1
|
Al Ahmad Y, Dardeer KT, Abo Daken AW. Partial nephrectomy without prior arterial embolization in a case of giant renal angiomyolipoma. Int J Surg Case Rep 2024; 123:110182. [PMID: 39191158 DOI: 10.1016/j.ijscr.2024.110182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE This is a case of giant renal angiomyolipoma treated with partial nephrectomy without pre-embolization of the supplying arteries. CASE PRESENTATION The patient presented for regular checkup, a mass in the left flank was found on examination. No other symptoms were present. No history of medical or surgical importance was found. CLINICAL DISCUSSION CT scan revealed a heterogenous mass in the left kidney at the upper pole. The treatment options were discussed with the patient and he opted for complete removal of the mass. Partial nephrectomy was done without pre embolization of the arteries. The procedure went without complications, the blood loss was manageable during the operation (200 cc). The patient was admitted for 48 h post operation and was discharged shortly after. The excised mass was sent for histopathological examination, the report was received, the features of the mass was consistent with angiomyolipoma without other types of malignant masses present. CONCLUSION The takeaway is that partial nephrectomy provides a convenient option for treatment of giant renal angiomyolipomas. Preservation of the renal function, reduction of the recurrence risk or re embolization of the supplying arteries makes it a viable alternative for other treatment modalities.
Collapse
Affiliation(s)
- Yamen Al Ahmad
- Urology Department, Faculty of medicine, Damascus University, Syria.
| | | | - Akram Wafiq Abo Daken
- Head of emergency and inpatient department, Faculty of medicine, Damascus University, Syria
| |
Collapse
|
2
|
Mao J, Wei K, Yang S, Wang C, Hu L. Giant renal angiomyolipomas with spontaneous hemorrhage associated with tuberous sclerosis complex during pregnancy. Arch Gynecol Obstet 2024:10.1007/s00404-024-07641-9. [PMID: 38987457 DOI: 10.1007/s00404-024-07641-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 07/05/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Jin Mao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Kai Wei
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Siyu Yang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Ling Hu
- Department of Ultrasound in Medicine, Hangzhou Women's Hospital, Hangzhou, Zhejiang, China.
| |
Collapse
|
3
|
Goedken AM, Ismail WW, Barrett LDG, Harshman LA. Kidney transplantation in patients with tuberous sclerosis complex. Pediatr Transplant 2024; 28:e14765. [PMID: 38778713 PMCID: PMC11125526 DOI: 10.1111/petr.14765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a disorder of the mammalian target of the rapamycin (mTOR) pathway associated with the development of multisystem tumors, including renal angiomyolipoma (AML). These renal tumors are benign by nature but locally invasive and carry a risk for the progression of chronic kidney disease (CKD) to end stage kidney disease (ESKD). The frequency of subsequent renal transplantation in this population is largely uncharacterized, although single-center data suggests that 5%-15% of adult TSC patients are kidney transplant recipients. METHODS This retrospective cohort study utilized United Network for Organ Sharing (UNOS) data. We included candidates waitlisted between 1987 and 2020 for a first kidney transplant with TSC-associated kidney failure. We utilized descriptive statistics to characterize the frequency of first-time kidney transplant waitlisting and transplantation among persons with TSC and the Fine-Gray subdistribution hazard model to evaluate characteristics associated with progression from waitlist. RESULTS We identified 200 TSC-associated kidney failure patients within the waitlist cohort. Of these, 12 were pediatric patients. Two-thirds (N = 134) of waitlisted persons were female. One hundred forty patients received a transplant with a median waitlist time of 2 years. Younger age at waitlisting was associated with a greater probability of progressing to transplant (HR 0.98 [95% CI: 0.96-0.99]). 91.8% of kidney transplant recipients survived 1-year post-transplant with a functioning allograft. CONCLUSIONS The majority of patients with TSC who are waitlisted for a kidney transplant progress onto transplantation with excellent 1-year post transplant patient and allograft survival.
Collapse
Affiliation(s)
- Amber M. Goedken
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Wesam W. Ismail
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA
| | - Lucas DG Barrett
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
- Medical Scientist Training Program, University of Iowa Carver College of Medicine; Iowa City, IA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Lyndsay A. Harshman
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine; Iowa City, IA
| |
Collapse
|
4
|
Kluiving MW, Peeters EFHI, Lely TA, van Oorschot N, de Ranitz-Greven WL. The effect of pregnancy on renal angiomyolipoma; a world of knowledge to gain, specifically in women with TSC. BMC Nephrol 2024; 25:113. [PMID: 38519911 PMCID: PMC10960455 DOI: 10.1186/s12882-024-03483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Women are counseled preconceptionally about the potential risks of rAML progression and chance of complications during and due to pregnancy. However, a systematic search investigating the evidence on which this advice is based does not exist. The aim of this systematic review is to determine the effect of pregnancy on renal angiomyolipoma (rAML) size and risk of haemorrhage in patients with tuberous sclerosis complex (TSC). METHODS We searched PubMed, EMBASE, Medline and ClinicalTrials.gov using terms for "renal angiomyolipoma" and "pregnancy". English-language articles published between January 1st 2000, and December 31st 2020 of which full-text was available were included. The initial search resulted in 176 articles. After the screening process we included 45 case reports and 1 retrospective study. For the retrospective study we assessed the risk of bias using the Newcastle-Ottawa Scale. We included articles about renal AML and pregnancy with and without an established diagnosis of TSC. From these articles we recorded the rAML sizes and rAML complications. RESULTS Seven case reports, from a total of 45 case reports, provided follow-up data on renal AML size (these were all cases of renal AML without a known diagnosis of TSC). Of these cases, renal AML size decreased in one patient, was stable in one patient, increased in three patients and fluctuated in two others. Renal AML size of women who suffered a haemorrhage were significantly larger (12.1 ± 4.6 cm) than rAMLs of women who did not suffer a haemorrhage (8.3 ± 3.2 cm). Data from the retrospective study showed no difference in renal complications between the women with and without a history of pregnancy. Haemorrhage occurred in 30% of the women with a history of pregnancy (n = 20) and in 11% in the patients without a history of pregnancy (n = 2), however this retrospective study had methodological limitations. CONCLUSION The effect of pregnancy on renal AML size and complications in patients with TSC is unclear. More research is needed to determine the risk of pregnancy on TSC-associated kidney disease in TSC patient.
Collapse
Affiliation(s)
- Marlou W Kluiving
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Evelien F H I Peeters
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Titia A Lely
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek van Oorschot
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wendela L de Ranitz-Greven
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
5
|
Almazedi B, Stubbs C. Renal angiomyolipoma: from imaging to intervention. Clin Radiol 2024; 79:25-32. [PMID: 37925365 DOI: 10.1016/j.crad.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 11/06/2023]
Abstract
A high volume of cross-sectional imaging has created a window of opportunity for radiologists to identify renal angiomyolipomas (AMLs). The purpose of this review is to help the reader recognise the spectrum of renal AML appearances using different imaging methods and to gain an understanding of the classic and atypical features for appropriate lesion characterisation. Risk factors for AML growth and rupture will be highlighted. An overview of the imaging features of acute AML rupture will be provided, principally relating to computed tomography (CT) assessment. A series of cases will be presented, including a case of peripartum renal AML rupture during Caesarean section leading to diagnostic dilemma. The indications for intervention and available treatment options will be considered: medical therapy, surgery, and interventional radiology (IR) techniques including their pros and cons. Emergency interventional radiology management with selective transarterial embolisation will be presented and analysed in relation to technique, angiographic appearances (pre and post embolisation) and associated complications.
