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Conroy S, Griffin J, Cumberbatch M, Pathak S. Acute haemorrhage from a large renal epithelioid angiomyolipoma: diagnostic and management considerations in a teenage patient with a rare cancer. BMJ Case Rep 2023; 16:e252351. [PMID: 37202109 PMCID: PMC10201216 DOI: 10.1136/bcr-2022-252351] [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] [Indexed: 05/20/2023] Open
Abstract
Acute renal haemorrhage is a life-threatening condition that is complicated in the context of renal malignancy. Here, we present the case of a teenage male presenting acutely with a large, bleeding renal epithelioid angiomyolipoma (EAML) of the kidney-a rare cancer, which is part of the perivascular epithelioid cell tumour family. The patient was managed acutely with prompt resuscitation, transfer to a centre of expertise and haemorrhagic control using radiologically guided endovascular techniques; this subsequently permitted an oncologically sound procedure (radical nephrectomy, inferior vena cava thrombectomy and lymphadenectomy) to be performed within 24 hours. The description and discussion around this unique case summarises the patient's clinical journey, while exploring the current literature surrounding diagnosis and outcomes of patients with renal EAMLs.
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Affiliation(s)
- Samantha Conroy
- Academic Unit of Urology, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jon Griffin
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Pathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Marcus Cumberbatch
- Academic Unit of Urology, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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2
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Kim TM, Ahn H, Lee HJ, Kim MG, Cho JY, Hwang SI, Kim SY. Differentiating renal epithelioid angiomyolipoma from clear cell carcinoma: using a radiomics model combined with CT imaging characteristics. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:2867-2880. [PMID: 35697856 DOI: 10.1007/s00261-022-03571-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/25/2022] [Accepted: 05/25/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE This study aims to assess the computed tomography (CT) findings of renal epithelioid angiomyolipoma (EAML) and develop a radiomics-based model for differentiating EAMLs and clear cell renal cell carcinomas (RCCs). METHOD This two-center retrospective study included 28 histologically confirmed EAMLs and 56 size-matched clear cell RCCs with preoperative three-phase kidney CTs. We conducted subjective image analysis to determine the CT parameters that can distinguish EAMLs from clear cell RCCs. Training and test sets were divided by chronological order of CT scans, and radiomics model was built using ten selected features among radiomics and CT features. The diagnostic performance of the radiomics model was compared with that of the three radiologists using the area under the receiver-operating characteristic curve (AUC). RESULTS The mean size of the EAMLs was 6.2 ± 5.0 cm. On multivariate analysis, a snowman or ice cream cone tumor shape (OR 16.3; 95% CI 1.7-156.9, P = 0.02) and lower tumor-to-cortex (TOC) enhancement ratio in the corticomedullary phase (OR 33.4; 95% CI 5.7-197, P < 0.001) were significant independent factors for identifying EAMLs. The diagnostic performance of the radiomics model (AUC 0.89) was similar to those of genitourinary radiologists (AUC 0.78 and 0.81, P > 0.05) and superior to that of a third-year resident (AUC 0.63, P = 0.04). CONCLUSIONS A snowman or ice cream cone shape and lower TOC ratio were more closely associated with EAMLs than with clear cell RCCs. A CT radiomics model was useful for differentiating EAMLs from clear cell RCCs with better diagnostic performance than an inexperienced radiologist.
