1
|
Combes A, McQueen S, Palma CA, Benz D, Leslie S, Sved P, Boulas J, Vasilaras A, Rogan C, Drivas I, Eisinger DR, Waugh R. Is Size All That Matters? New Predictors of Complications and Bleeding in Renal Angiomyolipoma. Res Rep Urol 2023; 15:113-121. [PMID: 36968628 PMCID: PMC10038158 DOI: 10.2147/rru.s400730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/04/2023] [Indexed: 03/22/2023] Open
Abstract
Purpose Renal angiomyolipoma (AML) is the most common benign renal tumor. Whilst generally asymptomatic, they can cause life-threatening bleeding. Selective angioembolization (SAE) may be used to treat large symptomatic and asymptomatic AMLs. We aimed to evaluate the efficacy of SAE for symptomatic and asymptomatic renal AMLs and determine characteristics that predict spontaneous bleeding. Patients and Methods Data were retrospectively collected from a prospectively maintained database from July 2011 to April 2022. Patients were included if AML was >4cm and they underwent subsequent SAE. Follow-up imaging was analyzed to calculate mean reduction in AML size. Clinical notes were reviewed to analyze lesion characteristics including vascularity, fat content and presence of aneurysm as well as post-procedural complications. Results 26 patients with 30 AMLs were identified. Interval of follow-up imaging ranged from 1 to 60 months. 25 AMLs were embolized electively with 5 emergency embolizations performed for bleeding. Mean reduction in AML volume was 41% at 3 months (p=0.013) and 63% at 12 months (p=0.007). All 5 bleeding AMLs had a rich vascularity with 60% also having either aneurysms or a low fat content. Complications included post-embolic syndrome (n=9), segmental renal parenchyma devascularization (n=3), acute bleeding requiring re-embolization (n=2), nephrectomy for ongoing bleeding (n=1) and delayed bleeding managed conservatively (n=1). No deterioration in renal function was observed. Conclusion SAE is an effective procedure for managing symptomatic and asymptomatic renal AML, with minimal significant complications. AML vascularity, fat content and aneurysms may be useful characteristics to assess future risk of bleeding in patients with renal AML.
Collapse
Affiliation(s)
- Alexander Combes
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- Correspondence: Alexander Combes, Department of Urology, Royal Prince Alfred Hospital, 50 Missenden Road, Camperdown, NSW, 2050, Australia, Tel +612 9515 7773, Fax +612 9515 7774, Email
| | - Simon McQueen
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | | | - David Benz
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- RPA Institute of Academic Surgery, Sydney, NSW, Australia
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Paul Sved
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - John Boulas
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Arthur Vasilaras
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Chris Rogan
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
- Department of Urology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Ilias Drivas
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - David Robert Eisinger
- Department of Urology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Richard Waugh
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| |
Collapse
|
2
|
Nozadze G, Larsen SB, Heerwagen S, Juhl Jensen R, Lönn L, Røder MA. Selective arterial embolization of renal angiomyolipomas: A 10‐year experience. BJUI COMPASS 2021; 3:86-92. [PMID: 35475158 PMCID: PMC8988688 DOI: 10.1002/bco2.107] [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: 04/21/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives To study safety and efficacy of selective endovascular trans‐arterial embolization (TAE) of renal angiomyolipoma (AML) in a 10‐year period at a regional tertiary referral center in Denmark. Patients and methods All 56 patients who underwent TAE of renal AML at Departments of Urology and Radiology, Copenhagen University Hospital – Rigshospitalet, Denmark, from 2009 to 2020 were included. Seven without preoperative and postoperative imaging were excluded, leaving 49 patients for analysis. From national electronic medical records, we retrieved patient characteristics, surgical data, and follow‐up data. Tumor size at the time of embolization and during follow‐up was compared using Student's paired t test. Estimated glomerular filtration rate (eGFR) pre‐ and post‐embolization were compared using Wilcoxon rank sum test. Results We included 49 patients of whom 4 had two tumors treated in the same TAE procedure. Median age was 50 years (interquartile range [IQR]: [29–67 years]), and the median follow‐up time was 4.6 years [IQR: 3.0–6.7 years]. Post‐embolization syndrome (PES) was experienced in 27 patients, and non‐PES in 5 patients. Median length of hospital stay was 0 days [IQR, 0–1]. Postoperative Everolimus immunosuppressive treatment was offered to seven patients. Median tumor size was 6.0 cm [IQR: 4.6–7.9 cm] and was significantly reduced to 3.7 cm [IQR: 2.5–5.2 cm] after treatment (p < 0.001). Kidney function was not affected by TAE. Three deaths, not related to AML, were noted during follow‐up. Conclusion Embolization of AML was in this cohort effective to significantly reduce tumor size without serious adverse events and loss of renal function. TAE is a safe and efficacious treatment and the preferred minimally invasive treatment option of AML.