Collapse
Affiliation(s)
- B Almazedi
- Department of Radiology, York Teaching Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK.
| | - C Stubbs
- Department of Radiology, York Teaching Hospital, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| |
Collapse
|
6
|
Toei H, Zhang X, Seyama K, Yashiro D, Kuwatsuru Y, Kuwatsuru R. Prophylactic renal artery embolization before pregnancy in patients with lymphangioleiomyomatosis and renal angiomyolipoma. J Int Med Res 2022; 50:3000605221123897. [PMID: 36124884 PMCID: PMC9500266 DOI: 10.1177/03000605221123897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Pregnant patients with lymphangioleiomyomatosis (LAM) and renal angiomyolipomas (AMLs) require care for both renal AMLs and pulmonary dysfunction because AMLs can grow and rupture during pregnancy, potentially causing hemorrhagic shock and fetal death. This study examined whether prophylactic transcatheter arterial embolization (TAE) could prevent the pregnancy-associated growth and rupture of renal AMLs in patients with LAM. METHODS This retrospective study included five women with 14 renal AMLs (initial diameter, ≥2 cm) first encountered between September 2010 and August 2015 who subsequently became pregnant. Seven tumors in five patients were embolized, and seven tumors in two patients were not treated. Changes in the volume of each tumor were evaluated. RESULTS Untreated tumors were much more likely to grow than embolized tumors both during pregnancy (100% vs. 0%) and at the first follow-up visit after delivery (100% vs. 14%). One untreated hypervascular tumor grew rapidly during pregnancy to 409% of the pretreatment volume. No tumor ruptured. CONCLUSIONS Prophylactic pre-pregnancy TAE decreased the growth and bleeding of renal AMLs during pregnancy in patients with LAM. TAE can be recommended for hypervascular tumors before pregnancy regardless of the size of the aneurysm.
Collapse
Affiliation(s)
- Hiroshi Toei
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Xixi Zhang
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan.,Department of Ultrasound, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Kuniaki Seyama
- Division of Respiratory Medicine, School of Medicine and Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Daisuke Yashiro
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Yoshiki Kuwatsuru
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, 2-1-1 Hongo Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
7
|
Diagnostic and Prognostic Impact of Progesterone Receptor Immunohistochemistry: A Study Evaluating More Than 16,000 Tumors. Anal Cell Pathol (Amst) 2022; 2022:6412148. [PMID: 35992051 PMCID: PMC9381849 DOI: 10.1155/2022/6412148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
Progesterone receptor (PR) is a member of the nuclear/steroid hormone receptor family of ligand-dependent transcription factors. It plays an important role in reproduction and mammary gland development and has various tissue-specific effects in nonreproductive organs. In diagnostic pathology, positive PR immunostaining is used to support a diagnosis of breast or gynecologic origin in a tumor. In this study, the expression of PR was analyzed by immunohistochemistry in 18,176 (interpretable: 16,445) samples from 147 different tumor types and subtypes in a tissue microarray format. PR immunostaining was detected in 57.4% of breast tumors, 28.6% of other gynecological tumors, and 1.8% of nongynecological and nonmammary tumors. Among the group of nongynecological and nonmammary tumors, particularly high rates of PR positivity were seen in neuroendocrine tumors (54.3%) and neuroendocrine carcinomas (35.7%) of the pancreas. A comparison with clinico-pathological parameters showed that reduced PR immunostaining was significantly associated with adverse histopathological and clinical features in breast carcinoma, endometrioid endometrial carcinoma, and pancreatic neuroendocrine tumors. In summary, our analysis of 147 different tumor types for PR immunostaining provides a ranking list of tumor entities according to their prevalence of PR positivity, helps to better understand the diagnostic utility of PR, and highlights the distinct PR positivity among neuroendocrine neoplasms of pancreatic origin.
Collapse
|
8
|
Barton JC, Cary BP, Frederickson RM. Polycythemia Rubra Vera and Sporadic Bilateral Renal Angiomyolipomas: A Case Report. Cureus 2022; 14:e24030. [PMID: 35573506 PMCID: PMC9093061 DOI: 10.7759/cureus.24030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 11/20/2022] Open
Abstract
Polycythemia rubra vera (PRV) is a clonal myeloproliferative neoplasm characterized by autonomous production of erythrocytes, neutrophils, and platelets. Angiomyolipomas (AMLs) are benign renal perivascular epithelioid cell neoplasms of which approximately 80% are sporadic. Here, we report synchronous diagnoses of PRV and asymptomatic sporadic bilateral renal AMLs in a 71-year-old woman. We describe her treatment with phlebotomy and hydroxyurea for PRV and surveillance for renal AMLs. We compare the features and treatment of the present case with those of two previously reported women who also had PRV and sporadic renal AMLs. Finally, we discuss the management and acquired genetic basis of both neoplasms.
Collapse
|
9
|
Takemoto G, Seki T, Takegami Y, Osawa Y, Makida K, Ochiai S, Ishizuka S, Suzuki K, Hasegawa Y, Imagama S. The development of knee osteoarthritis and serum carotenoid levels among community-dwelling people in Japan. Mod Rheumatol 2022; 32:205-212. [PMID: 33719826 DOI: 10.1080/14397595.2021.1900030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Carotenoids are plant pigments found in many vegetables, functioning as antioxidants scavenging singlet molecular oxygen and peroxyl radicals. No longitudinal study exists on the relationship between carotenoids and knee osteoarthritis (KOA) development. We aimed to determine the incidence of KOA development for 10 years in community-dwelling people in Japan and assess its association with serum carotenoids. METHODS Data of 440 participants (174 men, 266 women) with health-screening records for at least 10 years were analysed. We defined KOA development as advancing from K/L grade 0/1 at the initial check-up to grade ≥2 in a unilateral knee during a 10-year follow-up period. Serum carotenoid levels were measured using high-performance liquid chromatography. We used the Cox hazard model for multivariate analysis and investigated each carotenoid's impact on KOA development. RESULTS KOA developed in 33.4% of patients; the annual KOA development rate was significantly higher among women than among men (p < .01; 3.4% vs. 1.6%). Among the carotenoids measured, only retinol was associated with KOA development in women using multivariable analysis. KOA development was not associated with any carotenoids in men. CONCLUSION The annual rate of KOA development was higher in women, and retinol was associated with KOA development in women.
Collapse
Affiliation(s)
- Genta Takemoto
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Taisuke Seki
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yusuke Osawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Makida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Ochiai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Ishizuka
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Suzuki
- Department of Preventive Medical Sciences, Fujita Health University School of Medical Sciences, Toyoake, Japan
| | - Yukiharu Hasegawa
- Department of Rehabilitation, Kansai University of Welfare Sciences, Kashihara, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
10
|
Lim SS, Abdul Muien MZ, Aeria SD, Ng CY, Teh YG. Missed tuberous sclerosis complex with multi-system complications in a single patient. Radiol Case Rep 2021; 17:27-31. [PMID: 34765054 PMCID: PMC8569439 DOI: 10.1016/j.radcr.2021.09.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by widespread clinical manifestations. Early diagnosis is usually possible when typical TSC related skin lesions and neurologic presentations are detected in young patients. Undiagnosed TSC patients are at increased risk of morbidity and mortality as disease progression will inevitably lead to complications. While case reports of single complications in pediatric patients have been documented, to the best of our knowledge, multi-system complications of TSC in adults have yet to be reported in the literature. We present a case of tuberous sclerosis diagnosed in adulthood with complications involving the central nervous, renal and respiratory systems. This case highlights the need for a multidisciplinary approach in the management of TSC as well as the role of imaging in both diagnosis and intervention.