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Affiliation(s)
- Taek Min Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyungwoo Ahn
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Hyo Jeong Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Min Gwan Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Jeong Yeon Cho
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine and Kidney Research Institute, Seoul National University Medical Research Center, Seoul, 03080, Korea
| | - Sung Il Hwang
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea
| | - Sang Youn Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea. .,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
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3
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Saoud R, Kristof TW, Judge C, Chumbalkar V, Antic T, Eggener S, Modi P. Clinical and pathological features of renal epithelioid angiomyolipoma (PEComa): A single institution series. Urol Oncol 2021; 40:18-24. [PMID: 34815169 DOI: 10.1016/j.urolonc.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/20/2021] [Accepted: 09/20/2021] [Indexed: 10/19/2022]
Abstract
Renal angiomyolipomas are benign tumors of the kidney that belong to the 'PEComa: perivascular epithelioid cell' family. Epithelioid AMLs (eAML) are a rare monotypic subtype with malignant potential, that can occur sporadically or be associated with tuberous sclerosis (TSC). Due to their epithelioid nature, eAMLs can closely resemble high-grade renal cell carcinoma (RCC), which may result in misdiagnosis. Multiple clinicopathologic parameters are predictive of worse outcomes for patients with eAML. Those can be used to stratify patients into groups with low, intermediate and high risk for disease progression. A high index of suspicion and a thorough immunohistochemical study are required to correctly diagnose eAML. Radiographically, eAMLs are also a diagnostic challenge as they share features with RCC on CT and MR imaging. Due to this close mimicry, the true incidence of eAML is thought to be much higher than 200 cases as reported in the literature. We report a series of four patients diagnosed with eAML and compare their clinical courses. We also report on the successful treatment of a patient with pulmonary metastasis from eAML using the mTOR inhibitor, everolimus. By identifying eAML and recognizing its high-risk features, it is possible mTOR inhibitors may have a meaningful role in the adjuvant treatment of these patients.
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Affiliation(s)
- Ragheed Saoud
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IIllinois.
| | - Tanya W Kristof
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IIllinois
| | - Clark Judge
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IIllinois
| | - Vaibhav Chumbalkar
- Department of Pathology, The University of Chicago Medicine, Chicago, IIllinois
| | - Tatjana Antic
- Department of Pathology, The University of Chicago Medicine, Chicago, IIllinois
| | - Scott Eggener
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IIllinois
| | - Parth Modi
- Section of Urology, Department of Surgery, The University of Chicago Medicine, Chicago, IIllinois
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4
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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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Takai M, Kameyama K, Toyota S, Kamei S, Yokoi S, Ishihara S, Deguchi T. Metastatic epithelioid angiomyolipoma treated with everolimus in a patient receiving hemodialysis: A case report. IJU Case Rep 2020; 2:279-282. [PMID: 32743437 PMCID: PMC7292099 DOI: 10.1002/iju5.12103] [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: 04/24/2019] [Accepted: 06/17/2019] [Indexed: 01/16/2023] Open
Abstract
Introduction A patient undergoing hemodialysis and being treated with everolimus for metastatic epithelioid angiomyolipoma has never been described in the literature, to our knowledge. Case presentation A 53‐year‐old woman who had undergone trans‐arterial embolization for epithelioid angiomyolipoma was referred with a chief complaint about right knee pain. Hemodialysis had been started after the embolization. Needle biopsy specimens of tumors obtained from behind the right kidney and in the right femur were diagnosed as epithelioid angiomyolipoma metastases. The patient underwent treatment with everolimus and achieved a partial response after 6 months of treatment without serious adverse events. Conclusion Everolimus might be effective for patients with metastatic epithelioid angiomyolipoma who are undergoing hemodialysis.
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Affiliation(s)
- Manabu Takai
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
| | - Koji Kameyama
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
| | - Shohei Toyota
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
| | - Shingo Kamei
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
| | - Shigeaki Yokoi
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
| | - Satoshi Ishihara
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
| | - Takashi Deguchi
- Department of Urology Kizawa Memorial Hospital Minokamo Gifu Japan
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Lee G, Nabavizadeh R, Osunkoya AO, Master VA. A Rare Case of Vena Cava Tumor Thrombus Associated With Epithelioid Angiomyolipoma. Urology 2020; 142:e4-e7. [PMID: 32445769 DOI: 10.1016/j.urology.2020.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/18/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Grace Lee
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Reza Nabavizadeh
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Adeboye O Osunkoya
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Department of Pathology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory University, Atlanta, GA.
