1
|
Keles A, Iplikci A, Arikan O, Culpan M, Baydili KN, Keser F, Yildirim A. Evolving horizons in renal angiomyolipoma: two decades of management strategies and clinical perspectives in a single institutional study. Aging Male 2024; 27:2346308. [PMID: 38709235 DOI: 10.1080/13685538.2024.2346308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To assess various management options for renal angiomyolipoma (AML) to guide clinical practice. METHODS A single center retrospectively reviewed an AML series from 2002 to 2022. The image reports and chart reviews of patients who received two abdominal scans at least 6 months between the first and last scans were assessed. RESULTS A total of 203 patients with 209 tumors were identified and followed up for a median of 42.6 months. Active surveillance (AS) was the most frequently selected option (70.9% of cases). Interventions were required for 59 AMLs, of which 20 were treated with embolization, 29 with partial nephrectomy, 9 with radical nephrectomy, and 1 with radiofrequency (RF) ablation. The median size of the lesions at intervention was 5 cm. The average growth rate of the lesions was 0.12 cm/year, and there was a significant difference in the average growth rate of lesions ≤4 cm and those >4 cm (0.11 vs. 0.24 cm/year; p = 0.0046). CONCLUSION This series on AMLs confirms that lesions >4 cm do not require early intervention based on size alone. Appropriately selected cases of renal AML can be managed by AS.KEYWORDS: Angiomyolipoma; active surveillance; embolization; nephrectomy; nephron-sparing surgery.
Collapse
Affiliation(s)
- Ahmet Keles
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ayberk Iplikci
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Ozgur Arikan
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Meftun Culpan
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Kursad Nuri Baydili
- Department of Biostatistics, University of Health Sciences, School of Medicine, Istanbul, Turkey
| | - Ferhat Keser
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey
| |
Collapse
|
2
|
Awashra A, Sawaftah Z, Milhem F, Hamdan D, Odah AB, Sawafta A, Ahmad O, Khamaysa J, Khader M, Naseef O. Spontaneous angiomyolipoma rupture: A case of hemorrhagic shock and urgent embolization. Radiol Case Rep 2024; 19:6286-6291. [PMID: 39387028 PMCID: PMC11461921 DOI: 10.1016/j.radcr.2024.09.034] [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: 08/25/2024] [Accepted: 09/04/2024] [Indexed: 10/12/2024] Open
Abstract
This case report discusses a 64-year-old male with tuberous sclerosis complex (TSC), a genetic disorder characterized by benign tumor formation across multiple organ systems. The patient presented with a spontaneous hemorrhage from a right renal angiomyolipoma, a common and potentially life-threatening manifestation of TSC, particularly in patients with TSC2 mutations. The patient's significant comorbidities, including hypertension and dyslipidemia, further complicated his clinical course. Initial management involved aggressive fluid resuscitation and blood product transfusion, followed by urgent embolization to control active bleeding. Despite developing complications such as transfusion-associated circulatory overload (TACO), the patient was successfully stabilized. This case highlights the necessity for careful monitoring and prompt intervention in patients with TSC, given the high risk of hemorrhage from angiomyolipomas, especially those larger than 3 cm. We also emphasize the importance of differentiating TSC-associated angiomyolipomas from other renal masses, considering the variability in clinical presentation and the potential for late-onset symptoms. Additionally, it highlights the critical role of a multidisciplinary approach in managing TSC patients, addressing both acute complications and long-term surveillance to prevent recurrence and other systemic manifestations of the disease.
Collapse
Affiliation(s)
- Ameer Awashra
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Zaid Sawaftah
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Fathi Milhem
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Dawoud Hamdan
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Ali Bani Odah
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Ahmad Sawafta
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Ola Ahmad
- Department of Medicine, An Najah National University, Nablus, Palestine
| | - Jehad Khamaysa
- Department of Radiology, Tubas Turkish Governmental Hospital, Tubas, Palestine
| | - Mohammed Khader
- Department of Radiology, An Najah National University Hospital, Nablus, Palestine
| | - Omar Naseef
- Department of Radiology, An Najah National University Hospital, Nablus, Palestine
| |
Collapse
|
3
|
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 PMCID: PMC11400986 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
|
4
|
Qiu D, Wang W, Zhao Y, Wang Z, Wang X, Liao Z, Zhang Y. The impact of everolimus on hematologic parameters in patients with renal angiomyolipoma associated with tuberous sclerosis complex. Discov Oncol 2024; 15:438. [PMID: 39266797 PMCID: PMC11393373 DOI: 10.1007/s12672-024-01329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 09/09/2024] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Everolimus is an effective treatment for renal angiomyolipoma associated with TSC (TSC-RAML). However, its impact on hematologic parameters in TSC-RAML patients remains unclear. METHODS Hematologic data were collected from TSC-RAML patients undergoing everolimus treatment in two registered clinical trials. Dynamic changes in hematologic parameters during treatment were analyzed. Additionally, we also explored variations in hematologic impact based on gender and age within the patient population. RESULT A total of 55 patients from the two clinical trials are included in this analysis. Hemoglobin, white blood cells (WBC), lymphocytes, neutrophils, and platelet showed significant decreases during everolimus treatment (P < 0.05). However, the decline in hemoglobin, WBC, and neutrophils attenuated by the 12th month (P ≥ 0.05). Aspartate transaminase (AST), Alanine transferase (ALT), total cholesterol (TC), and triglyceride (TG) increased significantly during everolimus treatment (P < 0.05), and these increases persisted throughout the year-long treatment. Hemoglobin decreased significantly more in male patients (- 15 vs - 6, P = 0.010), and AST showed a more significant increase in males (7.0 vs 3.0, P = 0.041). Platelet counts decreased significantly more in younger patients (≤ 30 years old) compared to older patients (- 50 vs - 14, P = 0.020). CONCLUSION Everolimus administration in TSC-RAML patients may increase hematologic risks, with male and younger patients potentially exhibiting greater susceptibility to these effects.
Collapse
Affiliation(s)
- Dongxu Qiu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing, 100730, People's Republic of China
- Vancouver Prostate Centre, Department of Urologic Sciences, University of British Columbia, Vancouver, BC, V6H 3Z6, Canada
| | - Wenda Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing, 100730, People's Republic of China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing, 100730, People's Republic of China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing, 100730, People's Republic of China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing, 100730, People's Republic of China
| | - Zhangcheng Liao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China, 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China, 410008.
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 1 Shuaifuyuan Wangfujing, Beijing, 100730, People's Republic of China.
| |
Collapse
|
5
|
Su R, Huang T, Gu L, Bao Y, Liu Z, Dao P, Yao L, Hu X, Fu G, Wu J, Tricard T, Wu G, Chen M, Li C, Huang Z, Zheng B, Chen Y, Xue W, Guo G, Dong P, Huang J, Zhang J. Neoadjuvant everolimus in renal angiomyolipoma with or without tuberous sclerosis complex: Results from a multicenter, retrospective study. Cancer Med 2024; 13:e70181. [PMID: 39279295 PMCID: PMC11403123 DOI: 10.1002/cam4.70181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 08/01/2024] [Accepted: 08/21/2024] [Indexed: 09/18/2024] Open
Abstract
OBJECTIVES To assess the efficacy and safety of preoperative neoadjuvant everolimus in renal angiomyolipomas (AML) patients with or without Tuberous Sclerosis Complex (TSC). MATERIALS AND METHODS This multi-institutional retrospective study enrolled renal AML patients who underwent partial nephrectomy (PN) or total nephrectomy after receiving at least 1 month of pre-operative everolimus. Imaging evaluations were collected before and after treatment, along with demographic, surgical, and follow-up information. The primary outcome was tumor volume reduction of ≥25%, with additional outcomes including recurrence, perioperative outcomes, renal function, and safety. RESULTS From January 2015 to July 2022, 68 renal AML patients were studied-41 with TSC and 27 without. During everolimus treatment, 61.0% (25/41) of TSC patients and 44.4% (12/27) of non-TSC patients achieved tumor reduction of ≥25%. Additionally, 41.5% (17/41) of TSC patients and 18.5% (5/27) of non-TSC patients achieved a ≥ 50% reduction. Three TSC patients and 1 non-TSC patient discontinued treatment due to side-effects. Most patients (92.7% TSC, 85.2% non-TSC) underwent PN. After everolimus treatment, the necessary total nephrectomy decreased to 41.2% (7/17) from baseline. Postoperatively, 1 grade 3 and 3 grade 2 complications occurred, with no grade 4 or 5 complications. After a median follow-up of 24 months, only 1 TSC patient recurred with a diameter >3 cm. Retrospective nature is the major limitation of this study. CONCLUSION Everolimus was effective and well-tolerated in neoadjuvant treatment for renal AML, especially in TSC patients. This neoadjuvant combination strategy of everolimus and PN could effectively controls recurrence and preserves renal function.