Collapse
Affiliation(s)
- Shu Syi Lim
- Department of Radiology, Sabah Women & Children's Hospital, 88400 Kota, Kinabalu
| | | | - Shaun Darren Aeria
- Department of Radiology, Sabah Women & Children's Hospital, 88400 Kota, Kinabalu
| | - Chiak Yot Ng
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, 88400 Kota, Kinabalu
| | - Yong Guang Teh
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, 88400 Kota, Kinabalu
| |
Collapse
|
11
|
Kruseová J, Gottfriedová B, Zichová A, Švojgr K, Hošek P, Lukš A, Kynčl M, Eckschlager T. Is There a Higher Incidence of Sporadic Renal Angiomyolipoma in Childhood Cancer Survivors? Clin Epidemiol 2021; 13:707-716. [PMID: 34408499 PMCID: PMC8364828 DOI: 10.2147/clep.s317903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022] Open
Abstract
Background Cancer treatment can cause various long-term side effects, including those that impact ultrasound findings. During follow-up of childhood cancer survivors (CCSs), we often detected sporadic renal angiomyolipomas without histological confirmation (SAMLs), which is why we initiated this study. We compared the occurrence of SAML in CCSs to the previously reported data from a non-cancer population and correlated SAML with cancer treatment-related factors. Methods The cohort included 1098 CCSs (median age at cancer diagnosis (dg) 4.3 years) who had ultrasound follow-up (2014-2019). Of the CCSs, 525 (48%) were female, 132 (12%) had subsequent neoplasms (SNs), and 110 (10%) had genetic syndromes. CCSs were treated for lymphomas 269 (24%) and solid tumors 829 (76%). None of the CCSs had tuberous sclerosis complex (TSC). Results SAML developed in 48 (4.4%) CCSs; of these, 20 (42%) had SNs. The coincidence of SAMLs and SNs was found in CCSs with a follow-up period exceeding 20 years. The median age at SAML dg was 27.9 years (interquartile range (IQR) 22.3-34.1), and the median time to SAML dg was 22.6 years (IQR 17.4-27.6). Twenty-one (44%) CCSs developed multiple or bilateral SAMLs lesions; of these, six (12%) were in the radiotherapy field. SAML occurrence correlated with radiotherapy of the retroperitoneum (1.65-fold higher with 95% CI 0.90-3.02). The correlations with other cancer treatment factors and with female sex were less clear. Conclusion This study revealed the occurrence of SAMLs in CCSs to be 10 times higher than that in non-cancer studies. The current characteristics of CCSs with SAMLs: younger age, and more bilateral or multiple lesions are more similar to TSC associated angiomyolipoma. Moreover, we observed a coincidence of SAMLs with SNs. Our results support the hypothesis that SAML development in CCSs is not simply a late effect of therapy, and indicates other factors are involved in SAML development.
Collapse
Affiliation(s)
- Jarmila Kruseová
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Barbora Gottfriedová
- Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Andrea Zichová
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Karel Švojgr
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Petr Hošek
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Aleš Lukš
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Martin Kynčl
- Department of Radiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Tomáš Eckschlager
- Department of Paediatric Haematology and Oncology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| |
Collapse
|
12
|
Abdelwahab EMM, Bovari-Biri J, Smuk G, Harko T, Fillinger J, Moldvay J, Krymskaya VP, Pongracz JE. Normalization of Enzyme Expression and Activity Regulating Vitamin A Metabolism Increases RAR-Beta Expression and Reduces Cellular Migration and Proliferation in Diseases Caused by Tuberous Sclerosis Gene Mutations. Front Oncol 2021; 11:644592. [PMID: 34178631 PMCID: PMC8226169 DOI: 10.3389/fonc.2021.644592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Mutation in a tuberous sclerosis gene (TSC1 or 2) leads to continuous activation of the mammalian target of rapamycin (mTOR). mTOR activation alters cellular including vitamin A metabolism and retinoic acid receptor beta (RARβ) expression. The goal of the present study was to investigate the molecular connection between vitamin A metabolism and TSC mutation. We also aimed to investigate the effect of the FDA approved drug rapamycin and the vitamin A metabolite retinoic acid (RA) in cell lines with TSC mutation. Methods Expression and activity of vitamin A associated metabolic enzymes and RARβ were assessed in human kidney angiomyolipoma derived cell lines, primary lymphangioleiomyomatosis (LAM) tissue derived LAM cell lines. RARβ protein levels were also tested in primary LAM lung tissue sections. TaqMan arrays, enzyme activities, qRT-PCRs, immunohistochemistry, immunofluorescent staining, and western blotting were performed and analysed. The functional effects of retinoic acid (RA) and rapamycin were tested in a scratch and a BrDU assay to assess cell migration and proliferation. Results Metabolic enzyme arrays revealed a general deregulation of many enzymes involved in vitamin A metabolism including aldehyde dehydrogenases (ALDHs), alcohol dehydrogenases (ADHs) and Cytochrome P450 2E1 (CYP2E1). Furthermore, RARβ downregulation was a characteristic feature of all TSC-deficient cell lines and primary tissues. Combination of the two FDA approved drugs -RA for acute myeloid leukaemia and rapamycin for TSC mutation- normalised ALDH and ADH expression and activity, restored RARβ expression and reduced cellular proliferation and migration. Conclusion Deregulation of vitamin A metabolizing enzymes is a feature of TSC mutation. RA can normalize RARβ levels and limit cell migration but does not have a significant effect on proliferation. Based on our data, translational studies could confirm whether combination of RA with reduced dosage of rapamycin would have more beneficial effects to higher dosage of rapamycin monotherapy meanwhile reducing adverse effects of rapamycin for patients with TSC mutation.
Collapse
Affiliation(s)
| | - Judit Bovari-Biri
- Departments of Pharmaceutical Biotechnology, University of Pecs, Pecs, Hungary.,Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| | - Gabor Smuk
- Department of Pathology, University of Pecs, Pecs, Hungary
| | - Tunde Harko
- Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Janos Fillinger
- Department of Pathology, Semmelweis University, Budapest, Hungary.,Department of Pulmonology, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Judit Moldvay
- Department of Pathology, Semmelweis University, Budapest, Hungary.,Department of Pulmonology, National Koranyi Institute of Pulmonology, Budapest, Hungary
| | - Vera P Krymskaya
- Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Judit E Pongracz
- Departments of Pharmaceutical Biotechnology, University of Pecs, Pecs, Hungary.,Szentagothai Research Centre, University of Pecs, Pecs, Hungary
| |
Collapse
|
13
|
Vaggers S, Rice P, Somani BK, Veeratterapillay R, Rai BP. Evidence-based protocol-led management of renal angiomyolipoma: A review of literature. Turk J Urol 2021; 47:S9-S18. [PMID: 32966208 PMCID: PMC8057360 DOI: 10.5152/tud.2020.20343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/30/2020] [Indexed: 11/22/2022]
Abstract
Renal angiomyolipomas (R-AMLs) are rare benign tumors, which occur sporadically and in association with genetic conditions such as tuberous sclerosis complex (TSC) and lymphangioleiomyomatosis (LAM). The key clinical concern is life-threatening hemorrhage. There is uncertainty about the optimal management strategy for patients with R-AMLs. We aim to review the evidence and provide a protocolled approach for the management of R-AMLs. A literature search of R-AML was conducted using MEDLINE and EMBASE for articles published between January 1990 and March 2020. Patient with TSC and sporadic cases were included. Treatment strategies, including active surveillance, surgery, selective arterial embolization (SAE), ablation, and systemic therapies, were reviewed. Outcomes from contemporary case series of active surveillance, surgery, and SAE were collated. There were no randomized controlled trials on this topic. The retrospective case series reviewed showed that many R-AMLs can be managed safely with active surveillance. Tumor size is the most important predictor of bleeding, and other factors such as rate of growth, women of child-bearing age, aneurysm size, and symptoms should be considered when deciding on prophylactic treatment. There is limited evidence for the traditional 4-cm cutoff for treatment, which may lead to overtreatment. The primary intervention options are SAE and surgery; whereas SAE is a less invasive option, nephron sparing surgery offers a lower risk of recurrence. Both appear to have similar morbidity, and the current evidence does not recommend one over the other in most cases. Thermal ablation has promising results but has only been trialed in small case series. Patients with TSC can be offered mammalian target of rapamycin inhibitors of which everolimus appears to cause the greatest shrinkage of tumors with an acceptable side-effect profile. R-AMLs should be assessed for their risk of bleeding. Low-risk tumors should be treated with active surveillance. High-risk tumors should be treated with SAE or surgery. Systemic treatments are the first-line of treatment for patients with TSC to preserve renal parenchyma.
