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Xu Z, Wu J, Xu G, Luo H. Abdominal ultrasonographic manifestations in pediatric patients with tuberous sclerosis complex. Transl Pediatr 2020; 9:757-767. [PMID: 33457297 PMCID: PMC7804489 DOI: 10.21037/tp-20-150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC) is a rare genetic disease which leads to formation of benign tumors in the brain and other organs of the body. Ultrasound (US) can detect the location, quantity, size and internal echo of TSC-associated renal diseases, liver angiomyolipoma (AML), and co-existing lesions, providing important diagnostic basis for clinical diagnosis. The aim of the present study was to investigate the abdominal ultrasonographic features of pediatric TSC and explore the advantages of abdominal ultrasonography in clinical practice. METHODS Data of children with TSC, who presented to the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, between January 2016 and November 2018, were analyzed by a retrospective chart review. The cases were identified from electronic medical records (EMR) system and underwent ultrasonography, we yielded a total of 12 patients. RESULTS The 12 pediatric patients, including 5 boys and 7 girls, ranged in age from 9 months to 13 years old. And they all had a history of epilepsy. All the patients underwent brain magnetic resonance imaging (MRI) or computed tomography (CT) examination, which revealed a scattered distribution of multiple hyperintense nodules. Of the 12 patients, 10 had TSC-associated bilateral renal AMLs, 5 had hepatic AML, and 4 had renal cysts. CONCLUSIONS US is a useful and non-invasive tool for the detection of TSC-associated renal and liver lesions and for clinical follow-up among pediatric patients.
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Affiliation(s)
- Zhihua Xu
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Junbo Wu
- Department of Ultrasound Imaging, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guimin Xu
- Department of Anesthesia, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hongxia Luo
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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2
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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
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Abstract
Epithelioid angiomyolipoma is a recently recognized tumor entity. We report a case of epithelioid angiomyolipoma of the kidney that occurred in a 70-year-old female. The patient presented with massive abdominal hemorrhage and shock. There was no history of tuberous sclerosis complex. The tumor consisted of smooth muscle, adipocytes, small-to-medium-sized hyalinized blood vessels and numerous pleomorphic epithelioid cells with clear to eosinophilic cytoplasm. Mitosis was exceptional and no glandular pattern was recognizable. Immunohistochemically the epithelioid cells were strongly positive for HMB45 and CD68, focally positive for S-100, actin and vimentin, and negative for epithelial markers including epithelial membrane antigen and cytokeratins. Previous reports in the English literature suggest that epithelioid angiomyolipoma may have malignant potential. In our case, at six months from surgery the patient is alive and well without evidence of relapse or metastasis.
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Affiliation(s)
- B Lebe
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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4
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Dhua AK, Ranjan A, Agarwala S, Bhatnagar V, Mathur SR, Devasenathipathy K. Giant renal Angiomyolipoma masquerading as a Wilms tumor. INDIAN JOURNAL OF UROLOGY : IJU : JOURNAL OF THE UROLOGICAL SOCIETY OF INDIA 2017; 33:73-75. [PMID: 28197035 PMCID: PMC5264199 DOI: 10.4103/0970-1591.197325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Renal Angiomyolipoma (AML) is not commonly seen in the pediatric age group other than patients of tuberous sclerosis where in they can have renal AMLs within the first decade with bilateral in involvement. Diagnosis of renal AML can generally be made by the current radiological modalities in the appropriate clinical setting, but it can be mistaken for other tumors when it is large and has low-fat content. Herein we report a case of giant renal AML that was initially misdiagnosed as a Wilms tumor in a 12-year-old girl.
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Affiliation(s)
- Anjan Kumar Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Ranjan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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5
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Abstract
Many soft tissue tumors of childhood lack obvious differentiation toward a defined mesenchymal tissue type or have a phenotype that does not correspond to any defined normal tissue. These challenging tumors are currently regarded as neoplasms of uncertain differentiation. Nonetheless, there have been great strides in the understanding of their pathologic and genetic features and biologic underpinnings. The application of new genetic information to the pathologic diagnosis among this group of tumors is an emerging area in diagnostic pediatric pathology. This article reviews the clinicopathologic features of tumors of uncertain and/or miscellaneous origin, with an emphasis on the unique aspects of these neoplasms in children and adolescents, use of diagnostic adjuncts, and differential diagnosis.