Collapse
Affiliation(s)
- Ruopeng Su
- Department of UrologyRen Ji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tingxuan Huang
- Department of Urology OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Liangyou Gu
- Department of Urology, The Third Medical CentreChinese PLA General HospitalBeijingChina
| | - Yige Bao
- Department of Urology and Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Zhihong Liu
- Department of Urology and Institute of UrologyWest China Hospital, Sichuan UniversityChengduChina
| | - Pinghong Dao
- Department of UrologyXiangya Hospital, Central South UniversityChangshaChina
| | - Lin Yao
- Department of UrologyFirst Hospital of Peking University, Institute of Urology, Peking University, National Urological Cancer CenterBeijingChina
| | - Xiaoyi Hu
- Department of UrologyZhongshan Hospital, Fudan UniversityShanghaiChina
| | - Guanghou Fu
- Department of UrologyThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouChina
| | - Jitao Wu
- Department of UrologyYantai Yuhuangding Hospital, Qingdao UniversityYantaiShandongChina
| | - Thibault Tricard
- Department of UrologyRen Ji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of UrologyNouvel Hôpital Civil, Hôpitaux Universitaires de StrasbourgStrasbourgFrance
| | - Guangyu Wu
- Department of RadiologyRenji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Minfeng Chen
- Department of UrologyXiangya Hospital, Central South UniversityChangshaChina
| | - Chancan Li
- The Department of UrologyAnHui NO.2 Provincial People HospitalHefeiChina
| | - Zhiyang Huang
- Department of UrologyQuanzhou First Hospital affiliated to Fujian Medical UniversityQuanzhouChina
| | - Bing Zheng
- The Department of UrologyThe Second Affiliated Hospital of Nantong UniversityNantongChina
| | - Yonghui Chen
- Department of UrologyRen Ji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wei Xue
- Department of UrologyRen Ji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Gang Guo
- Department of Urology, The Third Medical CentreChinese PLA General HospitalBeijingChina
| | - Pei Dong
- Department of Urology OncologySun Yat‐sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer MedicineGuangzhouChina
| | - Jiwei Huang
- Department of UrologyRen Ji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jin Zhang
- Department of UrologyRen Ji Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| |
Collapse
|
6
|
Mekahli D, Müller RU, Marlais M, Wlodkowski T, Haeberle S, de Argumedo ML, Bergmann C, Breysem L, Fladrowski C, Henske EP, Janssens P, Jouret F, Kingswood JC, Lattouf JB, Lilien M, Maleux G, Rozenberg M, Siemer S, Devuyst O, Schaefer F, Kwiatkowski DJ, Rouvière O, Bissler J. Clinical practice recommendations for kidney involvement in tuberous sclerosis complex: a consensus statement by the ERKNet Working Group for Autosomal Dominant Structural Kidney Disorders and the ERA Genes & Kidney Working Group. Nat Rev Nephrol 2024; 20:402-420. [PMID: 38443710 DOI: 10.1038/s41581-024-00818-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the presence of proliferative lesions throughout the body. Management of TSC is challenging because patients have a multifaceted systemic illness with prominent neurological and developmental impact as well as potentially severe kidney, heart and lung phenotypes; however, every organ system can be involved. Adequate care for patients with TSC requires a coordinated effort involving a multidisciplinary team of clinicians and support staff. This clinical practice recommendation was developed by nephrologists, urologists, paediatric radiologists, interventional radiologists, geneticists, pathologists, and patient and family group representatives, with a focus on TSC-associated kidney manifestations. Careful monitoring of kidney function and assessment of kidney structural lesions by imaging enable early interventions that can preserve kidney function through targeted approaches. Here, we summarize the current evidence and present recommendations for the multidisciplinary management of kidney involvement in TSC.
Collapse
Affiliation(s)
- Djalila Mekahli
- PKD Research Group, Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium.
- Department of Paediatric Nephrology, University Hospitals Leuven, Leuven, Belgium.
| | - Roman-Ulrich Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Center for Rare Diseases Cologne, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matko Marlais
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tanja Wlodkowski
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Stefanie Haeberle
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - Marta López de Argumedo
- Basque Office for Health Technology Assessment, (OSTEBA), Basque Government, Vitoria-Gasteiz, Spain
| | - Carsten Bergmann
- Department of Medicine IV, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Medizinische Genetik Mainz, Limbach Genetics, Mainz, Germany
| | - Luc Breysem
- Department of Radiology, University Hospital of Leuven, Leuven, Belgium
| | - Carla Fladrowski
- Associazione Sclerosi Tuberosa ASP, Rome, Italy
- European Tuberous Sclerosis Complex Association (ETSC), Oestrich-Winkel, Germany
| | - Elizabeth P Henske
- Center for LAM Research and Clinical Care, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Janssens
- Department of Nephrology and Arterial Hypertension, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel, Brussels, Belgium
| | - François Jouret
- Division of Nephrology, Department of Internal Medicine, University of Liège Hospital, Liège, Belgium
- Interdisciplinary Group of Applied Genoproteomics, Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - John Christopher Kingswood
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Centre, St Georges University of London, London, UK
| | - Jean-Baptiste Lattouf
- Department of Surgery-Urology, CHUM-Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Marc Lilien
- Department of Paediatric Nephrology, Wilhelmina Children´s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Micaela Rozenberg
- European Tuberous Sclerosis Complex Association (ETSC), Oestrich-Winkel, Germany
- Associação de Esclerose Tuberosa em Portugal, Lisbon, Portugal
| | - Stefan Siemer
- Department of Urology and Paediatric Urology, Saarland University, Homburg, Germany
| | - Olivier Devuyst
- Department of Physiology, Mechanisms of Inherited Kidney Disorders, University of Zurich, Zurich, Switzerland
- Institute for Rare Diseases, Saint-Luc Academic Hospital, UC Louvain, Brussels, Belgium
| | - Franz Schaefer
- Division of Paediatric Nephrology, Center for Paediatrics and Adolescent Medicine, University Hospital, Heidelberg, Germany
| | - David J Kwiatkowski
- Cancer Genetics Laboratory, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olivier Rouvière
- Department of Radiology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
- Université Lyon 1, Lyon, France, Faculté de médecine Lyon Est, Lyon, France
| | - John Bissler
- Department of Paediatrics, University of Tennessee Health Science Center and Le Bonheur Children's Hospital, Memphis, TN, USA.
- Children's Foundation Research Institute (CFRI), Le Bonheur Children's Hospital, Memphis, TN, USA.
- Paediatric Medicine Department, St. Jude Children's Research Hospital, Memphis, TN, USA.
| |
Collapse
|
7
|
Aumatell J, Schwartzmann I, Bravo-Balado A, Subiela JD, Farré A, Moncada E, Martínez MJ, Palou J, Breda A, Ponce de León Roca J. Natural history of renal angiomyolipoma in a high-volume center: our experience during more than 15 years of follow up. Int Urol Nephrol 2024; 56:1551-1557. [PMID: 38085409 DOI: 10.1007/s11255-023-03839-z] [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: 08/26/2023] [Accepted: 10/03/2023] [Indexed: 04/09/2024]
Abstract
OBJECTIVES To describe the natural history of AML, the clinical results and the need for treatment during long-term follow-up of renal AML. METHODS Retrospective study of patients diagnosed with AML by computed tomography or nuclear magnetic resonance between 2001 and 2019, with at least two follow-up images. Clinical and imaging variables, need for intervention, complications and follow-up time were recorded. Statistical analysis was performed using SPSS 22.0. RESULTS 111 patients and 145 AML were included. The median follow-up was 6.17 years (range 0.7-18.1, IQR 11.8-12.2). The median tumor size at diagnosis was 13 mm (IQR 7.5-30), with 24 (16.4%) being ≥ 4 cm. Most presented as an incidental finding (85.5%); in 3 (2.1%) cases, the presentation was as a spontaneous retroperitoneal hematoma. The main indication for intervention was size ≥ 4 cm in 50%. Eighteen (12%) patients received a first intervention, being urgent in 3. Embolization was performed in 15 cases and partial nephrectomy in 3. The need for reintervention was recorded in five: two underwent partial nephrectomy and two total nephrectomy; one patient required a new urgent embolization. Of the non-operated patients, 43% decreased in size or did not change, while 57% increased, with the median annual growth being 0.13 mm (IQR - 0.11 to 0.73). There were no differences in the median growth in tumors measuring ≥ 4 cm (0.16 mm) at diagnosis vs. < 4 cm (0.13 mm) (p = 0.9). CONCLUSIONS The findings of this study suggest that AML typically demonstrate a slow-progressing clinical course during long-term follow-up. Moreover, our observations, which cast doubt on tumor size as a reliable predictor of adverse clinical outcomes, advocate for a less intensive monitoring strategy in both monitoring frequency and choice of imaging modality.
Collapse
Affiliation(s)
- Júlia Aumatell
- Urology Department, Hospital Universitario Rey Juan Carlos, Universidad Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - Iván Schwartzmann
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alejandra Bravo-Balado
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - José Daniel Subiela
- Urology Department, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain
| | - Alba Farré
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Enver Moncada
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - María José Martínez
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
- Radiology Department, Fundació Puigvert, Universidad Autónoma de Barcelona, Surgery Department, Barcelona, Spain
| | - Joan Palou
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Alberto Breda
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Javier Ponce de León Roca
- Urology Department, Fundació Puigvert, Surgery Department, Universidad Autónoma de Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Liao Z, Li J, Zhao Y, Wang Z, Wang X, Qiu D, Zhang Y. The association between computed tomography attenuation value of renal angiomyolipoma associated with tuberous sclerosis complex and response to everolimus. World J Urol 2024; 42:10. [PMID: 38183428 DOI: 10.1007/s00345-023-04708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The response to everolimus in patients with renal angiomyolipoma associated with tuberous sclerosis complex (TSC-RAML) varies among individuals. This study aims to identify potential factors associated with the response to everolimus. METHOD We retrospectively examined data encompassing age, gender, tumor size, computed tomography attenuation value (CT value), CT enhancement, and tumor reduction rate in patients with TSC-RAML undergoing everolimus in two previously registered clinical trials. RESULT A total of 33 participants (29.33 ± 6.63 years old, 20 females) were included. The correlation analysis conducted separately for tumors located in the left and right kidneys revealed significant negative correlations (P < 0.05) between tumor reduction rate and age, as well as tumor size. While significant positive correlations (P < 0.05) were observed between tumor reduction rate and unenhanced CT value as well as CT enhancement. Nonetheless, based on multiple linear regression analysis, unenhanced CT value emerged as the sole-independent predictor of tumor reduction rate among age, gender, tumor size, unenhanced CT value and CT enhancement for both left (coefficient = 0.00319, P < 0.0001) and right kidneys (coefficient = 0.00315, P = 0.0104). Notable reductions were observed in unenhanced CT value (- 3.81 vs - 24.70HU, P < 0.0001) and CT enhancement (48.16 vs 33.56HU, P < 0.0001) following a 3-month administration of everolimus. The decline in both unenhanced CT value and tumor size predominantly occurred within the initial 3 months, subsequently maintaining a relatively stable level throughout the treatment. CONCLUSION The unenhanced CT value of TSC-RAML showed an independent correlation with the response to everolimus, suggesting its potential as a predictor of everolimus efficacy in patients with TSC-RAML.