Collapse
Affiliation(s)
- Sophie Vaggers
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Patrick Rice
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Bhaskar K. Somani
- Urological Surgery Department, University Hospital Southampton NHS Trust, Southampton, UK
| | - Rajan Veeratterapillay
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Bhavan P. Rai
- Department of Urology, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| |
Collapse
|
14
|
Guo Y, Kapoor A, Cheon P, So AI, Lattouf JB, Jamal M. Canadian Urological Association best practice report: Diagnosis and management of sporadic angiomyolipomas. Can Urol Assoc J 2020; 14:E527-E536. [PMID: 33213697 DOI: 10.5489/cuaj.6942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Yanbo Guo
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Anil Kapoor
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Paul Cheon
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Baptiste Lattouf
- Departments of Surgery and Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Munir Jamal
- Division of Urology, Department of Surgery, Trillium Health Partners, Mississauga, ON, Canada
| |
Collapse
|
15
|
Liu Z, Zou Y, Lv T, Guan H, Fan Z. Spontaneous rupture of enormous renal angiomyolipoma in a pregnant tuberous sclerosis patient: a rare case. BMC Nephrol 2020; 21:455. [PMID: 33129297 PMCID: PMC7603716 DOI: 10.1186/s12882-020-02124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/26/2020] [Indexed: 11/12/2022] Open
Abstract
Background Renal angiomyolipoma (RAML) is a rare benign kidney tumour comprised of adipose tissue, smooth muscle, and blood vessels. It can cause fatal complications if it ruptures. Although there have been reports of RAMLs rupturing, it is unusual to see RAMLs rupture during pregnancy, especially in pregnant women with tuberous sclerosis (TSC). Moreover, we reported a rare complication after selective arterial embolization (SAE) for the first time, which called aseptic liquefaction necrosis. Case presentation The case is a 16-week-pregnant woman with TSC who presented with severe flank pain, which was secondary to the rupture of a large, previously unknown RAML. This was confirmed by emergency computed tomography and successfully treated with selective arterial embolization after the patient received counselling and provided prior informed written consent for medical termination of pregnancy (MTP). The patient underwent abortion 3 weeks after the SAE. The patient required drainage 2 months after the SAE because of aseptic liquefaction necrosis. During follow-up, the patient’s lesion remained stable. Conclusion RAML rupture is a rare but rather serious complication in pregnant tuberous sclerosis patients. Selective arterial embolization (SAE) should be performed immediately, and the status of the pregnancy needs to be assessed by a multidisciplinary team. We also report for the first time the rare complication of aseptic liquefaction necrosis after SAE of RAML, for which percutaneous drainage is effective.
Collapse
Affiliation(s)
- Zechuan Liu
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Yinghua Zou
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China.
| | - Tianshi Lv
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Haitao Guan
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| | - Zeyang Fan
- Department of Interventional and Vascular Surgery, Peking University First Hospital, Beijing, China
| |
Collapse
|
16
|
Hyodo T, Kono K, Nishi S, Itoh T, Hara S. An Incidental Diagnosis of Microscopic Renal Angiomyolipoma Completely Excised on Renal Biopsy: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e921353. [PMID: 32172274 PMCID: PMC7092777 DOI: 10.12659/ajcr.921353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Female, 44-year-old Final Diagnosis: Angiomyolipoma Symptoms: Asymptomatic proteinuria Medication:— Clinical Procedure: — Specialty: Pathology
Collapse
Affiliation(s)
- Toshiki Hyodo
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Keiji Kono
- Department of Nephrology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shinichi Nishi
- Department of Nephrology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.,Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| |
Collapse
|
17
|
Hatano T, Egawa S. Renal angiomyolipoma with tuberous sclerosis complex: How it differs from sporadic angiomyolipoma in both management and care. Asian J Surg 2020; 43:967-972. [PMID: 31959574 DOI: 10.1016/j.asjsur.2019.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 12/14/2019] [Accepted: 12/27/2019] [Indexed: 01/25/2023] Open
Abstract
Renal angiomyolipoma (AML) is the most common benign tumor of the kidney. It consists of blood vessels, smooth muscle and fat components in varying proportions. AML is divided into the sporadic type and tuberous sclerosis complex (TSC)-associated type. TSC-associated AML develops at a younger age and tends to exhibit a much faster growth rate over time than sporadic AML. AMLs are classified as classic AML, fat-poor AML and epithelioid AML. Epithelioid AML, though rare, shows aggressive behavior leading to distant metastasis and mortality. TSC-associated AML is more likely to have an epithelioid component than sporadic AML. Active surveillance is the suggested management for small AML. Clinical intervention is mainly indicated when there is a substantial risk of rupture. Minimally invasive therapies, including partial nephrectomy, transcatheter arterial embolization, and mammalian target of rapamycin (mTOR) inhibitor treatment are employed for patients who require treatment. An updated algorithm for the management of AML is herein described. According to this algorithm, treatment intervention is recommended for TSC-associated AML >3 cm, even in asymptomatic cases. In cases with asymptomatic sporadic AML >4 cm in size or with an intra-tumoral aneurysm of >5 mm, treatment, including transcatheter arterial embolization or partial nephrectomy, is advised. The major complication of AML is intra-tumoral or retroperitoneal hemorrhage due to rupture that may be serious and life threatening. Thus, correct diagnosis, proper observation, and appropriate treatment are very important in the management of renal AML.
Collapse
Affiliation(s)
- Takashi Hatano
- Department of Urology, JR Tokyo General Hospital, Japan.
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Japan
| |
Collapse
|
18
|
Nerli RB, Ghagane SC, Kadeli V, Nutalpati S, Mohan S, Hiremath MB. Bleeding angiomyolipoma mimiking a ruptured adrenal tumour. Urol Case Rep 2019; 28:101031. [PMID: 31641611 PMCID: PMC6796711 DOI: 10.1016/j.eucr.2019.101031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/26/2019] [Accepted: 09/29/2019] [Indexed: 11/18/2022] Open
Abstract
Angiomyolipoma is a benign neoplasm of the kidney, and is the most common renal tumour associated with haemorrhage. Risk of bleeding increases with the size of the angiomyolipoma. We report a case of spontaneous bleeding from an upper polar renal angiomyolipoma mimicking a spontaneous adrenal bleed from a pheochromocytoma.
Collapse
Affiliation(s)
- R B Nerli
- Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, 590010, Karnataka, India.,KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010, Karnataka, India
| | - Shridhar C Ghagane
- Department of Urology, KLES Kidney Foundation, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Nehru Nagar, Belagavi, 590010, Karnataka, India
| | - Vishal Kadeli
- Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, 590010, Karnataka, India
| | - Shreeharsha Nutalpati
- Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, 590010, Karnataka, India
| | - Sham Mohan
- Department of Urology, JN Medical College, KLE Academy of Higher Education & Research (Deemed-to-be-University), JNMC Campus, Belagavi, 590010, Karnataka, India
| | - Murigendra B Hiremath
- Department of Biotechnology and Microbiology, Karnatak University, Dharwad, Karnataka, India
| |
Collapse
|
19
|
Ahn T, Roberts MJ, Navaratnam A, Chung E, Wood ST. Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818759367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4
Collapse
Affiliation(s)
- Thomas Ahn
- Department of Urology, Princess Alexandra Hospital, Australia
| | - Matthew J Roberts
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Clinical Research, The University of Queensland, Australia
| | | | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- AndroUrology Centre, Australia
| | - Simon T Wood
- Department of Urology, Princess Alexandra Hospital, Australia
- Faculty of Medicine, The University of Queensland, Australia
- Centre for Kidney Disease Research, Translational Research Institute, Australia
| |
Collapse
|
20
|
Ng TL, Chu RWH, Leung CLH, Chan WKW, Cho CL, Law IC, Kan CF, Ho LY, Au WH. Spontaneous rupture of renal angiomyolipoma during pregnancy: A report of two cases and literature review. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tsz-Leung Ng
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | | | | | | | - Chak-Lam Cho
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - In-Chak Law
- Department of Surgery; Kwong Wah Hospital; Hong Kong
| | - Chi-Fai Kan
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | - Lap-Yip Ho
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | - Wing-Hang Au
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| |
Collapse
|
21
|
Chan DL, Calder T, Lawson JA, Mowat D, Kennedy SE. The natural history of subependymal giant cell astrocytomas in tuberous sclerosis complex: a review. Rev Neurosci 2018; 29:295-301. [PMID: 29211682 DOI: 10.1515/revneuro-2017-0027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/11/2017] [Indexed: 11/15/2022]
Abstract
Tuberous sclerosis complex (TSC) is an auto-somal-dominant inherited condition with an incidence of approximately 1:6000 births, characterised by deregulated mTOR activity with multi-site hamartomas. Subependymal giant cell astrocytomas (SEGA) are one such hamartoma, affecting up to 24% of patients with TSC. Their intraventricular location may lead to life-threatening obstructive hydrocephalus. Current management is hampered by a lack of understanding regarding the natural history, behaviour and growth patterns of SEGA. We review the current literature to summarise what is known about SEGA in the following areas: (1) diagnostic criteria, (2) prevalence, (3) origin, (4) imaging characteristics, (5) growth rate, (6) genotype-phenotype correlation, (7) congenital SEGA and (8) SEGA as a marker of severity of other TSC manifestations.
