be diagnosed when they are small and should be followed up carefully by periodic echograms or CT scans.