Collapse
Affiliation(s)
- Guram Nozadze
- Department of Urology, Urological Research Unit Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Signe Benzon Larsen
- Department of Urology, Urological Research Unit Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Søren Heerwagen
- Department of Radiology Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Ruben Juhl Jensen
- Department of Radiology Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Lars Lönn
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
- Department of Radiology Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit Copenhagen University Hospital – Rigshospitalet Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| |
Collapse
|
3
|
Hsieh B, Tariq MB, Ibrahim L, Khanpara SD, Kramer LA, Savitz SI. Heparin for Vertebral Intraluminal Thrombus Causing Retroperitoneal Hemorrhage from Occult Renal Angiomyolipoma. Case Rep Neurol 2021; 13:388-393. [PMID: 34248575 PMCID: PMC8255730 DOI: 10.1159/000514090] [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: 12/02/2020] [Accepted: 12/25/2020] [Indexed: 11/20/2022] Open
Abstract
Stroke is a common cause of mortality and serious long-term disability worldwide. In the acute setting, current American Heart Association/American Stroke Association guidelines do not recommend routine anticoagulation for the management of acute ischemic strokes. However, short-term use of unfractionated heparin (UFH) in select subpopulations has demonstrated improved outcomes. While tools such as CHADSVASC and HASBLED scores are useful in stratifying risk of long-term anticoagulation in patients with nonvalvular atrial fibrillation and additional risk factors, the carefully selected patient populations for the design of these studies do not account for risk of hemorrhage from other preexisting conditions. Here, we present a patient with a posterior circulation intraluminal thrombus treated with UFH, who manifested with a near-fatal intra-abdominal hemorrhage from a previously undetected renal angiomyolipoma (AML).
Collapse
Affiliation(s)
- Billie Hsieh
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
| | - Muhammad B Tariq
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
| | - Lamya Ibrahim
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
| | - Shekhar D Khanpara
- Department of Radiology, The University of Texas Health Science Center, Houston, Texas, USA
| | - Larry A Kramer
- Department of Radiology, The University of Texas Health Science Center, Houston, Texas, USA
| | - Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, The University of Texas Health Science Center, Houston, Texas, USA
| |
Collapse
|
4
|
Shimohira M, Nagai K, Ohta K, Sawada Y, Naiki T, Nagai T, Yasui T, Shibamoto Y. Use of microspheres in embolization for unruptured renal angiomyolipomas. Open Med (Wars) 2021; 16:655-659. [PMID: 33977148 PMCID: PMC8060982 DOI: 10.1515/med-2021-0280] [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: 11/04/2020] [Revised: 03/07/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe our initial experience with use of microspheres in transcatheter arterial embolization (TAE) for unruptured sporadic renal angiomyolipomas (AMLs). Materials and methods Seven consecutive patients with seven unruptured sporadic renal AMLs, 6 females and 1 male, with a median age of 45 years (range, 30–69 years), underwent TAE using microspheres between November 2016 and February 2020. We evaluated the technical success rate, complications related to the procedure, clinical success rate, and the shrinkage rate of renal AML. Technical success was defined as the completion of TAE. Clinical success was defined as presence of shrinkage of the renal AML after TAE. Results In all patients, TAE using microspheres was accomplished and technical success rate was 100% (7/7). Three patients exhibited slight pain, but it improved with only observation, and the minor complication rate was 43% (3/7) and major complication rate was 0% (0/7). After the TAE, shrinkage of renal AML was confirmed in 6 of 7 patients, and clinical success rate was 86% (6/7). The median of shrinkage rate was 47% (range, 26–83%) with a median follow-up period of 19 months (range, 4–30 months). Conclusion TAE using microspheres appears to be effective and safe for unruptured sporadic renal AMLs.