Collapse
Affiliation(s)
- Denise L Chan
- Department of Neurology, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - Tessa Calder
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2000, Australia
| | - John A Lawson
- Department of Neurology, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| | - David Mowat
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, NSW 2000, Australia
| | - Sean E Kennedy
- Department of Neurology, Sydney Children's Hospital, Randwick, NSW 2031, Australia
| |
Collapse
|
22
|
Wang SF, Lo WO. Benign Neoplasm of Kidney: Angiomyolipoma. J Med Ultrasound 2018; 26:119-122. [PMID: 30283196 PMCID: PMC6159326 DOI: 10.4103/jmu.jmu_48_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/03/2018] [Indexed: 01/20/2023] Open
Abstract
Angiomyolipoma is one of the renal benign neoplasms. The most of the angiomyolipomas are asymptomatic and found incidentally with ultrasound. They are more prevalent in patients with tuberous sclerosis. It is very important to make differential diagnosis from other renal neoplasm such as renal cell carcinoma. Growth rate is higher among pregnant women suggest that the hormones may play a role in the stimulation of angiomyolipoma. The most common serious presentation is rupture and hemorrhage, and sometimes it can lead to shock. Adequate diagnosis, treatment, and follow-up are very important in the face of renal angiomyolipoma.
Collapse
Affiliation(s)
- Shih-Feng Wang
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Wah-On Lo
- Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| |
Collapse
|
23
|
Lee KH, Tsai HY, Kao YT, Lin HC, Chou YC, Su SH, Chuang CK. Clinical behavior and management of three types of renal angiomyolipomas. J Formos Med Assoc 2018; 118:162-169. [PMID: 29549981 DOI: 10.1016/j.jfma.2018.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/14/2018] [Accepted: 02/23/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES To analyze and present the demography, clinical behavior, especially the risk factors of tumor hemorrhage and management of sporadic angiomyolipoma (SAML), tuberous sclerosis complex associated angiomyolipoma (TSCAML) and epithelioid angiomyolipoma (EAML) in our institution. METHODS A retrospective study of 587 patients who were diagnosed with renal angiomyolipoma in our institution between January 2000 and May 2015 was done. The AMLs were diagnosed by ultrasonography, CT, or MRI. EAML was confirmed by histopathology. Medical records and follow-up results were analyzed using the SPSS version 22 software. RESULTS Out of 587 cases of renal AMLs, 87.4% were SAMLs, 8.7% were TSCAMLs and 3.9% were EAMLs. Most of the AML patients were asymptomatic. The most common presenting symptoms included flank pain and abdominal pain. The median tumor size of SAML, TSCAML, EAML were 4.7, 2.7, 10.5 cm respectively. Approximately half of SAMLs were conservatively treated, almost all TSCAMLs were treated conservatively, while all EAMLs were surgically treated. The median tumor size of hemorrhagic SAML cases was 8 cm versus non-hemorrhagic cases of 4.1 cm. The optimal cut-off point on the ROC curve for predicting SAML tumor hemorrhage was 7.35 cm. CONCLUSION A larger tumor size, younger patient's age and higher BMI value correlated with a higher risk of tumor hemorrhage. For tumor sizes less than 7.35 cm, we recommend active surveillance or TAE for hemorrhage prevention. We also suggest that surgical management should be considered for patients with tumors larger than 7.35 cm, symptomatic and progressive AML, or suspicious EAML.
Collapse
Affiliation(s)
- Kun-Han Lee
- Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No.5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| | - Han-Yu Tsai
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No.5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| | - Yu-Ting Kao
- Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No.5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| | - Hsin-Chia Lin
- Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No.5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| | - Yi-Chun Chou
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, No. 5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| | - Shih-Huan Su
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No.5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, No.5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
| |
Collapse
|
24
|
Watanabe EH, Neves PD, Balbo BE, Sampaio CA, Onuchic LF. Giant Renal Angiomyolipoma Following Ovarian Stimulation Therapy. Urology 2017; 112:e3-e4. [PMID: 29154983 DOI: 10.1016/j.urology.2017.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/23/2017] [Accepted: 10/28/2017] [Indexed: 11/17/2022]
Abstract
Renal angiomyolipomas (AMLs) are benign tumors with higher prevalence in women. Female hormones have been shown to induce AML enlargement. This case refers to a 40-year-old woman with 4 left kidney AMLs, the larger ones with 1.0 and 1.3 cm. Ten months after ovarian stimulation for egg harvesting, a computed tomography revealed an 18-cm AML with large-caliber vessels. Given her high risk of AML bleeding, the patient was submitted to selective arterial embolization, which turned out unsuccessful, supporting a plan of nephron-sparing surgery. Our case highlights the pro-growth effects of female hormones on AML, with particular emphasis to ovarian stimulation.
Collapse
Affiliation(s)
- Elieser H Watanabe
- Department of Medicine, Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Precil D Neves
- Department of Medicine, Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Bruno E Balbo
- Department of Medicine, Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Carlos A Sampaio
- Department of Medicine, Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Luiz F Onuchic
- Department of Medicine, Divisions of Nephrology and Molecular Medicine, University of São Paulo School of Medicine, São Paulo, Brazil.
| |
Collapse
|
25
|
Wang L, Ni D, Zhong L, Wang J. Familial genetic tuberous sclerosis complex associated with bilateral giant renal angiomyolipoma: A case report. Oncol Lett 2017; 14:7099-7106. [PMID: 29344140 PMCID: PMC5754900 DOI: 10.3892/ol.2017.7165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/09/2017] [Indexed: 11/06/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disease involving multiple organs, but there are a limited number of reports on family TSC. In the present report, a case of a 52-year-old female with a familial genetic TSC, associated with bilateral giant renal angiomyolipoma, was described. The mother, second elder brother and daughter of the patient all exhibited TSC, but the clinical manifestations, and therapeutic prognosis between the family members were not the same. The present case report aimed at identifying an effective diagnostic method and treatment through additional study of familial genetic TSC, in order to prolong and improve the quality of life for patients with TSC. According to the present case and relevant literature reviews, it is suggested that fetal gene detection during pregnancy could prevent the passing of this disease onto further generations. Furthermore, early application of drug treatment may control the development of the disease in diagnosed patients. The combination of classical treatments with a small dose of mammalian target of rapamycin inhibitors is the typical recommendation, which may control the development of the disease more effectively and decrease adverse side-effects.
Collapse
Affiliation(s)
- Lina Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Dawei Ni
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Department of Urology, The Second People's Hospital of Hefei, Hefei, Anhui 230011, P.R. China
| | - Lin Zhong
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Jianbo Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| |
Collapse
|
26
|
The Role of Interventional Radiology Techniques in the Management of Renal Angiomyolipomas. Curr Urol Rep 2017; 18:36. [DOI: 10.1007/s11934-017-0687-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
27
|
Bardin F, Chevallier O, Bertaut A, Delorme E, Moulin M, Pottecher P, Di Marco L, Gehin S, Mourey E, Cormier L, Mousson C, Midulla M, Loffroy R. Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction. Quant Imaging Med Surg 2017; 7:8-23. [PMID: 28275556 DOI: 10.21037/qims.2017.01.02] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs. METHODS In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre- and post-procedure. RESULTS Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included. Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE. CONCLUSIONS SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.
