Angiomyolipome der Niere

Bilateral Renal Angiomyolipoma: Involvement of the Contralateral Kidney after 25 Years – An Unusual Case

“…In the great majority of cases angiomyolipoma re mains asymptomatic [4,5,16]. There have been fre quent reports of symptomatic renal angiomyolipoma with flank pain as a sign of spontaneous bleeding into the tumor [7,8,11,13,15], There are only few reports of massive retroperitoneal bleeding from the tumor causing unclear abdominal symptoms and even acute abdominal symptoms [17].…”

“…On a CT scan angiomyolipoma has the appearance of an intrarenal, extrapelvic, hypodense mass with low Hounsfield units between -2 0 and -50 [ 1,4,13]. It is likely that with magnetic resonance (MR) imaging, which also makes it possible to detect fat in a renal tumor, we will be able to make as confident a diag nosis as with CT [4], In our patient CT also showed an extensive tumor with low attenuation values compatible with fat and with cystic areas. In angiograms angiomyolipomas show up as tumors with varying degrees of vas cularity and sometimes with a pathological vascular pat tern.…”

“…These include benign renal processes, which account for less than 10% of the solid renal neoplasms [1], Renal angiomyolipoma is a rare benign renal tumor found in less than 1 % of all surgically explored renal tumors [2][3][4], Angiomyolipoma is classified as a hamartoma or choristoma [1,4]. Histo logically it consists of variable proportions of blood ves sels, smooth muscle and fat [5][6][7], The quantitative pro portion of the various tissues composing the tumor var ies greatly, with fat generally predominating [7][8][9], Mid dle-aged women are most commonly affected.…”

Value of Routine Sonography in the Diagnosis and Conservative Management of Renal Angiomyolipoma

“…However, CT-based differentiation from adenocarcinoma may become difficult if the angiomyolipoma predominantly consists of mesenchymal ele ments such as blood vessels and smooth muscles [24]. Similarly, angiomyolipomas with hemorrhage, yielding higher density values on the CT scan, cannot be reliably distinguished from malignant tumors [8], The use of MRI might be advantageous in such cases [12,25].…”

“…Only a few years ago, around 50% of patients with angiomyolipomas were nephrectomized [9]. Although conservative procedures are increasingly favored [1,2,6,8,10], surgical exploration is discussed even for asymp tomatic cases [11,12], Other authors believe that surgical intervention and, if necessary, organ-sparing surgery is warranted with tumors greater than 3-4 cm in size or in the presence of multiple lesions [6,8]. Routine obtainment of fine-needle biopsies has also been discussed [13],…”