Collapse
Affiliation(s)
- Zhangcheng Liao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongxu Qiu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| |
Collapse
|
9
|
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
|
10
|
Osawa T, Oya M, Okanishi T, Kuwatsuru R, Kawano H, Tomita Y, Niida Y, Nonomura N, Hatano T, Fujii Y, Mizuguchi M, Shinohara N. Clinical Practice Guidelines for tuberous sclerosis complex-associated renal angiomyolipoma by the Japanese Urological Association: Summary of the update. Int J Urol 2023; 30:808-817. [PMID: 37278492 DOI: 10.1111/iju.15213] [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: 03/09/2023] [Accepted: 05/14/2023] [Indexed: 06/07/2023]
Abstract
New clinical issues have been raised through an interval of 7 years from the previous version (2016). In this study, we update the "Clinical Practice Guidelines for tuberous sclerosis complex-associated renal angiomyolipoma" as a 2023 version under guidance by the Japanese Urological Association. The present guidelines were cooperatively prepared by the Japanese Urological Association and Japanese Society of Tuberous Sclerosis Complex; committee members belonging to one of the two societies or specializing in the treatment of this disease were selected to prepare the guidelines in accordance with the "Guidance for preparing treatment guidelines" published by Minds (2020 version). The "Introduction" consisted of four sections, "Background Questions (BQ)" consisted of four sections, "Clinical Questions (CQ)" consisted of three sections, and "Future Questions (FQ)" consisted of three sections (total: 14 sections). Concerning CQ, an agreement was confirmed through voting by the committee members based on the direction and strength of recommendation, accuracy of evidence, and recommendation comments. The present guidelines were updated based on the current evidence. We hope that the guidelines will provide guiding principles for the treatment of tuberous sclerosis complex-associated renal angiomyolipoma to many urologists, becoming a foundation for subsequent updating.
Collapse
Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tohru Okanishi
- Division of Child Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, School of Medicine and Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Haruna Kawano
- Department of Urology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshihiko Tomita
- Department of Urology and Department of Molecular Oncology, Niigata University Graduate School of Medicine, Niigata, Japan
| | - Yo Niida
- Center for Clinical Genomics, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Hatano
- Department of Urology, Seirei Yokohama Hospital, Yokohama, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masashi Mizuguchi
- Department of Pediatrics, National Rehabilitation Center for Children with Disabilities, Tokyo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| |
Collapse
|
11
|
Kumar D, Mittal A, Panwar V, Talwar H, Singh GJ. Small Tumor, Major Complication: A Case of Spontaneous Perinephric Hematoma From a Small Renal Angiomyolipoma. Cureus 2023; 15:e44761. [PMID: 37809192 PMCID: PMC10556976 DOI: 10.7759/cureus.44761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
A renal angiomyolipoma is a benign kidney tumor composed of muscle, fat, and blood vessels. It is the most common benign kidney tumor, and it affects women more frequently than men. Angiomyolipomas can be small and asymptomatic, or they can be large, presenting with symptoms such as discomfort, hematuria, and hypertension. Occasionally, the rupture of an angiomyolipoma can cause a perinephric hematoma. This case report discusses a patient who developed a spontaneous large perinephric hematoma alongside a small renal angiomyolipoma. Aneurysm was seen on imaging. Angioembolization was successfully used for treatment. We explore the significance of the presence or absence of an aneurysm in predicting the risk of hemorrhage, particularly in association with small lesions. Angioembolization is an excellent choice for treating angiomyolipomas associated with significant hematomas.
Collapse
Affiliation(s)
- Deepak Kumar
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Ankur Mittal
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Vikas Panwar
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Harkirat Talwar
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| | - Gurpremjit J Singh
- Urology, All India Institute of Medical Sciences (AIIMS) Rishikesh, Rishikesh, IND
| |
Collapse
|
12
|
Mora S, Derweesh I, Meagher M, Javier-Desloges J, Noyes SL, Lane BR. Renal Functional Outcomes in Patients With Angiomyolipomas: Surveillance vs Embolization vs Nephrectomy. Urology 2023; 173:119-126. [PMID: 36572219 DOI: 10.1016/j.urology.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate renal functional outcomes of surveillance, embolization, and surgery for angiomyolipomas (AML). METHODS Longitudinal data regarding patients with AML were analyzed retrospectively in this 2-center study. Demographic, radiographic, and functional data were tabulated according to treatment type. Primary outcome was change in renal function from diagnosis to within 6 months postdiagnosis (interim) and to latest glomerular filtration rate (GFR) assessment. RESULTS 318 patients were diagnosed with AMLs; mean follow-up was 6.2 years. 184 patients (57.9%) were managed with surveillance, 30 (9.4%) underwent embolization, and 103 (32.4%) underwent surgery (91 partial nephrectomy; 12 radical nephrectomy). Baseline characteristics, including tumor size, age, and race differed between the 3 groups (P<.05). Surveilled AMLs were smaller (P<.001) than the intervention groups: 1.9 cm vs 5.4 cm (embolization) and 4.9 cm (surgery). Greater interim decreases in GFR were observed following intervention with embolization (-14.0%) or surgery (-11.8%), when compared with surveillance (-4.1%); however, this was not statistically significant (P=.19). Latest GFR was also reduced more (P=.02) with embolization (-14.1%) and surgery (-14.7%) when compared to surveillance (-6.0%). At latest determination, chronic kidney disease progression by at least one stage occurred in 37.8% overall, including 33.7% of surveilled patients, and was not statistically different across the three cohorts (P=.074). CONCLUSION Within the study limitations, surveillance appears to be appropriate for most AML patients; embolization and surgical intervention should be reserved for selected patients with large and/or symptomatic AML. Renal functional deterioration is common in patients with AML, whether managed with surveillance, embolization, or surgery. Long-term monitoring of renal function should be obligatory for all AML patients.
Collapse
Affiliation(s)
- Silvia Mora
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | | | | | | | | | - Brian R Lane
- Michigan State University College of Human Medicine, Grand Rapids, MI; Spectrum Health Hospital System, Grand Rapids, MI.
| |
Collapse
|
13
|
Fejes Z, Sánta F, Jenei A, Király IE, Varga L, Kuthi L. Angiomyolipoma of the kidney-Clinicopathological analysis of 52 cases. Pathol Oncol Res 2023; 28:1610831. [PMID: 36699622 PMCID: PMC9868137 DOI: 10.3389/pore.2022.1610831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
The renal angiomyolipoma (AML) is a benign tumor characteristically composed of fat, smooth muscle tissue, and vessels. We collected AMLs from our nephrectomy database, reclassified them according to their histological appearance, recorded the demographic, clinical, and pathological parameters, and compared them with oncocytoma (RO) and renal cell carcinoma (RCC). Immunohistochemistry was ordered in 41 cases. In 2224 nephrectomies, we found 52 AMLs with a 53 mm median size. The mean age was 52.76. Forty-eight tumors were sporadic, while four were hereditary. The revision resulted in 31 classic, 13 leiomyoma-like, five lipoma-like, two epithelioid, and one AML with epithelial cysts. SMA was diffusely positive, except for the epithelioid type, while MelanA harbored stronger expression than HMB45. AML was more frequent in females and appeared ten and 7 years earlier than RO and RCC, respectively. The follow-up time was 7.42 years, and neither tumor-related death nor relapse occurred. AML is rare in nephrectomies and develops primarily in females in their 50s with an average size of 50-60 mm at the surgery. The histological appearance in order of frequency is classic, leiomyoma-like, lipoma-like, epithelioid, and cystic. The MelanA, HMB45, and SMA immunohistochemistry can support the light-microscopic findings.
Collapse
Affiliation(s)
- Zsuzsanna Fejes
- Department of Radiology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Fanni Sánta
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Alex Jenei
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - István Előd Király
- Department of Urology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Linda Varga
- Department of Oncotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Levente Kuthi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary,*Correspondence: Levente Kuthi,
| |
Collapse
|
14
|
Sapadin AJ, Girzadas D, Chhabra D, Ahmed T. Ruptured angiomyolipoma, a novel entity for emergency physicians in the differential diagnosis of haemorrhagic shock in a female patient of reproductive age. BMJ Case Rep 2022; 15:15/8/e248626. [PMID: 35944938 PMCID: PMC9367167 DOI: 10.1136/bcr-2021-248626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A woman in her 30s presented to the emergency department with acute onset, progressively worsening left-sided abdominal pain after exercise. She was found to be hypotensive and diaphoretic, with free intraperitoneal fluid detected on bedside point-of-care ultrasound. Resuscitation was initiated, a presumptive diagnosis of ruptured ectopic pregnancy was made, and obstetrics and gynaecology were consulted. Point-of-care urine pregnancy testing, however, was negative, and subsequent CT angiography of the patient’s abdomen revealed an angiomyolipoma (AML) with active haemorrhage. Ultimately, embolisation was performed in the interventional radiology suite, with improvement of patient haemodynamics. Ruptured AML is a rare, life-threatening condition that needs to be included in the differential diagnosis of haemorrhagic shock in female patients of reproductive age presenting to the emergency department.