Collapse
Affiliation(s)
- Florian Bardin
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Aurélie Bertaut
- Department of Epidemiology and Biostatistics, Georges François Leclerc Center, Dijon, France
| | - Emmanuel Delorme
- Department of Urology, Sainte Marie Private Hospital, Chalon-sur-Saône, France
| | - Morgan Moulin
- Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Pierre Pottecher
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Lucy Di Marco
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Sophie Gehin
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Eric Mourey
- Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Luc Cormier
- Department of Urology and Andrology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Christiane Mousson
- Department of Nephrology and Renal Transplantation, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Dijon School of Medicine, Dijon, France;; LE2I UMR CNRS 6306, Arts et Métiers, University of Bourgogne Franche-Comté, Dijon, France
| |
Collapse
|
28
|
Lucca I, Klatte T, Fajkovic H, de Martino M, Shariat SF. Gender differences in incidence and outcomes of urothelial and kidney cancer. Nat Rev Urol 2016; 12:585-92. [PMID: 26436686 DOI: 10.1038/nrurol.2015.232] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A gender discrepancy exists in the incidence of both urothelial and kidney carcinomas, with more men presenting with these cancers than women. Men have a threefold greater risk of developing bladder cancer than women, but female gender has been identified as an independent adverse prognostic factor for both recurrence and progression of this disease. In particular, women with bladder cancer are often diagnosed with a higher tumour stage than men. Conclusive data on the influence of gender on outcomes of patients with upper tract urothelial carcinoma are currently lacking, although men seem to have a higher disease incidence, whereas survival outcomes might be independent of gender. Patients with renal cell carcinoma are more often men and they typically have larger tumours and higher stage and grade disease than women with this cancer. Smoking habits, tumour biology, occupational risk factors and sex steroid hormones and their receptors could have a role in these observed gender disparities. The majority of data support the theory that gender influences incidence and prognosis of urothelial and kidney cancers; men and women are different genetically and socially, making the consideration of gender a key factor in the clinical decision-making process. Thus, the inclusion of this variable in validated prognostic tables and nomograms should be discussed as a matter of importance.
Collapse
Affiliation(s)
- Ilaria Lucca
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Harun Fajkovic
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Michela de Martino
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Währinger Gürtel 18-20, A-1090 Vienna, Austria
| |
Collapse
|
29
|
Flum AS, Hamoui N, Said MA, Yang XJ, Casalino DD, McGuire BB, Perry KT, Nadler RB. Update on the Diagnosis and Management of Renal Angiomyolipoma. J Urol 2015; 195:834-46. [PMID: 26612197 DOI: 10.1016/j.juro.2015.07.126] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Advances in minimally invasive therapies and novel targeted chemotherapeutics have provided a breadth of options for the management of renal masses. Management of renal angiomyolipoma has not been reviewed in a comprehensive fashion in more than a decade. We provide an updated review of the current diagnosis and management strategies for renal angiomyolipoma. MATERIALS AND METHODS We conducted a PubMed(®) search of all available literature for renal or kidney angiomyolipoma. Further sources were identified in the reference lists of identified articles. We specifically reviewed case series of partial nephrectomy, selective arterial embolization and ablative therapies as well as trials of mTOR inhibitors for angiomyolipoma from 1999 to 2014. RESULTS Renal angiomyolipoma is an uncommon benign renal tumor. Although associated with tuberous sclerosis complex, these tumors occur sporadically. Risk of life threatening hemorrhage is the main clinical concern. Due to the fat content, angiomyolipomas are generally readily identifiable on computerized tomography and magnetic resonance imaging. However, fat poor angiomyolipoma can present a diagnostic challenge. Novel research suggests that various strategies using magnetic resonance imaging, including chemical shift magnetic resonance imaging, have the potential to differentiate fat poor angiomyolipoma from renal cell carcinoma. Active surveillance is the accepted management for small asymptomatic masses. Generally, symptomatic masses and masses greater than 4 cm should be treated. However, other relative indications may apply. Options for treatment have traditionally included radical and partial nephrectomy, selective arterial embolization and ablative therapies, including cryoablation and radio frequency ablation, all of which we review and update. We also review recent advances in the medical treatment of patients with tuberous sclerosis complex associated angiomyolipomas with mTOR inhibitors. Specifically trials of everolimus for patients with tuberous sclerosis complex suggest that this agent may be safe and effective in treating angiomyolipoma tumor burden. A schema for the suggested management of renal angiomyolipoma is provided. CONCLUSIONS Appropriately selected cases of renal angiomyolipoma can be managed by active surveillance. For those patients requiring treatment nephron sparing approaches, including partial nephrectomy and selective arterial embolization, are preferred options. For those with tuberous sclerosis complex mTOR inhibitors may represent a viable approach to control tumor burden while conserving renal parenchyma.
Collapse
Affiliation(s)
- Andrew S Flum
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nabeel Hamoui
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mohammed A Said
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ximing J Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David D Casalino
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Barry B McGuire
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kent T Perry
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert B Nadler
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
30
|
Abstract
OBJECTIVE We review the imaging of renal angiomyolipomas, including differentiation of tuberous sclerosis complex (TSC)-associated and sporadic renal angiomyolipomas and other solid renal tumors. We also focus on radiologic interventions and molecular targeting of the TSC genetic pathway. CONCLUSION Imaging plays a central role in the diagnosis and management of renal angiomyolipomas. It provides essential information to make the best therapeutic decisions about the interventional and pharmacologic options to help prevent bleeding and preserve functional parenchyma.
Collapse
|
31
|
Grassia M, Romano A, Esposito G, Braccio B, Pezzella M, Rossetti ARR, Torelli F, Izzo G, Alfano R, Di Martino N. A rare case of Wunderlich syndrome five days after left hemicolectomy for colorectal cancer. Int J Surg Case Rep 2015; 16:33-6. [PMID: 26410804 PMCID: PMC4643345 DOI: 10.1016/j.ijscr.2015.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 08/02/2015] [Accepted: 09/05/2015] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Wunderlich syndrome (WS) is a surgical emergency characterized by spontaneous, non-traumatic retroperitoneal hemorrhage. Angiomyolipoma (AML), a benign mesenchymal tumor, is the most frequent cause of WS. We present a case of WS, appearance five days after a left hemicolectomy for cancer. PRESENTATION OF CASE A 66 years-old man with a sigmoid adenocarcinoma and a small left AML (3.4cm) was undergone to left hemicolectomy. He was subjected to bridging therapy with high doses of low-molecular-weight heparin for prosthetic replacement of heart valve secondary to endocarditis and atrial fibrillation. Five days after surgery he presents retroperitoneal hemorrhage due to rupture of AML diagnosed by a CT scan and scintigraphy with labeled red blood cells. Total left nephrectomy was performed as the patient became unstable. DISCUSSION Rupture of a renal AML is the main cause of WS. This risk increases with the size of the tumor (>4cm) and during pregnancy. CT scan is the best imaging modalities for diagnosis. The bridging therapy increases the perioperative bleeding risk. These patients are conservative treated with selective transarterial embolization. Nephrectomy is limited for the patients hemodynamically unstable or in case of failed embolization. CONCLUSION This is a unusual case of WS after surgery in patients with small AML and treated with high dose of anticoagulant for cardiac disease. There are no other similar cases in literature.