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De Bree E, Stamatiou D, Chryssou E, Michelakis D, Tzardi M. Late local, peritoneal and systemic recurrence of renal angiomyolipoma: A case report. Mol Clin Oncol 2019; 10:43-48. [PMID: 30655976 PMCID: PMC6313948 DOI: 10.3892/mco.2018.1755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/25/2018] [Indexed: 12/30/2022] Open
Abstract
Renal angiomyolipoma (AML) is a relatively rare tumor that is generally considered as merely benign. However, epithelioid AML (EAML), an uncommon subtype, is associated with potentially malignant behavior. We herein present the case of a 60-year old male patient who had undergone left nephrectomy with left adrenalectomy and lymphadenectomy for a renal tumor 12 years earlier, and presented to our hospital with dull abdominal pain. The histology report after the previous surgery had revealed an AML of the left kidney with a maximal diameter of 17 cm. Imaging studies demonstrated a large tumor of 13 cm in diameter in the area of the resected kidney, as well as hepatic and peritoneal metastases. Computed tomography-guided core needle biopsy of the mass and revision of the histology of the nephrectomy revealed an EAML. Four years after a two-stage resection of the recurrences the patient is in excellent condition and free of disease. From this case report and the literature review on EAML, it appears that correct histological diagnosis of this subtype of renal AML is crucial. Erroneous diagnosis of simple renal AML instead of EAML may lead to insufficient postoperative management. Clinicians should be aware of the malignant potential of EAML and the need for long-term follow-up. As effective surgical and emerging medical treatment options are available, timely detection of recurrent disease may lead to improved outcome.
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Affiliation(s)
- Eelco De Bree
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece
| | - Dimitris Stamatiou
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece
| | - Evangelia Chryssou
- Department of Radiology, Medical School of Crete University Hospital, 71110 Heraklion, Greece
| | - Dimosthenis Michelakis
- Department of Surgical Oncology, Medical School of Crete University Hospital, 71110 Heraklion, Greece
| | - Maria Tzardi
- Department of Pathology, Medical School of Crete University Hospital, 71110 Heraklion, Greece
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Lattanzi M, Deng FM, Chiriboga LA, Femia AN, Meehan SA, Iyer G, Voss MH, Sundatova Y, Huang WC, Balar AV. Durable response to anti-PD-1 immunotherapy in epithelioid angiomyolipoma: a report on the successful treatment of a rare malignancy. J Immunother Cancer 2018; 6:97. [PMID: 30285856 PMCID: PMC6167873 DOI: 10.1186/s40425-018-0415-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/18/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Malignant angiomyolipoma is an uncommon tumor of the class of perivasciular epithelioid cell neoplasms (PEComas). These tumors are characteristically driven by deleterious mutations in the tumor suppressors TSC1 and TSC2, whose gene products typically act to inhibit mTOR. There are several cases of malignant angiomyolipoma which exhibit transient responses to mTOR inhibitors, forming the basis of current practice guidelines in malignant PEComa. However the tumors ultimately acquire resistance, and there is no well-established second-line option. Despite the increasing prevalence of immunotherapy across a wide range of solid tumors, little is known about the immune infiltrate and PD-L1 expression of angiomyolipoma. Furthermore, there is no reported case on the treatment of malignant angiomyolipoma with an immune checkpoint inhibitor. CASE PRESENTATION A 38 year-old man presented with gross hematuria and was diagnosed with renal epithelioid angiomyolipoma. Despite surgical resection, the tumor recurred and metastasized. Targeted genomic sequencing revealed a deleterious mutation in TSC2, and the patient was treated with the mTOR inihbitor everolimus. The patient went on to have a partial response but ultimately progressed. He was then treated with the anti-PD-1 immune checkpoint inhibitor nivolumab, and achieved a durable near-complete response which is ongoing after two years of treatment. Immunohistochemical staining of tumor tissue revealed strong PD-L1 expression and a brisk T-cell infiltrate. CONCLUSIONS We report on the first durable systemic treatment of malignant epithelioid angiomyolipoima with the use of PD-1 antibody nivolumab. Given the absence of prospective clinical trials in this exceedingly rare disease, particularly in the second-line setting, immune checkpoint inhibitors like nivolumab should be considered.