Collapse
Affiliation(s)
- Masashi Shimohira
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Keiichi Nagai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Kengo Ohta
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Yusuke Sawada
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Taku Naiki
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takashi Nagai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| |
Collapse
|
5
|
Liulytė A, Žalimas A, Meškauskas R, Ušinskienė J, Jankevičius F. Partial nephrectomy can be a successful treatment option for renal epithelioid angiomyolipoma: a case report and literature review. Acta Med Litu 2020; 27:33-38. [PMID: 32577094 DOI: 10.6001/actamedica.v27i1.4264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Renal epithelioid angiomyolipoma is a rare tumour which involves kidneys in most cases. It is known for its aggressive behaviour as a significant number of cases have been associated with metastatic epithelioid angiomyolipoma. Usually, radical treatment with systemic therapy is recommended. Only a small number of cases of epithelioid angiomyolipomas have been reported with the standard treatment being radical or partial nephrectomy. We present a case report showing that partial nephrectomy can be a successful treatment option for renal epithelioid angiomyolipoma. This is the first case of this nature in Lithuania. Case presentation In this case, a 40-year-old male with epithelioid angiomyolipoma of the left kidney is presented. In 2012, a cystic left renal mass 40 × 41 mm in size was diagnosed incidentally while performing ultrasound and later confirmed by MRI. Due to the size of the tumour and the possibility of renal cell carcinoma, surgery was scheduled. Left partial nephrectomy was performed successfully. Final pathology report came back with the diagnosis of renal epithelioid angiomyolipoma. The patient had yearly follow-up for six years by CT scan, and neither recurrence nor progression were observed. Conclusions Early detection and diagnosis are crucial for treatment as the tumour tends to have malignancy potential. With early diagnosis, partial nephrectomy can be performed with yearly follow-up and no systemic treatment required.
Collapse
Affiliation(s)
| | - Algirdas Žalimas
- Life Sciences Centre, Vilnius University, Vilnius, Lithuania.,Department of Radiology, National Cancer Institute, Vilnius, Lithuania
| | - Raimundas Meškauskas
- National Centre of Pathology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Feliksas Jankevičius
- Urology Centre, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
6
|
Barnett JR, Grinspoon RA, Harisinghani M, Caruso PA, Thiele EA. The efficacy of cannabidiol on renal angiomyolipoma and subependymal giant cell tumor volume in tuberous sclerosis complex. J Clin Neurosci 2020; 77:85-88. [PMID: 32409220 DOI: 10.1016/j.jocn.2020.05.030] [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: 03/10/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
In patients with tuberous sclerosis complex (TSC) the upregulation of the mechanistic target of rapamycin (mTOR) pathway leads to the development and growth of subependymal giant cell tumors (SGCTs) and renal angiomyolipomas (AMLs). Drugs that inhibit the mTOR pathway, such as sirolimus, can reduce the size of both SGCTs and AMLs. Recent preclinical studies have suggested cannabidiol (CBD) may mediate the mTOR pathway, however, its exact effects are unclear. This study examines the volumes of SGCTs and renal AMLs in patients with TSC during treatment with purified CBD for refractory epilepsy. We retrospectively reviewed the medical records of patients with TSC with radiological evidence of AMLs and SGCTs who were being treated with plant-derived highly purified CBD in oral solution (Epidiolex®, GW Research Ltd) for refractory epilepsy at Massachusetts General Hospital. Patients who had surgical intervention for AMLs or SGCTS, and patients who had been treated with mTOR inhibitors were excluded. The volumes of SGCTs and dominant renal AML were measured before and after CBD initiation using abdominal and brain scans and compared. Patient demographics and CBD doses were collected from medical records. Six out of the seven dominant renal AMLs and three out of the three SGCTs increased in volume during CBD treatment. One AML had a decrease in volume after CBD initiation which was not considered significant. The results suggest that unlike mTOR inhibitors, CBD treatment does not decrease the volume of SGCTs or AMLs in TSC patients.