Collapse
Affiliation(s)
- Michele Grassia
- Department of General Surgery, Second University of Naples, Italy.
| | - Angela Romano
- Department of General Surgery, Second University of Naples, Italy.
| | | | | | | | | | | | - Giuseppe Izzo
- Department of General Surgery, Second University of Naples, Italy.
| | - Roberto Alfano
- Department of General Surgery, Second University of Naples, Italy.
| | | |
Collapse
|
32
|
Murray TE, Doyle F, Lee M. Transarterial Embolization of Angiomyolipoma: A Systematic Review. J Urol 2015; 194:635-9. [DOI: 10.1016/j.juro.2015.04.081] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy E. Murray
- Department of Radiology, Beaumont Hospital, and Division of Population and Health Sciences, Royal College of Surgeons in Ireland (FD), Dublin, Ireland
| | - Frank Doyle
- Department of Radiology, Beaumont Hospital, and Division of Population and Health Sciences, Royal College of Surgeons in Ireland (FD), Dublin, Ireland
| | - Michael Lee
- Department of Radiology, Beaumont Hospital, and Division of Population and Health Sciences, Royal College of Surgeons in Ireland (FD), Dublin, Ireland
| |
Collapse
|
33
|
Renal leiomyoma: a contemporary multi-institution study of an infrequent and frequently misclassified neoplasm. Am J Surg Pathol 2015; 39:349-56. [PMID: 25517956 DOI: 10.1097/pas.0000000000000354] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Renal leiomyoma is an exceptionally rare benign mesenchymal tumor of the kidney predominantly arising in proximity of the renal capsule or pelvis. Its rarity and nonspecific clinical and imaging features may lead to radical or partial nephrectomy on the basis of preoperative suspicion of renal cell carcinoma. The diagnosis of renal leiomyoma is challenging because of the histologic overlap with lipid-poor angiomyolipoma (AML). We conducted a multi-institution study to characterize renal leiomyoma in greater detail. We collected and reviewed 24 cases diagnosed initially as renal leiomyoma in 10 institutions from North America, Canada, and Europe. Immunohistochemical expression of desmin, HMB-45, estrogen receptor (ER), progesterone receptor (PR), and cathepsin K was evaluated. Upon central review, 9 tumors were classified as renal leiomyoma, whereas the remaining were reclassified as AML (n=13), myolipoma (n=1), and medullary fibroma (n=1). All renal leiomyomas were solitary and occurred in female patients (mean age 63 y; range, 44 to 74 y). Tumor size ranged from 0.6 to 7.0 cm (mean 2.9 cm); 7 originated from the renal capsule or the subcapsular area and 1 from a large vessel in the renal sinus. All leiomyomas were diffusely positive for desmin and negative for HMB-45 and cathepsin K; 6/9 (67%) showed diffuse ER and PR expression, and 1 case showed focal ER positivity only. Renal leiomyoma should be included in the histologic differential diagnosis of solid renal masses, particularly in perimenopausal women. The main differential diagnosis is with lipid-poor AML, and cathepsin K plays a key role in distinguishing these 2 lesions.
Collapse
|
34
|
Preece P, Mees B, Norris B, Christie M, Wagner T, Dundee P. Surgical management of haemorrhaging renal angiomyolipoma in pregnancy. Int J Surg Case Rep 2015; 7C:89-92. [PMID: 25598402 PMCID: PMC4336430 DOI: 10.1016/j.ijscr.2015.01.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 01/03/2015] [Accepted: 01/03/2015] [Indexed: 12/30/2022] Open
Abstract
We report the case of a 25-week pregnant woman that had a ruptured AML. This is the first case of nephrectomy in late second trimester with the foetus left in-utero. We present a literature review of the management of bleeding AML in pregnancy.
Introduction Renal angiomyolipoma (AML) is a benign mesenchymal tumour of the kidney with a tendency of aneurysm formation at risk of rupturing. Due to increased maternal circulation and hormonal influences, rupture risk is greater in pregnancy, often leading to a vascular emergency and premature delivery or termination. Presentation of case A 24-weeks pregnant woman (45 years old, G6P1) presented with haematuria and flank pain. CT showed AML with acute haemorrhage. The patient became haemodynamically unstable and underwent urgent embolisation and follow-on total radical nephrectomy with the foetus being left in-utero. This involved a multidisciplinary team (urologist, vascular surgeon, interventional radiologist and obstetrician). The procedure was uncomplicated and the pregnancy went to term with a healthy girl delivered at 38 weeks. Discussion The incidence of AML is 0.13% in the general population. 21 reports of haemorrhaging AML in pregnancy have been published in the last 35 years. Mean gestational age was 29.6 weeks. Eight were treated conservatively to term, one underwent exploratory laparotomy with evacuation of haematoma only, five were embolised, and seven were managed with nephrectomy. Of the nephrectomy subgroup, one was preceded by vaginal delivery and five underwent concurrent caesarean section (one with pre-op embolisation). There were two associated foetal deaths. Conclusion This case demonstrates that with a multidisciplinary approach, it is possible to successfully leave a foetus undelivered whilst performing a radical nephrectomy for a large bleeding AML in a woman carrying a late second trimester pregnancy.
Collapse
Affiliation(s)
- P Preece
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia.
| | - B Mees
- Department of Vascular Surgery, MUMC+, Maastricht, The Netherlands; Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - B Norris
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| | - M Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Melbourne, Australia
| | - T Wagner
- Department of Vascular Surgery, Royal Melbourne Hospital, Melbourne, Australia
| | - P Dundee
- Department of Urology, Royal Melbourne Hospital, Melbourne, Australia
| |
Collapse
|
35
|
Le P, Garg A, Brandao G, Abu-Sanad A, Panasci L. Hormonal manipulation with letrozole in the treatment of metastatic malignant pecoma. ACTA ACUST UNITED AC 2014; 21:e518-20. [PMID: 24940112 DOI: 10.3747/co.21.1849] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Perivascular epithelioid cell tumours (pecomas) are rare mesenchymal tumours. Some have a benign course; others metastasize. Treatment of malignant pecomas is challenging, and little is known about treatment for patients with metastatic disease. Here, we report a case of metastatic malignant pecoma with estrogen and progesterone receptor expression that showed a favourable and sustained response to letrozole.
Collapse
Affiliation(s)
- P Le
- Department of Medical Oncology, Jewish General Hospital (a McGill University affiliate), Montreal, QC
| | - A Garg
- Department of Medical Oncology, Jewish General Hospital (a McGill University affiliate), Montreal, QC
| | - G Brandao
- Department of Pathology, Jewish General Hospital (a McGill University affiliate), Montreal, QC
| | - A Abu-Sanad
- Department of Medical Oncology, Jewish General Hospital (a McGill University affiliate), Montreal, QC
| | - L Panasci
- Department of Medical Oncology, Jewish General Hospital (a McGill University affiliate), Montreal, QC
| |
Collapse
|
36
|
Prevalence of sporadic renal angiomyolipoma: a retrospective analysis of 61,389 in- and out-patients. ACTA ACUST UNITED AC 2014; 39:1009-13. [DOI: 10.1007/s00261-014-0129-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
37
|
Exacerbation and remission of pulmonary micronodules with lymphangioleiomyomatosis around the time of childbirth. Jpn J Radiol 2013; 31:633-6. [PMID: 23729367 DOI: 10.1007/s11604-013-0221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
Abstract
We present a case of multifocal micronodular pneumocyte hyperplasia (MMPH), lymphangiomyomatosis (LAM) and angiomyolipoma (AML) in a 33-year-old woman with tuberous sclerosis complex referred to us during her first pregnancy. Computed tomography of the chest showed diffuse micronodules and cysts in both lungs. Compared to those before pregnancy, the number of micronodules increased evidently. We hypothesized the micronodules in both lungs were either LAM, MMPH, or a combination of the two. Bilateral renal AML also intensified. About one month after childbirth, LAM and renal AML decreased without treatment. Therefore, we observed that LAM and AML were affected by the pregnancy. To the best of our knowledge, this is the first case report regarding the reversible alteration of LAM without treatment.
