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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.
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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
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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.
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Affiliation(s)
- Takashi Hatano
- Department of Urology, JR Tokyo General Hospital, Japan.
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Japan
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Application of Everolimus in Preoperative Neoadjuvant Therapy of Tuberous Sclerosis Complex Associated With Renal Angiomyolipoma: A Single-Center Report of 5 Cases. Clin Genitourin Cancer 2019; 17:e1099-e1103. [DOI: 10.1016/j.clgc.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
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Effect of everolimus treatment for regrown renal angiomyolipoma associated with tuberous sclerosis complex after transcatheter arterial embolization. Int J Clin Oncol 2018; 23:1134-1139. [PMID: 30069798 DOI: 10.1007/s10147-018-1325-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the effects and the utility of second-line everolimus treatment for regrown renal angiomyolipoma (AML) with tuberous sclerosis complex (TSC) after transcatheter arterial embolization (TAE). METHODS We investigated a total of 14 patients who underwent second-line everolimus treatment for TSC-AML that regrew after TAE, and assessed their effects and adverse events. Everolimus treatment was performed for AML with a maximum diameter of 4 cm. To determine the reduction ratio of AML, the volume of AML was measured using multislice helical computed tomography. Adverse events were evaluated according to CTCAE v4.0-JCOG. We further compared the treatment effect and adverse events with those in patients receiving first-line everolimus treatment. RESULTS The AML volume decreased in all patients, with a ≥ 50% volume decrease in 57% (8 of 14) of the cases, and the mean reduction rate was 53%. We observed no significant difference in the mean reduction rate of AML between second-line everolimus treatment for regrown TSC-AML after TAE and first-line everolimus treatment for TSC-AML. The adverse events were mild and consistent with those reported in our previous study. CONCLUSION Although further studies are needed, everolimus appears to be effective as second-line treatment for TSC-AML that regrew after TAE and a beneficial treatment option for TSC-AML.
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Chen SL, Hsiao WC, Tsai JD, Wang SC. Mammalian target of rapamycin inhibitor and transarterial embolization for treatment of tuberous sclerosis complex patients with renal angiomyolipoma. UROLOGICAL SCIENCE 2018. [DOI: 10.4103/uros.uros_19_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang L, Ni D, Zhong L, Wang J. Familial genetic tuberous sclerosis complex associated with bilateral giant renal angiomyolipoma: A case report. Oncol Lett 2017; 14:7099-7106. [PMID: 29344140 PMCID: PMC5754900 DOI: 10.3892/ol.2017.7165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 06/09/2017] [Indexed: 11/06/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disease involving multiple organs, but there are a limited number of reports on family TSC. In the present report, a case of a 52-year-old female with a familial genetic TSC, associated with bilateral giant renal angiomyolipoma, was described. The mother, second elder brother and daughter of the patient all exhibited TSC, but the clinical manifestations, and therapeutic prognosis between the family members were not the same. The present case report aimed at identifying an effective diagnostic method and treatment through additional study of familial genetic TSC, in order to prolong and improve the quality of life for patients with TSC. According to the present case and relevant literature reviews, it is suggested that fetal gene detection during pregnancy could prevent the passing of this disease onto further generations. Furthermore, early application of drug treatment may control the development of the disease in diagnosed patients. The combination of classical treatments with a small dose of mammalian target of rapamycin inhibitors is the typical recommendation, which may control the development of the disease more effectively and decrease adverse side-effects.
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Affiliation(s)
- Lina Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Dawei Ni
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China.,Department of Urology, The Second People's Hospital of Hefei, Hefei, Anhui 230011, P.R. China
| | - Lin Zhong
- Department of Pathology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
| | - Jianbo Wang
- Department of Urology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, P.R. China
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Hatano T, Inaba H, Endo K, Egawa S. Intermittent everolimus administration for renal angiomyolipoma associated with tuberous sclerosis complex. Int J Urol 2017; 24:780-785. [PMID: 28905429 DOI: 10.1111/iju.13428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/02/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effects and utility of intermittent everolimus treatment for renal angiomyolipoma associated with tuberous sclerosis complex. METHODS We investigated a total of 26 patients with tuberous sclerosis complex who had angiomyolipoma ≥4 cm in diameter. For each patient, we analyzed the reduction in the size of the angiomyolipoma, the change in size after everolimus withdrawal, the size reduction rate on everolimus readministration and adverse events caused by everolimus. The volume of angiomyolipoma was measured using abdominal computed tomography or magnetic resonance imaging. Adverse events were evaluated according to CTCAE v4.0-JCOG. RESULTS The average size reduction rate of angiomyolipoma in the initial treatment with everolimus was 67%. Eight patients (31%) did not have enlarged angiomyolipoma after everolimus withdrawal. The other 18 patients (69%) restarted everolimus treatment because of enlargement of the angiomyolipoma. The average size reduction rate of angiomyolipoma in the everolimus retreatment group was 61%, which was equivalent to the rate for the initial treatment. There were fewer adverse events during everolimus retreatment than in the initial treatment. CONCLUSIONS This is the first report regarding intermittent everolimus treatment for renal angiomyolipoma associated with tuberous sclerosis complex. This treatment is effective for tumor control and adverse event management. This beneficial treatment option for patients can minimize the drug dosage and the occurrence of adverse events.
