Diagnosis and Treatment of Renal Angiomyolipoma (Based on 15 Cases)

Abstract

Fifteen cases of renal angiomyolipoma not associated with tuberous sclerosis are presented. The clinical and radiological features, the pathology and the management of these rare but well-documented tumors are discussed. They pose problems in diagnosis, and controversy still exists regarding their management. Additional techniques such as ultrasonography and computerized tomography may help in the diagnosis. When conservative surgery is not possible, or when a solid tumor cannot be confidently excluded, nephrectomy should be performed.

Management of Renal Angiomyolipoma by Selective Arterial Embolization

“…They are found sporadically, predominantly in middle-aged women, or in 50-80% of patients with TS [2].…”

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

“…They frequently present as asymptomatic minor lesions, and 20-50% of cases are associated with tuberous sclerosis (Bourneville's disease), which in turn has been shown to be linked with angiomyolipomas in 40-80% of cases [8].…”

“…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],…”

“…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].…”

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

“…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.…”