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Affiliation(s)
| | - Fang-Ming Deng
- Department of Pathology, NYU Langone Health, New York, NY, USA.,Department of Urology, NYU Langone Health, New York, NY, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | | | - Alisa N Femia
- Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Shane A Meehan
- Department of Pathology, NYU Langone Health, New York, NY, USA.,Ronald O. Perelman Department of Dermatology, NYU Langone Health, New York, NY, USA
| | - Gopa Iyer
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Martin H Voss
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Yuliya Sundatova
- Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA.,Genitourinary Medical Oncology Program, NYU School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY, 10016, USA
| | - William C Huang
- Department of Urology, NYU Langone Health, New York, NY, USA.,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA
| | - Arjun V Balar
- Department of Medicine, NYU Langone Health, New York, NY, USA. .,Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, New York, NY, USA. .,Genitourinary Medical Oncology Program, NYU School of Medicine, Laura and Isaac Perlmutter Cancer Center, NYU Langone Health, 160 East 34th Street, 10th Floor, New York, NY, 10016, USA.
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9
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Espinosa M, Roldán-Romero JM, Duran I, de Álava E, Apellaniz-Ruiz M, Cascón A, Garrigos C, Robledo M, Rodriguez-Antona C. Advanced sporadic renal epithelioid angiomyolipoma: case report of an extraordinary response to sirolimus linked to TSC2 mutation. BMC Cancer 2018; 18:561. [PMID: 29764404 PMCID: PMC5952422 DOI: 10.1186/s12885-018-4467-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 04/30/2018] [Indexed: 02/04/2023] Open
Abstract
Background Renal epithelioid angiomyolipomas (EAML) are rare tumors with aggressive behavior. EAML can be sporadic or develop within the tuberous sclerosis complex syndrome, where mutations of TSC1 or TSC2 genes (critical negative regulators of mTOR Complex 1) result in an increased activation of mTOR pathway. Optimal EAML treatment, including mTOR inhibitors, remains undetermined. Case presentation Here we present the case of a young adult with a renal EAML that after radical nephrectomy developed metastases, first in liver and then in lumbar vertebrae. After complete surgical resection of these lesions, liver recurrence was detected, this time with incomplete surgical resection. After finding a new liver lesion, systemic treatment with sirolimus started. The patient exhibited a complete and durable response to this drug, being disease free at the time of publication, after 36 months of treatment. Targeted next generation sequencing (NGS) of MTOR, TSC1 and TSC2 genes in the primary tumor, metastasis and blood of the patient, revealed one inactivating TSC2 mutation (c.2739dup; p.K914*) in the tumor cells. Immunohistochemistry revealed decreased TSC2 protein content and increased phospho-S6 in the tumor cells, demonstrating mTOR pathway activation. Conclusion NGS on an EAML patient with an extraordinary response to sirolimus uncovered TSC2 inactivation as the mechanism for the response. This study supports NGS as a useful tool to identify patients sensitive to mTOR inhibitors and supports the treatment of malignant EAML with these drugs.
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Affiliation(s)
- Marta Espinosa
- Medical Oncology Department, Hospital Virgen del Rocío, Servicio de Oncología Medica, Avenida Manuel Siurot s/n, 41013, Sevilla, Spain
| | - Juan Maria Roldán-Romero
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Ignacio Duran
- Medical Oncology Department, Hospital Virgen del Rocío, Servicio de Oncología Medica, Avenida Manuel Siurot s/n, 41013, Sevilla, Spain. .,Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain.
| | - Enrique de Álava
- Pathology Department, Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla-CIBERONC, Sevilla, Spain
| | - María Apellaniz-Ruiz
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029, Madrid, Spain
| | - Alberto Cascón
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Carmen Garrigos
- Instituto de Biomedicina de Sevilla, IBiS/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Mercedes Robledo
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029, Madrid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Cristina Rodriguez-Antona
- Hereditary Endocrine Cancer Group, Human Cancer Genetics Programme, Spanish National Cancer Research Centre (CNIO), Melchor Fernández Almagro 3, 28029, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain.
