1
|
Bellouki O, Bakouch M, Ibrahimi A, Boualaoui I, El Aoufir O, Zouaidia F, Benhadda S, El Sayegh H, Nouini Y. Hybrid Management of a Wünderlich's Syndrome Secondary to a Giant Ruptured Renal Angiomyolipoma: A Case Report. Urology 2024; 184:e246-e249. [PMID: 38043904 DOI: 10.1016/j.urology.2023.11.011] [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: 10/28/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
Wünderlich's syndrome, a rare and life-threatening condition involving spontaneous renal hemorrhage, is commonly associated with renal angiomyolipoma (rAML). Management options for rAML include surveillance, mTOR inhibitors, selective arterial embolization (SAE), and surgery. When complicated by Wünderlich's syndrome, prompt and adequate interventional treatment is necessary to prevent fatal outcomes. We present a unique case of a young female patient with Tuberous Sclerosis Complex who experienced a massive ruptured rAML, leading to Wünderlich's syndrome. Our approach involved a multidisciplinary hybrid strategy, combining SAE and nephrectomy, highlighting SAE's valuable role even when radical treatment is required.
Collapse
Affiliation(s)
- Omar Bellouki
- Urology "A" Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco.
| | - Mohammed Bakouch
- Urology "A" Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ahmed Ibrahimi
- Urology "A" Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Imad Boualaoui
- Urology "A" Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Omar El Aoufir
- Emergency Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Fouad Zouaidia
- Pathology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Selim Benhadda
- Nephrology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Hachem El Sayegh
- Urology "A" Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Yassine Nouini
- Urology "A" Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| |
Collapse
|
2
|
Ahmed M, Teo H, Sami T, Otite U. Sporadic Renal Angiomyolipoma: Can We Adopt a Uniform Management Protocol? Rev Urol 2022. [DOI: 10.1055/s-0042-1759625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractRenal angiomyolipomas (AMLs), formerly known as PEComas (tumors showing perivascular epithelioid cell differentiation) are common benign renal masses composed of a varying ratio of fat, blood vessels, and smooth muscles. They are largely asymptomatic and diagnosed incidentally on imaging.The adipose tissue content is the factor that gives AMLs their characteristic appearance on imaging and makes them easily identifiable. However, the fat-poor or fat-invisible varieties, which are difficult to differentiate radiologically from renal cell carcinomas (RCCs), present a diagnostic challenge. It is thus essential to establish the diagnosis and identify the atypical and hereditary cases as they require more intense surveillance and management due to their potential for malignant transformation.Multiple management options are available, ranging from conservative approach to embolization and to the more radical option of nephrectomy. While the indications for intervention are relatively clear and aimed at a rather small cohort, the protocol for follow-up of the remainder of the cohort forming the majority of cases is not well established. The surveillance and discharge policies therefore vary between institutions and even between individual practitioners. We have reviewed the literature to establish an optimum management pathway focusing on the typical AMLs.
Collapse
Affiliation(s)
- Mussammet Ahmed
- Department of Urology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| | - Hong Teo
- Department of Radiology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| | - Tariq Sami
- Department of Urology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| | - Ugo Otite
- Department of Urology, Sandwell and West Birmingham NHS Trust, West Midlands, United Kingdom
| |
Collapse
|
3
|
Fu Y, Saxu R, Ahmad Ridwan K, Zhao C, Kong X, Rong Y, Zheng W, Yu P, Teng Y. Selenium substituted axitinib reduces axitinib side effects and maintains its anti-renal tumor activity. RSC Adv 2022; 12:21821-21826. [PMID: 36043080 PMCID: PMC9358677 DOI: 10.1039/d2ra01882a] [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: 03/23/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
Axitinib is a potent vascular endothelial growth factor receptor (VEGFR) inhibitor, which has a strong inhibitory effect on the three isoforms of VEGFR 1-3. Having strong therapeutic efficacy, its broad use is limited by its side effects such as hypertension, proteinuria, cardiovascular damage, and liver and kidney dysfunction. Selenium compounds are broadly reported to have a good protective effect on cardiovascular disease, inflammation, infection, and immune function. In this study, a selenium substitute of axitinib was synthesized, and its anti-renal cell carcinoma activity and side effects were investigated. The results of the study indicated that Se-axitinib had potent antitumor activity on renal cell carcinoma (RCC), alleviated vascular hyperpermeability, and also alleviated axitinib-related side effects including hypertension, liver dysfunction and kidney dysfunction significantly. Therefore, we suggest that Se-axitinib could be a solution to the severe side effects of VEGFR inhibitors and provide evidence to improve the outcome of RCC treatment.
Collapse
Affiliation(s)
- Ying Fu
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Rengui Saxu
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Kadir Ahmad Ridwan
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Cai Zhao
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Xiangshun Kong
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Yao Rong
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Weida Zheng
- Medical College, Yanbian University No.977 Gongyuan Road Yanji City Jilin Province 133002 P. R. China
| | - Peng Yu
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| | - Yuou Teng
- China International Science and Technology Cooperation Base of Food Nutrition/Safety and Medicinal Chemistry, College of Bioengineering, Tianjin University of Science and Technology Tianjin 300457 China
| |
Collapse
|
4
|
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
|
5
|
Hamartomas cervicomediastínicos múltiples asociados a linfangioleiomiomatosis. Arch Bronconeumol 2022; 58:713. [DOI: 10.1016/j.arbres.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/20/2022]
|