Collapse
Affiliation(s)
- Abby Jo Sapadin
- Emergency Department, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Daniel Girzadas
- Emergency Department, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Darshika Chhabra
- Nephrology, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| | - Tasneem Ahmed
- Emergency Department, Advocate Christ Medical Center, Oak Lawn, Illinois, USA
| |
Collapse
|
15
|
Zeid M, Sayedin H, Nabi N, Abdelrahman M, Jacob PT, Alhadi B, Giri S. Active Surveillance for Renal Angiomyolipoma Less Than 4 Centimeters: A Systematic Review of Cohort Studies. Cureus 2022; 14:e22678. [PMID: 35371642 PMCID: PMC8966366 DOI: 10.7759/cureus.22678] [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] [Accepted: 02/27/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this review is to evaluate the current evidence regarding the best management in terms of active surveillance of angiomyolipoma (AML) cases less than 4 cm, particularly the optimal timing of active surveillance. In addition, we aimed to describe their initial size, clinical presentation, and growth rates. The present systematic review included prospective and retrospective studies that evaluated and followed up patients with AML through active surveillance. Studies were retrieved through an online bibliographic search of the Medline database via PubMed, SCOPUS, Web of Science, and Cochrane Library from their inception to January 2022. Seven studies were included in the present systematic review. Concerning the active surveillance protocol, only four studies describe the frequency of active surveillance and the utilized imaging modality. Some studies followed up lesions by ultrasound annually for two to five years, while other studies followed-up patients twice for the first year, then annually for a median follow-up period of 49 (9-89) months. The used modalities were ultrasound, CT, and magnetic resonance imaging (MRI). Notably, the incidence of spontaneous bleeding was consistent across the included studies (ranging from 2.3 - 3.1%), except for one study which showed an incidence rate of 15.3%. In terms of the need for active treatment, the rate of active treatment was slightly higher in some studies than the others. However, this variation could not be considered clinically relevant to favor one surveillance strategy over the other. We concluded that active surveillance is the first line of management in all small asymptomatic ALMs. ALMs less than 2 cm do not require active surveillance. The current published literature suggested that active surveillance for two years may provide the same benefits as a five-year surveillance strategy, with fewer radiation hazards and less socioeconomic burden.
Collapse
Affiliation(s)
- Mohamed Zeid
- Urology, University Hospital Limerick, Limerick, IRL
| | - Hani Sayedin
- Urology, Warrington and Halton Teaching Hospitals National Health Service (NHS) Foundation Trust, Warrington, GBR
| | - Nauman Nabi
- Urology, University Hospital Limerick, Limerick, IRL
| | | | | | - Bassem Alhadi
- Emergency Department, Mater Misericordiae University Hospital, Dublin, IRL
| | - Subhasis Giri
- Urology, University Hospital Limerick, Limerick, IRL
| |
Collapse
|
16
|
Chung NKX, Metherall P, McCormick JA, Simms RJ, Ong ACM. OUP accepted manuscript. Clin Kidney J 2022; 15:1160-1168. [PMID: 35754971 PMCID: PMC9214570 DOI: 10.1093/ckj/sfac037] [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] [Received: 09/13/2021] [Indexed: 12/05/2022] Open
Abstract
Background Everolimus is a potential alternative to embolization and nephrectomy for managing tuberous sclerosis complex (TSC)-associated renal angiomyolipoma (AML). In 2016, National Health Service England approved its use through regional centres for renal AML ≥30 mm showing interval growth. Evidence of lesion stabilization or reduction after 6 months is mandated for continuation of long-term treatment. Methods From November 2016 to June 2021, all potentially eligible adult TSC patients with AML across Yorkshire and Humber were referred for assessment and monitoring. Eligible patients underwent baseline renal magnetic resonance imaging (MRI) assessment and a follow-up MRI scan after 6 months on everolimus. Dose titration was guided by trough levels and lesion responsiveness using a new 3D MRI volumetric protocol. Results Of 28 patients commencing treatment, 19 tolerated everolimus for >3 months. Overall, 11 patients (40%) discontinued treatment, mostly due to recurrent infections (42%) and allergic reactions (25%). Sixty-eight percent required dose adjustments from the initiating dose (10 mg) due to sub-optimal trough levels (38%), minimal AML response (15%) or adverse events (47%). 3D volumetric assessment confirmed a reduction in AML volume of a pre-selected index lesion in all treatment-naïve cases (n = 14), showing superiority over 2D measurements of lesion diameter. Conclusion In this cohort, everolimus promoted AML regression in all patients who tolerated the drug for >6 months with stabilization observed over 3 years. Trough levels enabled individual dose titration to maximize responsiveness and minimize side effects. The use of 3D MRI assessment of lesion volume was superior to 2D measurements of lesion diameter in monitoring treatment response.
Collapse
Affiliation(s)
- Noelle K X Chung
- The Medical School, University of Sheffield, Sheffield, UK
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Peter Metherall
- 3D Lab, Medical Imaging and Medical Physics, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Janet A McCormick
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Roslyn J Simms
- Sheffield Kidney Institute, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | |
Collapse
|
17
|
Menon P, Rao KLN, Nazki S, Behera S, Gupta K, Samujh R, Solanki S, Saxena A, Bansal D, Trehan A. Benign Renal Tumors in Pediatric Age Group: Retrospective Analysis. J Indian Assoc Pediatr Surg 2021; 26:380-392. [PMID: 34912134 PMCID: PMC8637978 DOI: 10.4103/jiaps.jiaps_214_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/26/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Benign renal tumors are extremely rare and were studied here. This series also includes a renal teratoma in a horseshoe kidney, probably only the second in the pediatric literature. Materials and Methods: Retrospective review of children with benign renal tumors operated between 2006 and 2018 at one center. Results: Twelve patients (M:F ratio 10:2), age range 3 weeks (31-week gestation) to 13 years presented with large palpable renal swelling (n = 12) and hematuria (n = 3). Computed tomography (CT) scan showed features typical of the tumor. Final histopathology (age group [mean]) showed: multilocular cystic nephroma (MLCN) - n = 5 (41.7%), (11–16 months [13.6]); congenital mesoblastic nephroma (CMN) - n = 4 (33.3%) (classic 1, cellular 3) (0.75–5 months [2.125]); mature cystic teratoma - n = 1 (8.3%): (48 months, in a horseshoe kidney), and angiomyolipoma (AML) - n = 2 (16.7%) (144 months [sporadic] and 156 months [tuberous sclerosis]) One patient with cystic teratoma with no calcification on CT scan received pre-operative chemotherapy as fine-needle aspiration cytology (FNAC) reported malignant small blue cell tumor. Nephroureterectomy with Gerota's fascia could be done easily in all without intraoperative complications. Delay in presentation in MLCN and CMN led to increased symptoms and CT scan changes. All patients did well in 1.5–12 years (median 3 years) follow-up including cellular mesoblastic nephroma. Conclusions: Benign renal tumors often occur in specific age groups but may overlap that of Wilms tumor. Proper interpretation of clinical presentation, CT scan, and FNAC findings help in avoiding preoperative chemotherapy. Upfront nephroureterectomy is curative. Histopathological findings decide further treatment. Children with AML and tuberous sclerosis need lifelong follow-up.
Collapse
Affiliation(s)
- Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Saalim Nazki
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Saswati Behera
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shailesh Solanki
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Saxena
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Department of Pediatric Hemato Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatric Hemato Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
18
|
Ma Y, Xu X, Pang P, Wen Y. A CT-Based Tumoral and Mini-Peritumoral Radiomics Approach: Differentiate Fat-Poor Angiomyolipoma from Clear Cell Renal Cell Carcinoma. Cancer Manag Res 2021; 13:1417-1425. [PMID: 33603485 PMCID: PMC7886092 DOI: 10.2147/cmar.s297094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 01/20/2021] [Indexed: 01/13/2023] Open
Abstract
Objective This study aimed to evaluate the role of tumor and mini-peritumor in the context of CT-based radiomics analysis to differentiate fat-poor angiomyolipoma (fp-AML) from clear cell renal cell carcinoma (ccRCC). Methods A total of 58 fp-AMLs and 172 ccRCCs were enrolled. The volume of interest (VOI) was manually delineated in the standardized CT images and radiomics features were automatically calculated with software. After methods of feature selection, the CT-based logistic models including tumoral model (Ra-tumor), mini-peritumoral model (Ra-peritumor), perirenal model (Ra-Pr), perifat model (Ra-Pf), and tumoral+perirenal model (Ra-tumor+Pr) were constructed. The area under curves (AUCs) were calculated by DeLong test to evaluate the efficiency of logistic models. Results The AUCs of Ra-peritumor of nephrographic phase (NP) were slightly higher than those of corticomedullary phase (CMP). Furthermore, the Ra-Pr showed significant higher efficiency than the Ra-Pf, and relative more optimal radiomics features were selected in the Ra-Pr than Ra-Pf. The Ra-tumor+Pr combined tumoral and perirenal radiomics analysis was of most significant in distinction compared with Ra-tumor and Ra-peritumor. Conclusion The validity of NP to differentiate fp-AML from ccRCC was slightly higher than that of CMP. To the NP analysis, the Ra-Pr was superior to the Ra-Pf in distinction, and the lesions invaded to the perirenal tissue more severely than to the perifat tissue. It is important to the individual therapeutic surgeries according to the different lesion location. The pooled tumoral and perirenal radiomics analysis was the most promising approach in distinguishing fp-AML and ccRCC.
