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Tao B, Zhang H, Zhang G, Liu H, Meng L, Zhu X, Ji X, Jia G, Qi A, Wang C. Management of Nontraumatic Spontaneous Renal Hemorrhage (Wünderlich Syndrome) through Robotic-Assisted Laparoscopic Nephrectomy: A Case Series. Am J Case Rep 2024; 25:e942826. [PMID: 38659203 DOI: 10.12659/ajcr.942826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Wünderlich syndrome (WS) is a rare diagnosis of nontraumatic spontaneous renal hemorrhage into the subcapsular, perirenal, or pararenal spaces. Prompt and effective intervention is necessary for an accurate pathological diagnosis and preservation of life. In the current literature, open surgery is the primary option when conservative treatment fails, but there can be serious trauma and corresponding consequences. Herein, we present 3 cases of Wünderlich syndrome managed by robot-assisted laparoscopic nephrectomy via a retroperitoneal approach. CASE REPORT Patient 1 was a 44-year-old woman with right flank pain for 6 h. Patient 2 was a 53-year-old woman with a history of diabetes who had pain in her right flank pain and nausea for 1 day. Patient 3 was a 45-year-old man with left flank pain for 1 day. All cases of WS were confirmed by CT. All 3 patients were treated with retroperitoneal robot-assisted nephrectomy after conservative treatment failed. Pathological examination confirmed that patient 1 had angiomyolipoma, and patients 2 and 3 had renal clear cell carcinoma. At the 9-month follow-up, renal function was good and no evidence of recurrence or metastasis has been detected. CONCLUSIONS These cases have highlighted the importance of the clinical history and imaging findings in the diagnosis of Wünderlich syndrome, and show that rapid management can be achieved using robot-assisted laparoscopic nephrectomy. However, it is crucial to have a skilled surgical team and adequate preoperative preparation.
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Affiliation(s)
- Boju Tao
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Haoxun Zhang
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Guoling Zhang
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Hua Liu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Le Meng
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Xiangyu Zhu
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Xuran Ji
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Guang Jia
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Ao Qi
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
| | - Chunyang Wang
- Department of Urology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China (mainland)
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陈 克, 邓 绍, 刘 茁, 张 洪, 马 潞, 张 树. [Discussion on the surgical timing of rupture and hemorrhage of renal angiomyolipoma]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:326-331. [PMID: 38595253 PMCID: PMC11004956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 04/11/2024]
Abstract
OBJECTIVE To investigate the effect of different surgical timing on the surgical treatment of renal angiomyolipoma (RAML) with rupture and hemorrhage. METHODS The demographic data and perioperative data of 31 patients with rupture and hemorrhage of RAML admitted to our medical center from June 2013 to February 2023 were collected. The surgery within 7 days after hemorrhage was defined as a short-term surgery group, the surgery between 7 days and 6 months after hemorrhage was defined as a medium-term surgery group, and the surgery beyond 6 months after hemorrhage was defined as a long-term surgery group. The perioperative related indicators among the three groups were compared. RESULTS This study collected 31 patients who underwent surgical treatment for RAML rupture and hemorrhage, of whom 13 were males and 18 were females, with an average age of (46.2±11.3) years. The short-term surgery group included 7 patients, the medium-term surgery group included 12 patients and the long-term surgery group included 12 patients. In terms of tumor diameter, the patients in the long-term surgery group were significantly lower than those in the recent surgery group [(6.6±2.4) cm vs. (10.0±3.0) cm, P=0.039]. In terms of operation time, the long-term surgery group was significantly shorter than the mid-term surgery group [(157.5±56.8) min vs. (254.8±80.1) min, P=0.006], and there was no significant difference between other groups. In terms of estimated blood loss during surgery, the long-term surgery group was significantly lower than the mid-term surgery group [35 (10, 100) mL vs. 650 (300, 1 200) mL, P < 0.001], and there was no significant difference between other groups. In terms of intraoperative blood transfusion, the long-term surgery group was significantly lower than the mid-term surgery group [0 (0, 0) mL vs. 200 (0, 700) mL, P=0.014], and there was no significant difference between other groups. In terms of postoperative hospitalization days, the long-term surgery group was significantly lower than the mid-term surgery group [5 (4, 7) d vs. 7 (6, 10) d, P=0.011], and there was no significant difference between other groups. CONCLUSION We believe that for patients with RAML rupture and hemorrhage, reoperation for more than 6 months is a relatively safe time range, with minimal intraoperative bleeding. Therefore, it is more recommended to undergo surgical treatment after the hematoma is systematized through conservative treatment.