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Affiliation(s)
- Rita Alaggio
- Department of Pathology, University of Padova, Padova, Italy.
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Abstract
PEComas (perivascular epithelioid cell tumours) are rare mesenchymal tumours, characterised by epithelioid, clear cell morphology with coexpression of melanocytic and smooth muscle markers. They are usually seen in adult females in a variety of anatomical locations, of which, kidney, lung and the gynaecologic tract are the most common. We present a case of PEComa arising from the kidney of a 12-year-old boy.
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Affiliation(s)
- Zeeshan Uddin
- Aga Kahn University, Pathology, Stadium Road, Karachi, Sindh, 74800, Pakistan
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7
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Leflore A, McKenna PH, Schwartz BF. Laparoscopic Cryotherapy for Pediatric Angiomyolipoma: The First Report. J Endourol 2007; 21:321-4; discussion 324. [PMID: 17444779 DOI: 10.1089/end.2006.0268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Renal cryotherapy for pediatric angiomyolipoma has never been reported in the literature. We present the first experience with this procedure, describing techniques and short-term outcome. CASE REPORT A 14-year-old girl was being followed for a 2-cm left renal angiomyolipoma. Growth was demonstrated by ultrasonography and CT imaging over a 2-year period, and the family desired intervention. A transperitoneal approach employing three 5-mm laparoscopic ports was used. Tumor size was measured by intraoperative ultrasonography as 25 x 28 mm. Intraoperative biopsy was done with a biopsy gun through the lateral port. An 8-mm cryoprobe was utilized. Two freeze-thaw cycles were performed with cooling to -160 degrees C. Hemostasis was accomplished with thrombin (FloSeal) and oxidized cellulose (Surgicel). RESULTS The operative time was 92 minutes, and the blood loss was minimal. No perioperative complications occurred. There was mild perioperative hematuria that resolved within 20 hours without stenting. The hospital stay was 46 hours. There were no complications or hematuria at 1-week postoperative follow-up. CONCLUSION Laparoscopic cryotherapy can be performed in the pediatric population. To our knowledge, this is the first case of pediatric renal angiomyolipoma managed with laparoscopic cryotherapy.
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Affiliation(s)
- Antoine Leflore
- Center for Laparoscopy and Endourology, Southern Illinois University School of Medicine, Springfield, Illinois 62794-0665, USA
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8
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Winterkorn EB, Daouk GH, Anupindi S, Thiele EA. Tuberous sclerosis complex and renal angiomyolipoma: case report and review of the literature. Pediatr Nephrol 2006; 21:1189-93. [PMID: 16791610 DOI: 10.1007/s00467-006-0133-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2005] [Revised: 02/08/2006] [Accepted: 02/10/2006] [Indexed: 10/24/2022]
Abstract
A 5-year-old boy with a known diagnosis of tuberous sclerosis complex was found to have an enlarging renal mass on routine ultrasound. He was diagnosed with an angiomyolipoma (AML) and scheduled for close observation. Follow-up magnetic resonance imaging demonstrated the AML to be significantly enlarged and hypervascular. Selective arterial embolization of the tumor was performed, which resulted in an appropriate decrease in tumor size. Angiomyolipoma is a known and well-described complication of the tuberous sclerosis complex that is usually found among patients in their adolescent and adult years. The case presented here illustrates the need for early and repeated renal imaging of younger pediatric patients with tuberous sclerosis. Our experience adds to the literature on young pediatric patients requiring embolization for treatment of large renal angiomyolipomas.
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Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominance disorder with variable penetrance. Renal angiomyolipoma (AML) is one of the commonest urological manifestations. These lesions may cause significant morbidity and mortality. We report two patients with multiple and huge renal angiomyolipomas presenting with gross haematuria. They subsequently underwent unilateral nephrectomy. The difficulty in diagnosis and controversies in management will be briefly discussed.