Collapse
Affiliation(s)
- Yanqing Ma
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, People's Republic of China
| | - Xiren Xu
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, People's Republic of China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou, 310000, People's Republic of China
| | - Yang Wen
- Department of Radiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, 310000, People's Republic of China
| |
Collapse
|
19
|
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
|
20
|
Anton DG, Kovvuru K, Kanduri SR, Aeddula NR, Bathini T, Thongprayoon C, Kaewput W, Wijarnpreecha K, Watthanasuntorn K, Salim SA, Matemavi P, Vaitla P, Rivera FC, Cheungpasitporn W. Use and outcomes of kidneys from donors with renal angiomyolipoma: A systematic review. Urol Ann 2021; 13:67-72. [PMID: 33897168 PMCID: PMC8052899 DOI: 10.4103/ua.ua_14_20] [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: 02/23/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Renal angiomyolipoma (AML) is the most frequent mesenchymal tumor of the kidney. Although there is a rare possibility of malignant transformation of AML, this risk has not been studied in immunosuppressed patients. The safety of donors with AML and their kidney transplant recipients has not been well established. Methods: A literature search was conducted utilizing MEDLINE, EMBASE, and Cochrane databases from inception through May 15, 2018 (updated on October 2019). We included studies that reported the outcomes of kidney donors with AML or recipients of donor with AML. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42018095157). Results: Fourteen studies with a total of 16 donors with AML were identified. None of the donors had a diagnosis of tuberous sclerosis complex (TSC), pulmonary lymphangioleiomyomatosis (LAM), or epithelioid variant of AML. Donor age ranged from 35 to 77 years, and recipient age ranged from 27 to 62 years. Ninety-two percent of the donors were female. Only 8% were deceased donor renal transplant. The majority underwent ex vivo resection (65%) before transplantation, followed by no resection (18%), and the remaining had in vivo resection. Tumor size varied from 0.4 cm to 7 cm, and the majority (87%) were localized in the right kidney. Follow-up time ranged from 1 to 107 months. Donor creatinine prenephrectomy ranged 0.89–1.1 mg/dL and postnephrectomy creatinine 1.0–1.17 mg/dL. In those who did not have resection of the AML, tumor size remained stable. None of the donors with AML had end-stage renal disease or died at last follow-up. None of the recipients had malignant transformation of AML. Conclusion: These findings are reassuring for the safety of donors with AML (without TSC or LAM) as well as their recipients without evidence of malignant transformation of AML. As such, this can also positively impact the donor pool by increasing the number of available kidneys.
Collapse
Affiliation(s)
- Desiree Garcia Anton
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Karthik Kovvuru
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Swetha R Kanduri
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Narothama Reddy Aeddula
- Department of Medicine, Division of Nephrology, Deaconess Health System, Evansville, IN, USA
| | - Tarun Bathini
- Department of Internal Medicine, University of Arizona, Tucson, AZ, USA
| | | | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Sohail Abdul Salim
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Praise Matemavi
- Department of Department of Transplant and Hepatobiliary Surgery, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pradeep Vaitla
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Franco Cabeza Rivera
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Wisit Cheungpasitporn
- Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| |
Collapse
|
21
|
Lionberg A, Jeffries J, Van Ha TG. Renal Artery Embolization for Neoplastic Conditions. Semin Intervent Radiol 2020; 37:420-425. [PMID: 33041489 DOI: 10.1055/s-0040-1715884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Alex Lionberg
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - James Jeffries
- Department of Radiology, The University of Chicago, Chicago, Illinois
| | - Thuong G Van Ha
- Department of Radiology, The University of Chicago, Chicago, Illinois
| |
Collapse
|
22
|
Nason GJ, Morris J, Bhatt JR, Richard PO, Martin L, Ajib K, Tan GH, Jewett MAS, Jhaveri K, Zlotta AR, Lee JY, Perlis N, Hamilton RJ, Finelli A. Natural History of Renal Angiomyolipoma Favors Surveillance as an Initial Approach. Eur Urol Focus 2020; 7:582-588. [PMID: 32636160 DOI: 10.1016/j.euf.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Traditionally, intervention was recommended for angiomyolipomas (AMLs) >4 cm due to the risk of catastrophic hemorrhage. OBJECTIVE To delineate the natural history of AMLs, including growth rates and need for intervention. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was performed of an AML series from 2002 to 2013, which have been followed prospectively until 2018. We defined lesion size by maximum axial diameter and categorized lesion size at baseline. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS A total of 458 patients with 593 AMLs, with a median follow-up of 65.2 mo, were identified. At diagnosis, 534 (90.1%) lesions were ≤4 cm. Forty-three interventions were required for 34 (5.7%) AMLs: 30 were treated with embolization, seven surgery, two with radiofrequency ablation (RFA), three with mammalian target of rapamycin (mTOR) inhibitors, and one with nivolumab when epithelioid AML was confirmed. The median size at intervention was 4.9 cm (range 1.1-29 cm). RESULTS AND LIMITATIONS Most (94%) of the lesions grew slowly (growth rate of <0.25 cm/yr) during the period of observation. The number of AMLs <4 cm needed to treat (NNT) prophylactically to prevent one emergent bleed would have been 136 or that to prevent one blood transfusion would have been 205. The NNT (<4 cm) prophylactically to prevent one elective intervention would have been 82. On multivariate analysis, there were significant differences in intervention rates based on tuberous sclerosis complex, size at presentation, and clinical presentation. CONCLUSIONS This large single-institution updated series of renal AMLs demonstrates that early intervention is not required, regardless of the traditional 4 cm cut-off. The vast majority of AMLs are indolent lesions that are predominantly asymptomatic and slow growing. Follow-up should be no more frequent than annually. PATIENT SUMMARY The majority of angiomyolipomas (AMLs) are indolent, slow-growing lesions that do not require intervention, regardless of size at presentation. We suggest that surveillance is a safe initial approach for patients presenting with AMLs.
Collapse
Affiliation(s)
- Gregory J Nason
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jonathan Morris
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jaimin R Bhatt
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada; Department of Urology, University Hospital Ayr, Ayr, Scotland, UK
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada; Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke and Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Lisa Martin
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Guan Hee Tan
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Michael A S Jewett
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Kartik Jhaveri
- Division of Abdominal Imaging, Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Robert J Hamilton
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada
| | - Antonio Finelli
- Division of Urology, Department of Surgery, Princess Margaret Cancer Center, University of Toronto, ON, Canada.
| |
Collapse
|
23
|
Diamond M, Shin D, Wang J, Samuelsen B, LeBedis C. Imaging of Nontraumatic Upper Urinary Tract Emergencies. Semin Roentgenol 2020; 55:180-196. [PMID: 32438979 DOI: 10.1053/j.ro.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Donghoon Shin
- Department of Radiology, Boston Medical Center, Boston, MA
| | | | | | | |
Collapse
|
24
|
Zhang S, Lin T, Liu G, Zhang S, Guo H. Comparisons of the safety and effectiveness of robot-assisted versus laparoscopic partial nephrectomy for large angiomyolipomas: a propensity score-matched analysis. Int Urol Nephrol 2020; 52:1675-1682. [PMID: 32219641 DOI: 10.1007/s11255-020-02441-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/06/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) versus laparoscopic partial nephrectomy (LPN) for large angiomyolipomas (AMLs). MATERIALS AND METHODS We retrospectively evaluated 150 patients who were treated with either RAPN or LPN for large angiomyolipomas from 2014 to 2018. Propensity score matching was performed on age, gender, BMI, Charlson Comorbidity Index, tumour side and size, preoperative eGFR and RENAL score. RESULTS In total, 63 and 87 patients underwent RAPNs and LPNs, respectively. There were more large and complex AMLs in the RAPN cohort, with the median tumour maximal diameters and RENAL scores differing between the two groups (8 versus 7 cm and 9 versus 8, P = 0.01). After matching, the median warm ischemic time was significantly shorter in the RAPNs versus the LPNs (17 versus 22 min, P = 0.001). The rate of intraoperative complications in the RAPNs appeared lower than the LPNs (3.2% versus 8.1%). The median postoperative length of stay was significantly shorter in the RAPN cohort than the LPNs (P = 0.001). Twelve months after surgery, RAPNs received a 94.6% renal function prevention; while this was 90.8% in LPNs (P = 0.001). Subgroup analysis indicated that prior selective arterial embolization (SAE) was related to better renal function preservation in the RAPN cohort (P = 0.01). No recurrence occurred in either of the two cohorts. CONCLUSIONS RAPN is a safe and effective alternative to LPNs for large AMLs with a shorter warm ischemic time and higher renal preservation rate. Recurrence was equivalent in both RAPNs and LPNs.