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Affiliation(s)
- Takashi Hatano
- Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
| | - Hiroyuki Inaba
- Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
| | - Katsuhisa Endo
- Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
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Kwatra S, Krishnappa V, Mhanna C, Murray T, Novak R, Sethi SK, Kumar D, Raina R. Cystic Diseases of Childhood: A Review. Urology 2017; 110:184-191. [PMID: 28826877 DOI: 10.1016/j.urology.2017.07.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 07/20/2017] [Accepted: 07/28/2017] [Indexed: 12/13/2022]
Abstract
Renal cystic lesions are considered the most common abnormality associated with the kidneys. Most renal cysts are usually uncomplicated simple cysts that are not life-threatening; however, fatal renal cystic diseases can develop from these space-occupying lesions. Although renal cystic diseases are similar in presentation, they possess distinct features, variable prognoses, and complications later in life. Early identification and effective management of these respected diseases has led to longer survival rates and better quality of life. The purpose of this review is to provide a comprehensive analysis of the most prevalent cystic diseases of the pediatric population in hopes to aid in early distinction and appropriate treatment.
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Affiliation(s)
- Shivani Kwatra
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH; Department of Internal Medicine, Northside Medical Center, Youngstown, OH
| | - Vinod Krishnappa
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH
| | - Christiane Mhanna
- Ohio University Heritage College of Osteopathic Medicine, Cleveland, OH
| | - Taryn Murray
- Northeast Ohio Medical University, Rootstown, OH
| | - Robert Novak
- Department of Pathology, Akron Children's Hospital, Akron, OH
| | - Sidharth Kumar Sethi
- Pediatric Nephrology, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - Deepak Kumar
- Department of Pediatrics (Neonatology), Metro Health Medical Center/Case Western Reserve University, Cleveland, OH
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General, Akron, OH; Department of Pediatric Nephrology, Akron Children's Hospital, Akron, OH.
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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.
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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
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Trelborg K, Nielsen TK, Østraat EØ, Olsen LH. Laparoscopic cryoablation of angiomyolipomas in adolescents and young adults: A report of four cases associated with tuberous sclerosis and 1 case of sporadic origin. J Pediatr Urol 2016; 12:384.e1-384.e6. [PMID: 27346068 DOI: 10.1016/j.jpurol.2016.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 03/24/2016] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Renal angiomyolipomas (AMLs) can be of sporadic origin or associated with tuberous sclerosis (TS). TS-associated AMLs often present in childhood, tend to be bilateral and multiple, and often exhibit a faster growth rate with an increased risk of hemorrhage. Renal cryoablation is well described in adults, whereas experiences with adolescents and young adults are limited. We present here for the first time a series of renal AMLs within adolescents and young adults treated with laparoscopic assisted cryoablation (LCA). OBJECTIVE The aim was to evaluate whether LCA of AMLs in adolescents and young adults is a safe and feasible treatment modality. STUDY DESIGN From October 2009 to September 2013 a total of five patients at our institution were diagnosed with AMLs requiring treatment. Four patients had TS and one had AML of sporadic origin, all five patients underwent LCA. Data were retrospectively collected by a systematic review of patient material and reassessment of renal imaging. RESULTS The median age was 16 years (range 13-27 years). Eight AMLs with a median size of 3.9 cm (range 2.1-7.7 cm) were treated in five patients because of tumor size and rapid growth. Follow-up was a median 37 months (range 20-62 months), and all tumors showed a reduction in tumor size, and no regrowth was recognized (see summary table). The procedure was well tolerated, with only few perioperative complications and no postoperative complications. DISCUSSION When considering the indication for treating AMLs, the origin (sporadic or TS associated) and size of the tumor are the decisive factors. To preserve renal function and prevent spontaneous hemorrhage caution should be intensified when tumors reach 4 cm, particularly if TS is present. After the diagnosis is established, patients should be monitored with renal imaging at regular intervals to identify rapid-growing tumors. As an alternative to current treatment modalities such as partial nephrectomy and super selective angioembolization, cryoablation is an emerging approach, although experience with pediatric patients is limited. For patients not requiring immediate surgery, pharmacological treatment with mTOR inhibitors is now being evaluated as an alternative treatment option or as neo-adjuvant therapy to ablative techniques. CONCLUSION Prophylactic treatment of large or rapid growing AMLs with LCA appears to be a safe and feasible nephron-sparing approach in adolescents and young adults. The low perioperative complication rate and promising effect on outcome might allow treatment of subclinical AMLs in order to minimize the risk of potentially life-threatening complications and preserve renal function.
