Parasitic arterial supply to renal angiomyolipoma

The sub-peritoneal arterial plexus of Sir William Turner

Sir William Turner (1832-1916) was Professor of Anatomy at the University of Edinburgh. His classic paper of 1863 on the anastomoses between the parietal and visceral branches of the abdominal aorta, later known as the sub-peritoneal arterial plexus of Turner, has mostly been forgotten. Located in the retroperitoneum and surrounding the kidneys and other adjacent structures, this plexus is an important route of collateral circulation. In the current paper, we discuss the sub-peritoneal arterial plexus as described by Turner in 1863 and review the literature concerning its potential clinical significance in the kidney, emphasizing its probable role in the metastatic spread of various tumors of abdominal organs and in the continuing viability of the kidney after renal artery occlusion. A biographical sketch of Sir William Turner is also presented.

Computerized tomographic demonstration of inferior vena caval tumor thrombus from renal angiomyolipoma

A case of renal angiomyolipoma with gross venous tumor thrombus extension into the inferior vena cava is presented. This fatty tumor thrombus is visualized easily by computerized tomography and is confirmed by inferior venacavography, surgery and histology. Macroscopic renal vein and vena caval tumor thrombi rarely occur in patients with angiomyolipoma and may be diagnosed preoperatively by the demonstration of abundant fat within the tumor components.

The significance of lymph nodal involvement in renal angiomyolipoma

Renal angiomyolipoma, a benign tumor, can involve regional lymph nodes. Although this phenomenon has been reported previously followup information has been scant. We have treated 3 patients who had renal angiomyolipoma with nodal involvement and all had further evidence of tuberous sclerosis. Each patient had hematuria with flank pain and required nephrectomy. In the ensuing 3 to 11 years none of these patients has had evidence of further disease progression. Nodal involvement may reflect the multicentricity of angiomyolipoma or may represent a form of "benign metastasis" but it does not appear to be a harbinger of disease progression.

Collateral blood supply to an autotransplanted kidney

Collateral lumbar arterial blood supply to an autotransplanted kidney was angiographically documented in a patient with bilateral Wilms' tumor and postoperative transplant renal artery stenosis. During autotransplantation, most collateral pathways are interrupted. The development of a collateral circulation after autotransplantation may be postulated to begin with a vascular response to postoperative inflammation and adhesions. The small anastomotic pathways so formed may then dilate in response to ischemia resulting from renal artery stenosis.