Collapse
|
7
|
Sanampudi S, Raissi D. Optimal Ethanol-Ethiodol Emulsion Ratio in Renal Angiomyolipoma Embolization: A Question that Remains Unanswered. J Clin Imaging Sci 2019; 9:16. [PMID: 31448167 PMCID: PMC6702862 DOI: 10.25259/jcis-21-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/08/2019] [Indexed: 11/30/2022] Open
Abstract
The authors, a case series of five cases of angiomyolipomas (AMLs), embolized with a high ethanol:ethiodol ratio of 6:1 emulsion at a single tertiary center. Although ethanol as an embolic agent has been reported in the past for AMLs, much higher ratios of ethiodol were used, and administration is typically performed using an occlusion balloon. Two of the patients were incidentally diagnosed, while the other four were diagnosed after hematuria workup. Of the five patients, only one developed postembolization syndrome. Otherwise, no complications, recurrences, or reinterventions are reported. Our higher ratio seems to allow for adequate radio-opacity of the emulsion with minimal negative dilution effect.
Collapse
Affiliation(s)
- Sreeja Sanampudi
- UK Medical Center MN 150, University of Kentucky College of Medicine, University of Kentucky, Lexington, Kentucky, United States
| | - Driss Raissi
- Department of Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, United States
| |
Collapse
|
8
|
Lin L, Li X, Guan H, Wang J, Tong X, Yang M, Zou Y. Renal function, complications, and outcomes of a reduction in tumor size after transarterial embolization for renal angiomyolipomas: a meta-analysis. J Int Med Res 2019; 47:1417-1428. [PMID: 30898061 PMCID: PMC6460598 DOI: 10.1177/0300060519834447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/07/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE The present study aimed to evaluate renal function, complications, and changes in tumor size after transarterial embolization for patients with renal angiomyolipomas. METHODS We performed a meta-analysis of transarterial embolization in patients with renal angiomyolipomas from January 1994 to April 2018. Endpoints of interest were the estimated glomerular filtration rate, serum creatinine levels, blood urea nitrogen levels, complications, and reduction of tumors. RESULTS A total of 30 studies comprising 653 patients were included. A total of 32.0% of patients were treated by urgent transarterial embolization for spontaneous ruptured renal angiomyolipomas. Other patients sought to relieve symptoms or received embolism prophylactically. The estimated glomerular filtration rate showed no significant difference between before and after embolization. In 363 patients with data on complications, post-embolization syndrome occurred most frequently (54.0%). Only 16 (4.4%) patients had major complications. The diameter of sporadic angiomyolipomas was reduced by a mean of 2.09 cm (95% confidence interval [CI], 0.73-3.45 cm; I2 = 29.3%) and they were reduced in size by 30.0% (95% CI, 16.0%-44.0%; I2 = 27.9%). CONCLUSIONS Transarterial embolization of renal angiomyolipomas affects renal function preservation, with a low complication rate. Transarterial embolization is useful for sporadic and tuberous sclerosis complex-related angiomyolipomas.