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Affiliation(s)
- S Y Chan
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR
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Joniau S, Goeman L, Kreuzbauer S, Bogaert G, Dal Cin P, Oyen R, Sciot R, van Poppel H. Benign renal mesenchymoma in the pediatric age group: a novel pathologic and karyotype entity. Urology 2004; 63:981-4. [PMID: 15134997 DOI: 10.1016/j.urology.2004.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2003] [Revised: 01/05/2004] [Accepted: 01/05/2004] [Indexed: 11/23/2022]
Abstract
Benign mesenchymal renal tumors are extremely rare in the pediatric age group. We report a case of a benign renal tumor composed of smooth muscle cells, adipose tissue, and areas of cartilaginous differentiation and expressing a 46,XX, t(8;10)(q21;q24) karyotype in a 13-year-old girl. Although some pediatric renal tumors show a degree of heterologous differentiation, none of them exclusively consist of these three well-differentiated mesenchymal components. The unique features of the present case were further confirmed by the karyotype changes, which to our knowledge, have never been described before in a pediatric renal tumor.
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Affiliation(s)
- Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
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Yeniyol CO, Zeyrek N, Parildar M, Selek E, Taşli F, Memiş A. Life threatening hematuria in a patient with renal angiomyolipoma and selective renal embolization prior to nephrectomy. Int Urol Nephrol 2003; 34:185-8. [PMID: 12775090 DOI: 10.1023/a:1023262230455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rabii R, Fekak H, Moufid K, Joual A, Benjelloun S, Khaleq K, Idali B, Harti A, Barrou L. [Renal angiomyolipoma complicated by retroperitoneal hematoma]. ANNALES D'UROLOGIE 2002; 36:250-3. [PMID: 12162189 DOI: 10.1016/s0003-4401(02)00115-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.
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Affiliation(s)
- R Rabii
- Service d'urologie, CHU Ibn Rochd, Casabanca, Maroc.
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Esparza Paz P, Sarasua Miranda A, García de Andoin Barandiaran N, Nogués Pérez A. Angiomiolipoma renal: un caso de difícil diagnóstico. An Pediatr (Barc) 2002. [DOI: 10.1016/s1695-4033(02)77977-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ousehal A, Essodegui F, Kadiri R. Imagerie des angiomyolipomes du rein : à propos de neuf cas. ACTA ACUST UNITED AC 2001; 35:84-92. [PMID: 11355285 DOI: 10.1016/s0003-4401(01)00006-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the radiological polymorphism of angiomyolipoma (AML). MATERIAL AND METHODS [corrected] A retrospective series of eight cases of AML explored by US and CT scan. The diagnosis was radiological in seven cases and histopathological in one case. RESULT Five cases of AML were discovered fortuitously. The tuberous sclerosis of Bourneville disease (TSB) was noted in five cases. The cverage age was 37 years with female predominance noted in seven cases. The AML were multiple in half cases all of thein had TSB. The tumoral size ranged from 0.5 cm and 20 cm. The US showed an homogenous hyperechogenique mass in six cases and heterogenous in two cases. The CT scan showed polymorph parenchymal lesions. The fatty component was detected in seven cases. An intratumoral bleeding was noted in one case. CONCLUSION The radiological feature of AML is variable, related to tumoral size. It's typical when a tumor of kidney contains fat. An association with TSB is a supplementary argument of diagnosis.
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Affiliation(s)
- A Ousehal
- Service central de radiologie, CHU Ibn Rochd, Casablanca, Maroc
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Türker Köksal I, Tunç M, Kiliçaslan I, Ander H, Ozcan F, Kaplancan T. Lymph nodal involvement by renal angiomyolipoma. Int J Urol 2000; 7:386-9. [PMID: 11144508 DOI: 10.1046/j.1442-2042.2000.00213.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Angiomyolipoma of the kidney is a clonal neoplasm, apparently part of a family of neoplasms derived from perivascular epithelial cells. A 40-year-old woman presented with right flank pain and an otherwise non-significant medical history. An abdominal computed tomography scan revealed an 18 cm solid mass in the mid-portion of the right kidney and multiple perihilar lymph nodes. Presumptive diagnosis was renal cell carcinoma. Right radical nephrectomy and a perihilar lymph node dissection was performed through a Chevron incision for the anticipated diagnosis of renal adenocarcinoma. The renal tumor was diagnosed as angiomyolipoma and a component was identified pathologically in a dissected lymph node. There was no evidence of tumor recurrence in the follow-up period of eight years. The consensus from other studies suggests that this phenomenon is a manifestation of the multicentric nature of angiomyolipoma, rather than due to metastasis. Genetic studies may resolve this question in the future.
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Affiliation(s)
- I Türker Köksal
- Department of Urology, Faculty of Medicine, Istanbul University, Turkey.
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