Facteurs associés à l’échec du diagnostic préopératoire des angiomyolipomes rénaux

[Renal cancer and hereditary diseases]

Renal tumors associated with hereditary diseases are a rare entity characterized by many renal tumors and other manifestations such as pulmonary, neurological and dermatological expressions. The management requires a close collaboration between surgical specialties and geneticists. Precocious, bilateral and/or multifocal tumors call to mind a hereditary disease. Early diagnosis and screening are essential to optimize a strict observation and a most conservative treatment.

[Preventive and emergency embolization of angiomyolipomas: our experience]

AIM

To present our experience with emergency or programmed embolization of angiomyolipomas.

PATIENTS AND METHODS

The retrospective study 1999-2000 included a total of 20 patients with AML, five of whom had hypothyroidism. Group I emergency embolization: 11 patients age being 61.4 ± 15.6 years and the size of AML 8.2 ± 2.8 cm presented retroperitoneal hemorrhage from spontaneous rupture. Two had a hemorrhagic shock. A transfusion of 3.4 blood units per patient was performed for five patients. A clinical and radiological follow-up was done by scanning during the first week and in one month. Group II preventive embolization: nine patients, with age between 58.3 ± 15.2 years and tumor size 5.2 ± 2.2 cm, all asymptomatic. All successfully received a unilateral preventive embolization. A scan was performed one month later.

RESULTS

Group I: the embolization was effective in 100% of patients. No intraoperative incident was reported. After one month, the reduction in tumor volume was 40%. At eight months, a patient underwent nephrectomy because of a new fracture, and another a second embolization after 14 months. The technical result was maintained in 83% of cases after 18 months. Two patients developed HTA after embolization controlled by a single treatment, and five had limited renal ischemic sequels. Group II: no intraoperative incidents and no postoperatively complications have been reported. One month after embolization, the reduction in tumor volume was 23%. After 24 months, patients remained completely asymptomatic, no spontaneous bleeding has been reported, no surgery has been performed, and no HTA has been described. Only one re-embolization was done at 20 months (artery duplicity). Limited renal ischemic sequels were reported for one patient but no renal failure.

CONCLUSIONS

The required embolization became the method of choice in emergency with excellent results and few complications at distance. Programmed embolization effectively prevented the risk of bleeding, without impact on the renal function, with a low economic cost compared to hospitalization and emergency care. The significance of the observed AML--hypothyroidism association in our series requires a confrontation with more important cohorts.