Collapse
Affiliation(s)
| | | | - Haitao Guan
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China
| | - Jian Wang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China
| | - Xiaoqiang Tong
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China
| | - Min Yang
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China
| | - Yinghua Zou
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, P.R. China
| |
Collapse
|
9
|
Use of a mixture of Lipiodol and Cyanoacrylate in percutaneous embolization treatment of symptomatic renal Angiomyolipomas: Our experience. Radiol Case Rep 2018; 14:343-347. [PMID: 30581521 PMCID: PMC6297069 DOI: 10.1016/j.radcr.2018.11.019] [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: 10/04/2018] [Revised: 11/17/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose of this report is to describe safety and effectiveness of selective artery embolization in the treatment of bleeding angiomyolipomas (AMLs) of the kidney using a mixture of Lipiodol and Cyanoacrylate. Two patients with bleeding AMLs underwent to superselective embolization of the lesions using microcatheter and Lipiodol mixed with Cyanoacrylate in the ratio 3:1. Primary bleeding control rate was 100% with no major complications. Follow-up CT (mean time 18 months) demonstrated a significant reduction in size (about 50%) of the lesions. In conclusion, selective artery embolization with Lipiodol and Cyanoacrylate appear to be safe and effective in the treatment of bleeding AMLs.
Collapse
|
10
|
The Risks of Renal Angiomyolipoma: Reviewing the Evidence. J Kidney Cancer VHL 2017; 4:13-25. [PMID: 29090118 PMCID: PMC5644357 DOI: 10.15586/jkcvhl.2017.97] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 09/23/2017] [Indexed: 12/26/2022] Open
Abstract
Renal angiomyolipoma (RAML), though a rare benign tumor, may impose a significant morbidity or even mortality due to its unique characteristics and the complications subsequent to its treatment. The classic tumor variant is composed of smooth muscular, vascular, and fatty components. The most straightforward diagnosis is when the fat component is abundant and gives a characteristic appearance on different imaging studies. In fat-poor lesions, however, the diagnosis is difficult and presumed a renal cell carcinoma. Yet, some variants of RAML, though rare, express an aggressive behavior leading to metastasis and mortality. The challenge lies in the early detection of benign variants and identifying aggressive lesions for proper management. Another challenge is when the vascular tissue component predominates and poses a risk of hemorrhage that may extend to the retroperitoneum in a massive life-threatening condition. The predicament here is to identify the characteristics of tumors at risk of bleeding and provide a prophylactic treatment. According to the clinical presentation, different treatment modalities, prophylactic or therapeutic, are available that span the spectrum of observation, embolization, or surgery. Renal impairment may result from extensive tumor burden or as a complication of the management itself. Improvement of diagnostic techniques, super-selective embolization, nephron-sparing surgery, and late treatment with the mammalian target of rapamycin inhibitors have provided more effective and safe management strategies. In this review, we examine the evidence pertaining to the risks imposed by RAML to the patients and identify merits and hazards associated with different treatment modalities.
Collapse
|
11
|
Partial Nephrectomy for a Massive Sporadic Renal Angiomyolipoma: Case Report and Review of the Literature. Case Rep Urol 2016; 2016:3420741. [PMID: 28070443 PMCID: PMC5192326 DOI: 10.1155/2016/3420741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 11/23/2016] [Indexed: 12/26/2022] Open
Abstract
Introduction. Angiomyolipomas are the most common benign tumor of the kidney, associated with Tuberous Sclerosis in 20% of cases and arising sporadically in 80% of cases. Renal angiomyolipomas are neoplasms of mesenchymal origin with varying proportions of vasculature, smooth muscle spindle cells, and adipocytes, making management of such neoplasms a challenging endeavor. Possible management options include partial or radical nephrectomy and segmental renal artery embolization. Case Presentation. A 61-year-old woman admitted for a large retroperitoneal hemorrhage was discovered to have a giant, sporadic, 3818.3 g, 30.0 × 26.5 × 18.0 cm left perinephric angiomyolipoma. Given her hemodynamic instability upon presentation, she underwent segmental arterial embolization, followed by an open left partial nephrectomy. Ten-month follow-up revealed no noticeable loss of renal function. Discussion. Literature review revealed occasional renal angiomyolipomas of comparable size, with all angiomyolipomas larger than this requiring treatment with radical nephrectomy. Conclusion. We show that nephron-sparing surgery may be considered in the treatment of even the largest of renal angiomyolipomas.
Collapse
|