Collapse
Affiliation(s)
- Shengjie Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Tingsheng Lin
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Guangxiang Liu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Shiwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, 321 Zhongshan Rd., Nanjing, 210008, Jiangsu, People's Republic of China.
| |
Collapse
|
25
|
Abou Heidar NF, Degheili JA, Khauli RB, Abi Saad G. A large bi-lobed classic renal angiomyolipoma with vena caval extension. Radiol Case Rep 2020; 15:353-361. [PMID: 32055259 PMCID: PMC7005504 DOI: 10.1016/j.radcr.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 12/31/2019] [Accepted: 01/07/2020] [Indexed: 11/21/2022] Open
Abstract
Renal angiomyolipomas (AMLs) are the most common benign renal tumors encountered, and composed of 3 components: mature adipose tissues, smooth muscles, and blood vessels. Mostly asymptomatic and discovered incidentally, the classic type of AMLs rarely extend to involve great vessels. Radiological confirmation of such lesions is paramount for diagnosis and planned intervention. Management of AMLs is based on clinical presentation and varies from active surveillance to invasive surgical interventions. A case of sizeable classic AML with extension to inferior vena cava is presented here, with successful tumor resection performed after complete liver mobilization. A literature review and a summary of similar cases are also presented. A multidisciplinary approach is required for proper and precise radiological diagnosis to achieve an adequate surgical resection, which might sometimes be complicated and complex, as in this current case.
Collapse
Affiliation(s)
- Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Raja B Khauli
- Division of Urology, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - George Abi Saad
- Division of General Surgery, Department of Surgery, American University of Beirut-Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| |
Collapse
|
26
|
Liu F, Yuan H, Li X, Tang J, Tian X, Ji K. A new management strategy for renal angiomyolipomas: superselective arterial embolization in combination with radiofrequency ablation. ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:766. [PMID: 32042782 DOI: 10.21037/atm.2019.11.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The present study analyzed the safety and efficacy of superselective arterial embolization (SAE) combined with radiofrequency ablation (RFA) to treat renal angiomyolipoma (RAML). Methods This retrospective study included the clinical data of 6 patients with RAML treated between March 2016 and October 2017. All patients underwent RFA treatment immediately after SAE guided by angio-computed tomography (angio-CT). The tumor size, renal function and complications, and time to recurrence were compared before and after treatment. Results The success rate of the SAE + RFA technique was 100%, and no serious complications were found during or after surgery. After treatment, the patients' symptoms, including low back pain and hematuria, were relieved. The pre-treatment creatinine level (55.6±11.0 µmol/L) did not differ significantly from the post-treatment creatinine level (68.2±13.7 µmol/L), which was measured 1 day after surgery (t=1.75, P=0.109). The mean follow-up time was 29.5±6.1 months. By the end of the follow-up period, the maximum diameter of the tumor was 3.1±0.6 cm, which was significantly smaller than the pre-treatment diameter of 5.9±1.01 cm (t=5.83, P<0.001). At 3 months after surgery, the maximum diameter of the tumor was reduced by 22-38% in all 6 patients. At the last follow-up examination, the maximum diameter of the tumor was reduced by 36-61%. Contrast-enhanced CT or magnetic resonance imaging scans showed that the enhanced part of the original lesion had disappeared, the renal parenchyma was full of even fat signals, and only one patient had new enhanced lesions at the site of the original lesions. Conclusions SAE combined with RFA is a safe and effective treatment for RAML, and its strengths qualify it to become a new treatment strategy for RAML.
Collapse
Affiliation(s)
- Fengyong Liu
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Hongjun Yuan
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Xin Li
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jing Tang
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Xiaomei Tian
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Kan Ji
- The First Medical Center of PLA General Hospital, Beijing 100853, China
| |
Collapse
|
27
|
Swärd J, Henrikson O, Lyrdal D, Peeker R, Lundstam S. Renal angiomyolipoma-patient characteristics and treatment with focus on active surveillance. Scand J Urol 2020; 54:141-146. [PMID: 31971051 DOI: 10.1080/21681805.2020.1716066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objectives: To present a patient material of renal angiomyolipoma (AML) with focus on the risk of bleeding during active surveillance (AS).Methods: Medical records, 1999-2014, were studied and 98 patients (80 female, 18 men) with renal AML were identified. Eleven patients had tuberous sclerosis complex (TSC). Mean age was 54 (13-89) years.Results: Sixty patients (61%) were asymptomatic at presentation, 33 (34%) presented with flank pain and five (5%) with hematuria. Retroperitoneal bleeding or hematuria was diagnosed in 20 patients with a mean AML size of 74 mm (25-200 mm). Twenty-one patients were treated with angioembolization at time of diagnosis and 25 had surgery. Forty-five patients with sporadic AML (mean size 34 mm) and six with TSC (mean size 120 mm) were selected for AS. Only one patient with sporadic AML (46 mm) had a bleeding, whereas two of the six TSC patients had bleedings from three kidneys (AML 70-300 mm). In 25 patients (49%), the AML-size increased with 2.7 mm/year in sporadic and 5.4 mm/year in TSC-associated AML. Thirteen patients were treated with AE (including all six TSC-patients) and five with surgery in 22 kidneys due to AML-size in 16, bleeding in four and suspicion of cancer in two.Conclusion: Bleeding occurred in 20% of AML at presentation. In patients selected for AS, we found a very low risk of bleeding in sporadic AML justifying our cut off size of 50 mm to trigger intervention. In TSC-associated AML individually tailored follow-up is needed due to a higher intervention rate.
Collapse
Affiliation(s)
- Jesper Swärd
- Department of Urology, NU-Hospital Group, Uddevalla, Sweden
| | - Olof Henrikson
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - David Lyrdal
- Department of Urology, Carlanderska Hospital, Gothenburg, Sweden
| | - Ralph Peeker
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven Lundstam
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
28
|
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
|
29
|
Anis O, Rimon U, Ramon J, Khaitovich B, Zilberman DE, Portnoy O, Dotan ZA. Selective Arterial Embolization for Large or Symptomatic Renal Angiomyolipoma: 10 Years of Follow-up. Urology 2019; 135:82-87. [PMID: 31618658 DOI: 10.1016/j.urology.2019.09.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/25/2019] [Accepted: 09/29/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess long-term outcome after selective arterial embolization (SAE) as first-line treatment for large or symptomatic AML. DESIGN, SETTING, AND PARTICIPANTS Data from a prospectively maintained database on 71 patients who underwent SAE for large or symptomatic AML were reviewed. Patients with sporadic and tuberous-sclerosis-complex (TSC) were included. OUTCOME MEASUREMENTS The main endpoints were re-embolization rates, occurrence of clinical events related to AML, size of AML, and renal function. RESULTS Thirteen (19.1%) patients reported at least 1 major clinical event. Major complications affected 2 patients (2.9%), both ending in complete loss of renal unit function. Four renal units (5.9%) were eventually treated surgically. The re-embolization rate was 41.1%, with an average time from the initial to a repeat SAE of 2.18 years (range 0.31-10.65 years). The size of the tumor prior to SAE and after 5 and 10 years of follow-up were 8.9 cm (7-12), 6.5 cm (4-7.5), 7 cm (4-7.8), respectively [median (IQR)]. These results are translated to a size reduction of 27% in 10 years follow-up. Patients with TSC had larger tumors on long-term follow-up (77.8 vs 41.3 mm, P = .045). The long-term follow-up estimated average glomerular filtration rate was 81.97 (range 26-196). No patient needed renal replacement therapy, and disease-specific survival was 100%. CONCLUSIONS SAE is a safe treatment option for patients with symptomatic or large AML. It represents a minimally invasive intervention with good long-term outcome. SAE may be offered as first-line treatment in most cases, though, it is associated with high retreatment rates.
Collapse
Affiliation(s)
- Omer Anis
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Uri Rimon
- Departments of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Jacob Ramon
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Khaitovich
- Departments of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Dorit E Zilberman
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Orith Portnoy
- Departments of Diagnostic Imaging, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zohar A Dotan
- Departments of Urology, Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
30
|
Percutaneous microwave ablation of renal angiomyolipomas in tuberous sclerosis complex to improve the quality of life: preliminary experience in an Italian center. Radiol Med 2018; 124:176-183. [DOI: 10.1007/s11547-018-0967-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/04/2018] [Indexed: 12/26/2022]
|
31
|
Hatfield BS, Mochel MC, Smith SC. Mesenchymal Neoplasms of the Genitourinary System: A Selected Review with Recent Advances in Clinical, Diagnostic, and Molecular Findings. Surg Pathol Clin 2018; 11:837-876. [PMID: 30447845 DOI: 10.1016/j.path.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Mesenchymal neoplasms of the genitourinary (GU) tract often pose considerable diagnostic challenges due to their wide morphologic spectrum, relative rarity, and unexpected incidence at GU sites. Soft tissue tumors arise throughout the GU tract, whether from adventitia surrounding or connective tissues within the kidneys, urinary bladder, and male and female genital organs. This selected article focuses on a subset of these lesions, ranging from benign to malignant and encompassing a range of patterns of mesenchymal differentiation, where recent scholarship has lent greater insight into their clinical, molecular, or diagnostic features.