Collapse
|
38
|
Liu M, Xu YF, Feng Y, Zhai W, Che JP, Xia SQ, Wang GC, Zheng JH. Androgen-STAT3 activation may contribute to gender disparity in human simply renal cysts. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2013; 6:686-694. [PMID: 23573315 PMCID: PMC3606858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 02/22/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Simple renal cysts (SRC) are a common urological disease mostly in elderly, however the male-to-female ratio was 2.81. Androgen receptor (AR) activation was initially proposed as a vital signaling pathway in prostate cancer and consequent signal transducer and activator of transcription 3 (STAT3)-AR complex led an important putative mechanism by which prostate cells are sensitized with growth factor signals. However, in SRC disease, no related study emerged. METHODS 30 patients with SRC and 20 age-matched healthy controls were recruited. Puncture biopsy was performed to acquire cyst-adjacent kidney tissue and normal kidney tissues were from healthy kidney donor who received living-related donor nephrectomy. The expression of STAT3 and androgen receptor was determined by immunohistochemical staining and western blotting. The in-vitro effect of androgen on human HK-2 (an immortalized proximal tubule epithelial cell line from normal adult human kidney) cells' STAT3 expression was analyzed as well. RESULTS Activated STAT3 was strongly expressed in tubular epithelial cells from kidneys of SRC patients, while it was barely found in normal kidneys. Meanwhile, the androgen receptor positive cyst epithelial cells and adjacent normal renal tubule cells were observed in kidneys from SRC patients, however, AR was weakly expressed in normal healthy male kidneys, statistically significant differences existed. In-vitro experiment demonstrated that when treated with exogenous added androgen, the expression level of STAT3 in HK-2 cells was significantly elevated. CONCLUSIONS Our data raised the possible novel evidence that androgen-STAT3 activation might contribute to gender disparity in human SRC disease and clarification the esoteric mechanisms will provide us attractive therapy target for cystic kidney disease.
Collapse
Affiliation(s)
- Min Liu
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| | - Yun-Fei Xu
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| | - Yuan Feng
- Department of Nephrology, Nanjing University Affiliated Drum Tower HospitalNanjing, 210093, China
| | - Wei Zhai
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| | - Jian-Ping Che
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| | - Sheng-Qiang Xia
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| | - Guang-Chun Wang
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| | - Jun-Hua Zheng
- Department of Urology & Nephrology, Shanghai Tenth People’s Hospital, Tongji UniversityShanghai, 200072, China
| |
Collapse
|
39
|
Gender differences in benign renal masses. World J Urol 2013; 31:1051-7. [DOI: 10.1007/s00345-013-1032-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/24/2013] [Indexed: 01/10/2023] Open
|
40
|
Peces R, Cuesta-López E, Peces C, Selgas R. Giant bilateral renal angiomyolipomas and lymphangioleiomyomatosis presenting after two successive pregnancies successfully treated with surgery and rapamycin. ScientificWorldJournal 2011; 11:2115-23. [PMID: 22125460 PMCID: PMC3217590 DOI: 10.1100/2011/263137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 10/04/2011] [Indexed: 12/02/2022] Open
Abstract
We report the case of a 25-year-old woman who presented with abdominal and flank pain with two successive pregnancies and was diagnosed of giant bilateral renal AMLs and pulmonary LAM associated with TSC in the post-partum of her second pregnancy. This case illustrates that in women with TSC rapid growth from renal AMLs and development of LAM may occur with successive pregnancies. It also stresses the potential for preservation of renal function despite successive bilateral renal surgery of giant AMLs. Moreover, the treatment with a low-dose rapamycin may be an option for LAM treatment. Finally, a low-dose rapamycin may be considered as an adjuvant treatment together to kidney-sparing conservative surgery for renal AMLs.
Collapse
Affiliation(s)
- Ramón Peces
- Servicio de Nefrología, Hospital Universitario La Paz, IdiPAZ, 28046 Madrid, Spain.
| | | | | | | |
Collapse
|
41
|
Butte JM, Do RK, Shia J, Gönen M, D'Angelica MI, Getrajdman GI, Allen PJ, Fong Y, Dematteo RP, Klimstra DS, Jarnagin WR. Liver angiomyolipomas: a clinical, radiologic, and pathologic analysis of 22 patients from a single center. Surgery 2011; 150:557-67. [PMID: 21621235 DOI: 10.1016/j.surg.2011.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 03/22/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver angiomyolipomas (AML) are mesenchymal neoplasms with an uncertain clinical behavior. The spectrum of presentation, imaging and histologic features, and outcomes were analyzed in all patients treated at Memorial Sloan-Kettering Cancer Center. METHODS Demographics, disease, pathologic, treatment, and outcome-related variables for consecutive patients were reviewed retrospectively. All imaging studies obtained at presentation were reexamined, categorized, and compared using Fisher and Wilcoxon tests. RESULTS Between 1989 and 2010, 238 patients with AML were seen and 22 (9.3%) had liver involvement (exclusive = 17; combined with kidney = 5). The median age was 53 years; 18 were females, and 15 had symptoms. AML was not suspected at initial presentation in any patient. Fat-containing neoplasms on imaging were larger (P = .03), with more heterogeneous enhancement compared with fat-poor neoplasms (P = .001), but none of the imaging/histologic features correlated with outcome. Thirteen patients underwent resection (R0 = 9), 4 were observed, 2 received chemotherapy, 2 embolization, and 1 embolization plus intra-arterial chemotherapy. Two patients treated with R0-resection recurred and 2 treated with chemotherapy progressed, but no patient died of AML-related causes. At a median follow-up of 36 months, 7 patients were free of disease, 13 were alive with disease, 1 died of an unrelated cause, and another was lost to follow-up. CONCLUSION AMLs are rare neoplasms with an indolent course in most patients. Subtypes based on fat content are recognized, but clinical behavior does not seem to be different. Recurrence after resection is not associated with disease-related mortality. Resection may be unnecessary in selected asymptomatic patients if the diagnosis can be established definitively.
Collapse
Affiliation(s)
- Jean M Butte
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Lee SH, Park SU, Rha KH, Choi YD, Hong SJ, Yang SC, Mah SY, Chung BH. Trends in the incidence of benign pathological lesions at partial nephrectomy for presumed renal cell carcinoma in renal masses on preoperative computed tomography imaging: A single institute experience with 290 consecutive patients. Int J Urol 2010; 17:512-6. [DOI: 10.1111/j.1442-2042.2010.02514.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
43
|
Boorjian SA, Sheinin Y, Crispen PL, Lohse CM, Leibovich BC, Kwon ED. T-cell co-regulatory molecule expression in renal angiomyolipoma and pulmonary lymphangioleiomyomatosis. Urology 2009; 74:1359-64. [PMID: 19501877 DOI: 10.1016/j.urology.2009.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 02/05/2009] [Accepted: 03/02/2009] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate the expression of B7-H3 and B7-H1 in renal angiomyolipoma (AML) tumors and the related, devastating syndrome of pulmonary lymphangioleiomyomatosis (LAM). We recently reported the high expression of T-cell co-regulatory B7-H ligands in renal cell carcinoma tumor vasculature and tumor cells. AML is a highly vascular tumor that most frequently emanates from the kidney. Events leading to its pathogenesis remain enigmatic and understudied. METHODS Immunohistochemical methods were used to assess the tumor expression of B7-H1 and B7-H3 in paraffin-embedded tissues from 110 patients who had undergone partial or radical nephrectomy for renal AML and from 7 patients with LAM who had undergone lung biopsy. RESULTS B7-H3 was expressed by 100% of the AML and LAM specimens, and B7-H1 expression was detected in only 2.7% of the specimens studied. Both membranous and cytoplasmic B7-H3 expression was noted in the smooth muscle, blood vessel, and lipoid cell components of the tumors; however, no expression was detected in the adjacent, normal parenchyma tissue. B7-H3 staining was noted in a median of 90% (range 20%-100%) of cells from renal AMLs and was independent of patient age (P = .43), sex (P = .27), tumor size (P = .21), and symptomatic presentation (P = .35). CONCLUSIONS B7-H3 was expressed at high levels in renal AMLs and pulmonary LAM, and B7-H1 was infrequently expressed in these tumors. Additional studies are needed to evaluate the utility of B7-H3 as a diagnostic marker or immune/angiogenic target to improve the management of AML and the potentially devastating condition of LAM, for which effective treatment is lacking.
Collapse
Affiliation(s)
- Stephen A Boorjian
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, Minnesota 55905, USA
| | | | | | | | | | | |
Collapse
|