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10
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The Risks of Renal Angiomyolipoma: Reviewing the Evidence. J Kidney Cancer VHL 2017; 4:13-25. [PMID: 29090118 PMCID: PMC5644357 DOI: 10.15586/jkcvhl.2017.97] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/23/2017] [Indexed: 12/26/2022] Open
Abstract
Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or even mortality due to its unique characteristics and the complications subsequent to its treatment. The classic tumor variant is composed of smooth muscular, vascular, and fatty components. The most straightforward diagnosis is when the fat component is abundant and gives a characteristic appearance on different imaging studies. In fat-poor lesions, however, the diagnosis is difficult and presumed a renal cell carcinoma. Yet, some variants of RAML, though rare, express an aggressive behavior leading to metastasis and mortality. The challenge lies in the early detection of benign variants and identifying aggressive lesions for proper management. Another challenge is when the vascular tissue component predominates and poses a risk of hemorrhage that may extend to the retroperitoneum in a massive life-threatening condition. The predicament here is to identify the characteristics of tumors at risk of bleeding and provide a prophylactic treatment. According to the clinical presentation, different treatment modalities, prophylactic or therapeutic, are available that span the spectrum of observation, embolization, or surgery. Renal impairment may result from extensive tumor burden or as a complication of the management itself. Improvement of diagnostic techniques, super-selective embolization, nephron-sparing surgery, and late treatment with the mammalian target of rapamycin inhibitors have provided more effective and safe management strategies. In this review, we examine the evidence pertaining to the risks imposed by RAML to the patients and identify merits and hazards associated with different treatment modalities.
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11
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[Two cases of epithelioid angiomyolipoma of the kidney]. Nihon Hinyokika Gakkai Zasshi 2014; 104:712-5. [PMID: 24564079 DOI: 10.5980/jpnjurol.104.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Two cases of epithelioid angiomyolipoma of the kidney are reported. A 62-year-old female with incidental left renal tumor underwent laparoscopic leftpartial nephrectomy under a diagnosis of renal cell carcinoma. A pathological examination revealed epithelioid angiomyolipoma. The second case was that of a 35-year-old female with back pain. A laparoscopic right nephrectomy revealed epithelioid angiomyolipoma. This recently identified variant of angiomyolipoma is sometimes associated with aggressive clinical behavior including local recurrence and metastasis.
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12
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Alayev A, Holz MK. mTOR signaling for biological control and cancer. J Cell Physiol 2013; 228:1658-64. [PMID: 23460185 DOI: 10.1002/jcp.24351] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/12/2013] [Indexed: 12/20/2022]
Abstract
Mammalian target of rapamycin (mTOR) is a major intersection that connects signals from the extracellular milieu to corresponding changes in intracellular processes. When abnormally regulated, the mTOR signaling pathway is implicated in a wide spectrum of cancers, neurological diseases, and proliferative disorders. Therefore, pharmacological agents that restore the regulatory balance of the mTOR pathway could be beneficial for a great number of diseases. This review summarizes current understanding of mTOR signaling and some unanswered questions in the field. We describe the composition of the mTOR complexes, upstream signals that activate mTOR, and physiological processes that mTOR regulates. We also discuss the role of mTOR and its downstream effectors in cancer, obesity and diabetes, and autism.
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Affiliation(s)
- Anya Alayev
- Department of Biology, Stern College for Women of Yeshiva University, New York, New York 10016, USA
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13
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Nagashima Y. Editorial comment to role of mammalian target of rapamycin inhibitor in the treatment of metastatic epithelioid angiomyolipoma: a case report. Int J Urol 2013; 20:942. [PMID: 23379352 DOI: 10.1111/iju.12116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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