Collapse
Affiliation(s)
- Bryce Shawn Hatfield
- Department of Pathology, VCU School of Medicine, 1200 East Marshall Street, PO Box 980662, Richmond, VA 23298, USA
| | - Mark Cameron Mochel
- Department of Pathology, VCU School of Medicine, 1200 East Marshall Street, PO Box 980662, Richmond, VA 23298, USA
| | - Steven Christopher Smith
- Departments of Pathology and Urology, VCU School of Medicine, 1200 East Marshall Street, PO Box 980662, Richmond, VA 23298, USA.
| |
Collapse
|
32
|
Short-term safety of mTOR inhibitors in infants and very young children with tuberous sclerosis complex (TSC): Multicentre clinical experience. Eur J Paediatr Neurol 2018; 22:1066-1073. [PMID: 30005812 DOI: 10.1016/j.ejpn.2018.06.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 06/08/2018] [Accepted: 06/18/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the safety of mTOR inhibitors (sirolimus or everolimus) in infants and very young children with tuberous sclerosis complex (TSC) under two years of age. METHODS Study design was retrospective to capture medical record data from 52 international TSC Centres who initiated treatment with sirolimus or everolimus in TSC children before the age of two years. Data collection included demographic and clinical information including reason(s) for initiating treatment with mTOR inhibitors, treatment duration, dosing, and corresponding serum trough levels, response to treatment, and adverse events (AE). RESULTS 19 of 52 (37%) TSC Centres reported treatment of at least one child with TSC under the age of two years with everolimus or sirolimus. Treatment-related data were provided for 45 patients meeting inclusion criteria. Everolimus was utilised 87% of the time, compared to 24% for sirolimus (5 subjects, 11%, were treated separately with both). Refractory epilepsy (45%) was the most common primary reason for initiating treatment and treatment was initiated on average at 11.6 ± 7.6 months of age. At least one AE, suspected or definitely treatment-related, occurred in 35 of 45 (78%) treated subjects. Most AEs were mild (Grade 1) or moderate (Grade 2) in severity and most commonly related to infections. Severe AE (Grade 3) was reported in 7 subjects (20%) and no life-threatening AE (Grade 4) or death/disability (Grade 5) was reported. Treatment was discontinued due to an AE in 9 of 45 (20%). CONCLUSIONS Everolimus, and to a lesser extent sirolimus, are increasingly being used to treat TSC infants and very young children for multiple TSC-associated clinical indications. While AEs were common, most were not severe and did not prevent continued treatment in the majority of this younger population.
Collapse
|
33
|
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
|
34
|
Chan KE, Chedgy ECP, Bent CL, Turner KJ. Surveillance imaging for sporadic renal angiomyolipoma less than 40 mm: lessons learnt and recommendations from the experience of a large district general hospital. Ann R Coll Surg Engl 2018; 100:480-484. [PMID: 29658337 PMCID: PMC6111918 DOI: 10.1308/rcsann.2018.0040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction Sporadic renal angiomyolipomas, although benign in natural can cause life-threatening spontaneous haemorrhage. Surveillance of smaller lesions is recommended but there is no guidance on the surveillance interval or modality. Our aim was to study our sporadic angiomyolipoma population to determine the growth rate, factors that were associated with a higher growth rate and design a surveillance programme. Materials and methods All sporadic renal angiomyolipomas diagnosed between September 2009 and March 2015 were included. Patients with a diagnosis of tuberous sclerosis were excluded. Results A total of 217 sporadic renal angiomyolipomas were diagnosed. The median follow-up was 24 months (range 10-118 months). The median size at diagnosis was 9.00 mm with a mean growth rate of 0.13 mm/year (standard deviation 0.88). One hundred and fifty angiomyolipomas (69%) were shown to have negative or zero growth. In the remaining 67, 59 had a growth rate of less than 2.00 mm/year. Size of angiomyolipoma, tumour burden and age were not associated with a higher growth rate on multivariate analysis. Conclusion The majority of sporadic angiomyolipomas are small and do not grow. Our practice is to perform surveillance for those greater than 20 mm, with five-yearly ultrasound scans for 21-29 mm, and two-yearly surveillance for 30-39 mm tumours.
Collapse
Affiliation(s)
- KE Chan
- Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
| | - ECP Chedgy
- Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
| | - CL Bent
- Department of Radiology, Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
| | - KJ Turner
- Department of Urology, Royal Bournemouth and Christchurch Hospitals NHS Trust, Bournemouth, UK
| |
Collapse
|
35
|
Kızılay F, Akıncıoğlu E, Aliyev E, Şimşir A. Tüberoz skleroz ile ilişkili anjiyolipoma rüptürüne bağlı kanamada girişimsel radyoloji. EGE TIP DERGISI 2018. [DOI: 10.19161/etd.414646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
36
|
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
|
37
|
Cockerell I, Guenin M, Heimdal K, Bjørnvold M, Selmer KK, Rouvière O. Renal manifestations of tuberous sclerosis complex: patients' and parents' knowledge and routines for renal follow-up - a questionnaire study. BMC Nephrol 2018; 19:39. [PMID: 29439672 PMCID: PMC5812037 DOI: 10.1186/s12882-018-0835-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal angiomyolipomas (AMLs) are a major clinical feature in patients with tuberous sclerosis complex (TSC). Spontaneous bleeding can be life threatening, and appropriate information and proper surveillance and management are important to limit morbidity and mortality. Because TSC is a rare disease, patients are at risk of suboptimal medical management. Our aim was to investigate patients' and parents' knowledge about renal angiomyolipomas (AMLs) in Tuberous Sclerosis Complex (TSC) and to identify current routines for renal follow-up. METHODS A questionnaire survey was initiated by the French Reference Centre on TSC. It was distributed in France through university hospitals and the patients' association (2009-2011), and to patients registered by the Norwegian National Centre for Rare Epilepsy-Related Disorders (2013-2014). Contingency tables with Chi-Square test for independence (with Yates Continuity Correction) and Pearson-Chi-Square value were used for correlation statistics. RESULTS We included 357 patients (France, n=257; Norway n=100). Most participants knew that TSC is associated with AMLs. However, 42 % did not know about the risk of AMLrelated bleeding, and 37 % had been informed about the risk of bleeding only after the age of 15 years. Furthermore, 14 % did not know whether they themselves or their child had AMLs. Patients had less knowledge than parents. Medical consultations and patient associations were the main sources of information. Among 30 % of patients, renal imaging was not received at all, or not conducted every 1-3 years, as recommended by current guidelines. Regular imaging was more frequent in patients with AMLs < 15 years, than in patients with AMLs ≥ 15 years. Ultrasound was the most frequently used imaging modality. CONCLUSIONS Knowledge of renal AML in TSC patients and their parents was lower than expected, and follow-up by renal imaging was suboptimal for a substantial proportion of patients. Patients and parents should be informed about the risk and symptoms of renal bleeding, at the latest when the patient is 15 years. Monitoring the growth of AMLs should be standardized to comply with guidelines. Transition between adolescence and adulthood is a high-risk period and ensuring appropriate follow-up at this time is particularly important.
Collapse
Affiliation(s)
- I Cockerell
- Department of Rare Disorders and Disabilities, Oslo University Hospital, National Centre for Rare Epilepsy-Related Disorders, Pb 4950, Nydalen, 0424, Oslo, Norway.
| | - M Guenin
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France
| | - K Heimdal
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - M Bjørnvold
- National Centre for Epilepsy, Division for Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - K K Selmer
- Department of Rare Disorders and Disabilities, Oslo University Hospital, National Centre for Rare Epilepsy-Related Disorders, Pb 4950, Nydalen, 0424, Oslo, Norway.,Department of Medical Genetics, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - O Rouvière
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Lyon, France
| |
Collapse
|
38
|
Factors associated with the number and size of renal angiomyolipomas in sporadic angiomyolipoma (sAML): a study of adult patients with sAML managed in a Dutch tertiary referral center. Int Urol Nephrol 2018; 50:459-467. [PMID: 29333579 PMCID: PMC5845070 DOI: 10.1007/s11255-017-1766-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/05/2017] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe the patient characteristics, treatments, disease monitoring, and kidney function of patients with sporadic angiomyolipoma (sAML), stratified by the number and size of renal angiomyolipomas (AMLs). METHODS Single-center retrospective analysis of patients with sAML treated from 1990 to 2015 in a dedicated clinic for inheritable tumor syndromes in a tertiary referral center from the Netherlands. Patients' first AML assessment at the clinic was defined as the index date. Patient characteristics were measured at the index date. Treatments, disease monitoring, and kidney function were measured post-index date. RESULTS The study sample included 53 patients followed for a total of 184.6 patient-years. At the index date, the largest AML was ≥ 3.5 cm for 26 patients and < 3.5 cm for 27 patients (including six patients with five or more AMLs of < 3.5 cm). As compared to patients with AMLs < 3.5 cm, patients with largest AML ≥ 3.5 cm had higher frequency of pre-index bleeding episodes (31 vs. 4%), pre-index hypertension (35 vs. 15%), post-index nephrectomy (19 vs. 4%), post-index embolization (8 vs. 0%), and post-index renal scans (1.14 vs. 0.74 scans/year). Kidney impairment was especially pronounced in young adults with AML ≥ 3.5 cm. On average, patients with sAML developed chronic kidney disease stage two earlier than the general Dutch population (age 42 vs. 55 years), but later than the patients with tuberous sclerosis complex (35 years). CONCLUSIONS Patients with sAML, especially those with larger AMLs, have high disease burden.
Collapse
|
39
|
Murray TE, Lee MJ. Are We Overtreating Renal Angiomyolipoma: A Review of the Literature and Assessment of Contemporary Management and Follow-Up Strategies. Cardiovasc Intervent Radiol 2017; 41:525-536. [PMID: 29260305 DOI: 10.1007/s00270-017-1862-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/14/2017] [Indexed: 12/13/2022]
Abstract
Renal angiomyolipoma (AML) are benign tumours composed of fat, muscle, and disorganised blood vessels. Historic treatment algorithms for sporadic AML based on size fail to consider additional risk factors such as tumour vascularity and pseudoaneurysm formation. As AML is now predominantly incidental, rupture is rare and its mortality low. The recent publication of the largest longitudinal series to date also suggest that growth is uncommon, challenging existing surveillance paradigms. The evidence assessing treatment strategies in AML are reviewed, with particular emphasis on incidental sporadic AML. The relative merits of various AML treatments are discussed, and areas of clinical uncertainty highlighted.