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Affiliation(s)
- Karina Trelborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Renal Angiomyolipoma: Mid- to Long-Term Results Following Embolization with Onyx. Cardiovasc Intervent Radiol 2016; 39:1759-1764. [DOI: 10.1007/s00270-016-1432-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
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Evidence Supporting a Lymphatic Endothelium Origin for Angiomyolipoma, a TSC2(-) Tumor Related to Lymphangioleiomyomatosis. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:1825-1836. [PMID: 27289491 DOI: 10.1016/j.ajpath.2016.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/02/2016] [Accepted: 03/07/2016] [Indexed: 12/27/2022]
Abstract
Angiomyolipoma (AML) is a tumor closely related to lymphangioleiomyomatosis (LAM). Both entities are characterized by the proliferation of smooth muscle actin and melanocytic glycoprotein 100 (recognized by antibody HMB-45)-positive spindle-shaped and epithelioid cells. AML and LAM are etiologically linked to mutations in the tsc2 and tsc1 genes in the case of LAM. These genes encode the proteins tuberous sclerosis complex (TSC)-1 and TSC2, which are directly involved in suppressing the mechanistic target of rapamycin cell growth signaling pathway. Although significant progress has been made in characterizing and pharmacologically slowing the progression of AML and LAM with rapamycin, our understanding of their pathogenesis lacks an identified cell of origin. We used an AML-derived cell line to determine whether TSC2 restitution brings about the cell type from which AML arises. We found that AML cells express lymphatic endothelial cell markers consistent with lymphatic endothelial cell precursors in vivo and in vitro. Moreover, on TSC2 correction, AML cells mature into adult lymphatic endothelial cells and have functional attributes characteristic of this cell lineage, suggesting a lymphatic endothelial cell of origin for AML. These effects are dependent on TSC2-mediated mechanistic target of rapamycin inactivation. Finally, we demonstrate the in vitro effectiveness of norcantharidin, a lymphangiogenesis inhibitor, as a potential co-adjuvant therapy in the treatment of AML.
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Kapoor A, Girard L, Lattouf JB, Pei Y, Rendon R, Card P, So A. Evolving Strategies in the Treatment of Tuberous Sclerosis Complex-associated Angiomyolipomas (TSC-AML). Urology 2015; 89:19-26. [PMID: 26723178 DOI: 10.1016/j.urology.2015.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/01/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022]
Abstract
Tuberous sclerosis complex (TSC) is a rare autosomal dominant genetic disorder characterized by the development of numerous benign tumors that occur in multiple organ systems throughout the lifetime of the affected individuals. Renal angiomyolipomas occur in up to 80% of TSC patients, and chronic kidney disease from increasing tumor burden is the primary cause of TSC-related mortality. Our review evaluates evidence for localized and systemic therapy in the management of TSC-angiomyolipomas. Urologists or nephrologists experienced in TSC disease should coordinate the care of TSC patients with renal involvement to improve care and reduce costs.
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Affiliation(s)
- Anil Kapoor
- Division of Urology, McMaster University, Hamilton, Ontario, Canada
| | - Louis Girard
- Department of Medicine, The University of Calgary, Alberta, Canada
| | | | - York Pei
- University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - Ricardo Rendon
- QEII Health Sciences Centre-Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Card
- Kaleidoscope Strategic, Toronto, Ontario, Canada
| | - Alan So
- University of British Columbia, BCCA, Prostate Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada.
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