Collapse
Affiliation(s)
| | - Michael J Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland. .,Royal College of Surgeons in Ireland, Dublin, Ireland.
| |
Collapse
|
40
|
Taveira-DaSilva AM, Moss J. Addressing the challenges of lymphangioleiomyomatosis assessment in the clinic. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1400966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Angelo M. Taveira-DaSilva
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
41
|
Croghan SM, Orla McCormack, Walsh AL, Ted McDermott. Ascending cholangitis: rare presentation of a ruptured right-sided renal angiomyolipoma. J Surg Case Rep 2017; 2017:rjx191. [PMID: 29026516 PMCID: PMC5632343 DOI: 10.1093/jscr/rjx191] [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] [Received: 05/28/2017] [Accepted: 09/05/2017] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 46-year-old female who presented to the Emergency Department with acute, painful obstructive jaundice, with evidence of secondary ascending cholangitis. Surprisingly, imaging revealed the clinical picture to be caused not by hepatobiliary pathology, but by external compression of the biliary tree from a ruptured renal angiomyolipoma (AML) of the right kidney. The patient remained haemodynamically stable and conservative management saw resolution of biliary obstruction. We believe this to be the first report of a renal AML presenting in this way. This report highlights the diverse spectrum of presentations of renal angiomyolipomas.
Collapse
Affiliation(s)
| | - Orla McCormack
- Department of Surgery, St. James's Hospital, Dublin 8, Ireland
| | - Anna L Walsh
- Department of Urology, St. James's Hospital, Dublin 8, Ireland
| | - Ted McDermott
- Department of Urology, St. James's Hospital, Dublin 8, Ireland
| |
Collapse
|
42
|
Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches. Nephrourol Mon 2017. [DOI: 10.5812/numonthly.14251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
43
|
Bissler JJ, Kingswood JC, Radzikowska E, Zonnenberg BA, Belousova E, Frost MD, Sauter M, Brakemeier S, de Vries PJ, Berkowitz N, Voi M, Peyrard S, Budde K. Everolimus long-term use in patients with tuberous sclerosis complex: Four-year update of the EXIST-2 study. PLoS One 2017; 12:e0180939. [PMID: 28792952 PMCID: PMC5549893 DOI: 10.1371/journal.pone.0180939] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/21/2017] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES We examined the long-term effects of everolimus in patients with renal angiomyolipoma associated with tuberous sclerosis complex or sporadic lymphangioleiomyomatosis. METHODS Following favorable results from the double-blind core phase of EXIST-2 (NCT00790400), patients were allowed to receive open-label everolimus (extension phase). Patients initially randomly assigned to everolimus continued on the same dose; those who were receiving placebo crossed over to everolimus 10 mg/day. Dose modifications were based on tolerability. The primary end point was angiomyolipoma response rate, defined as a ≥50% reduction from baseline in the sum volume of target renal angiomyolipomas in the absence of new target angiomyolipomas, kidney volume increase of >20% from nadir, and angiomyolipoma-related bleeding grade ≥2. The key secondary end point was safety. RESULTS Of the 112 patients who received ≥1 dose of everolimus, 58% (95% CI, 48.3% to 67.3%) achieved angiomyolipoma response. Almost all patients (97%) experienced reduction in renal lesion volumes at some point during the study period. Median duration of everolimus exposure was 46.9 months. Sixteen (14.3%) patients experienced angiomyolipoma progression at some point in the study. No angiomyolipoma-related bleeding or nephrectomies were reported. One patient on everolimus underwent embolization for worsening right flank pain. Subependymal giant cell astrocytoma lesion response was achieved in 48% of patients and skin lesion response in 68% of patients. The most common adverse events suspected to be treatment-related were stomatitis (42%), hypercholesterolemia (30.4%), acne (25.9%), aphthous stomatitis and nasopharyngitis (each 21.4%). Ten (8.9%) patients withdrew because of an adverse event. Renal function remained stable, and the frequency of emergent adverse events generally decreased over time. CONCLUSIONS Everolimus treatment remained safe and effective over approximately 4 years. The overall risk/benefit assessment supports the use of everolimus as a viable treatment option for angiomyolipoma associated with tuberous sclerosis complex or sporadic lymphangioleiomyomatosis. TRIAL REGISTRATION ClinicalTrials.gov NCT00790400.
Collapse
Affiliation(s)
- John J. Bissler
- Department of Pediatric Nephrology, St. Jude Children’s Research Hospital, Le Bonheur Children’s Hospital, and the University of Tennessee Health Science Center, Memphis, Tennessee, United States of America
- * E-mail:
| | - J. Chris Kingswood
- Department of Nephrology, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Elzbieta Radzikowska
- Department of Lung Diseases, National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Bernard A. Zonnenberg
- Department of Internal Medicine, Universitair Medisch Centrum, Utrecht, The Netherlands
| | - Elena Belousova
- Department of Pediatrics, The Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Michael D. Frost
- Department of Pediatric Neurology, Minnesota Epilepsy Group, St. Paul, Minnesota, United States of America
| | - Matthias Sauter
- Department of Nephrology, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
| | | | - Petrus J. de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Noah Berkowitz
- Department of Oncology, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Maurizio Voi
- Department of Oncology, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States of America
| | - Severine Peyrard
- Department of Oncology, Novartis Pharmaceuticals S.A.S., Rueil-Malmaison, France
| | - Klemens Budde
- Department of Nephrology, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
44
|
Brandt MP, Tsaur I, Vallo S, Krimphove M, Frellesen C, Vogl T, Hoefner T, Bartsch G, Haferkamp A, Thomas C. Ruptured angiomyolipoma of the kidney: a rare differential diagnosis of flank pain. Scand J Urol 2017; 51:342-344. [DOI: 10.1080/21681805.2017.1304988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
| | - Igor Tsaur
- Department of Urology, University of Mainz, Mainz, Germany
| | - Stefan Vallo
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Marieke Krimphove
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Claudia Frellesen
- Department of Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Vogl
- Department of Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Thomas Hoefner
- Department of Urology, University of Mainz, Mainz, Germany
| | - Georg Bartsch
- Department of Urology, University of Mainz, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology, University of Mainz, Mainz, Germany
| | | |
Collapse
|
45
|
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]
|
46
|
Hoshii T, Morita S, Ikeda Y, Hasegawa G, Nishiyama T. Laparoscopic Retroperitoneal Nephron-Sparing Surgery Without Renal Artery Clamping with Preoperative Selective Arterial Embolization for Management of Right Renal Angiomyolipoma of Diameter 10 cm: A Case Report. J Endourol Case Rep 2017; 3:13-16. [PMID: 28265590 PMCID: PMC5314993 DOI: 10.1089/cren.2016.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 38-year-old female without the tuberous sclerosis complex was diagnosed with right renal angiomyolipoma of 10 cm in diameter. She underwent laparoscopic retroperitoneal nephron-sparing surgery without renal artery clamping with preoperative selective arterial embolization to avoid a significant risk of hemorrhage and the damage of the renal function during nephron-sparing surgery. The tumor was resected completely. The time taken to complete the procedure was 4 hours 11 minutes and blood loss was 780 mL. She was transfused 400 mL of autologous blood.
Collapse
Affiliation(s)
- Tatsuhiko Hoshii
- Department of Urology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Shinichi Morita
- Department of Gastroenterology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yohei Ikeda
- Department of Diagnostic Radiology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Go Hasegawa
- Pathology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Tsutomu Nishiyama
- Department of Urology, Niigata University Medical and Dental Hospital, Niigata, Japan
| |
Collapse
|
47
|
Abstract
Lymphangioleiomyomatosis is a rare multisystem disease predominantly affecting women that can occur sporadically or in association with tuberous sclerosis. Lung cysts progressively replace the lung parenchyma, which leads to dyspnea, recurrent pneumothorax, and in some cases respiratory failure. Patients may also have lymphatic disease in the thorax, abdomen, and pelvis, and renal angiomyolipomas. Treatment includes supportive care, bronchodilators, and for those with progressive disease, mammalian target of rapamycin (mTOR) inhibitors.
Collapse
|
48
|
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
|
49
|
Golan S, Johnson SC, Maurice MJ, Kaouk JH, Lai WR, Lee BR, Kheyfets SV, Sundaram CP, Cahn DB, Uzzo RG, Shalhav AL. Safety and early effectiveness of robot-assisted partial nephrectomy for large angiomyolipomas. BJU Int 2017; 119:755-760. [DOI: 10.1111/bju.13747] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Shay Golan
- Section of Urology; University of Chicago; Chicago IL USA
| | | | - Matthew J. Maurice
- The Glickman Urological & Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Jihad H. Kaouk
- The Glickman Urological & Kidney Institute; Cleveland Clinic; Cleveland OH USA
| | - Weil R. Lai
- Department of Urology; Tulane University; New Orleans LA USA
| | - Benjamin R. Lee
- Department of Urology; Tulane University; New Orleans LA USA
| | | | | | - David B. Cahn
- Division of Urologic Oncology and Urology; Fox Chase Cancer Center; Philadelphia PA USA
| | - Robert G. Uzzo
- Division of Urologic Oncology and Urology; Fox Chase Cancer Center; Philadelphia PA USA
| | | |
Collapse
|
50
|
Sheth RA, Feldman AS, Paul E, Thiele EA, Walker TG. Sporadic versus Tuberous Sclerosis Complex–Associated Angiomyolipomas: Predictors for Long-Term Outcomes following Transcatheter Embolization. J Vasc Interv Radiol 2016; 27:1542-9. [DOI: 10.1016/j.jvir.2016.05.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/21/2016] [Accepted: 05/21/2016] [Indexed: 01/08/2023] Open
|