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Affiliation(s)
- 克伟 陈
- />北京大学第三医院泌尿外科, 北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 绍晖 邓
- />北京大学第三医院泌尿外科, 北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 茁 刘
- />北京大学第三医院泌尿外科, 北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 洪宪 张
- />北京大学第三医院泌尿外科, 北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 潞林 马
- />北京大学第三医院泌尿外科, 北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - 树栋 张
- />北京大学第三医院泌尿外科, 北京 100191Department of Urology, Peking University Third Hospital, Beijing 100191, China
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Kluiving MW, Peeters EFHI, Lely TA, van Oorschot N, de Ranitz-Greven WL. The effect of pregnancy on renal angiomyolipoma; a world of knowledge to gain, specifically in women with TSC. BMC Nephrol 2024; 25:113. [PMID: 38519911 PMCID: PMC10960455 DOI: 10.1186/s12882-024-03483-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/25/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Women are counseled preconceptionally about the potential risks of rAML progression and chance of complications during and due to pregnancy. However, a systematic search investigating the evidence on which this advice is based does not exist. The aim of this systematic review is to determine the effect of pregnancy on renal angiomyolipoma (rAML) size and risk of haemorrhage in patients with tuberous sclerosis complex (TSC). METHODS We searched PubMed, EMBASE, Medline and ClinicalTrials.gov using terms for "renal angiomyolipoma" and "pregnancy". English-language articles published between January 1st 2000, and December 31st 2020 of which full-text was available were included. The initial search resulted in 176 articles. After the screening process we included 45 case reports and 1 retrospective study. For the retrospective study we assessed the risk of bias using the Newcastle-Ottawa Scale. We included articles about renal AML and pregnancy with and without an established diagnosis of TSC. From these articles we recorded the rAML sizes and rAML complications. RESULTS Seven case reports, from a total of 45 case reports, provided follow-up data on renal AML size (these were all cases of renal AML without a known diagnosis of TSC). Of these cases, renal AML size decreased in one patient, was stable in one patient, increased in three patients and fluctuated in two others. Renal AML size of women who suffered a haemorrhage were significantly larger (12.1 ± 4.6 cm) than rAMLs of women who did not suffer a haemorrhage (8.3 ± 3.2 cm). Data from the retrospective study showed no difference in renal complications between the women with and without a history of pregnancy. Haemorrhage occurred in 30% of the women with a history of pregnancy (n = 20) and in 11% in the patients without a history of pregnancy (n = 2), however this retrospective study had methodological limitations. CONCLUSION The effect of pregnancy on renal AML size and complications in patients with TSC is unclear. More research is needed to determine the risk of pregnancy on TSC-associated kidney disease in TSC patient.
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Affiliation(s)
- Marlou W Kluiving
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Evelien F H I Peeters
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Titia A Lely
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niek van Oorschot
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Wendela L de Ranitz-Greven
- Department of Internal Medicine, Center of Expertise for Tuberous Sclerosis Complex, University Medical Center Utrecht, Utrecht, The Netherlands
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Xing L, Yilun Y, Ji Z, Wei C. Rare Case of Renal Epithelioid Angiomyolipoma With Tumor Thrombus Into the IVC and Right Atrium. Circ Cardiovasc Imaging 2024; 17:e016083. [PMID: 38288625 DOI: 10.1161/circimaging.123.016083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Affiliation(s)
- Luo Xing
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital (L.X., Z.J., C.W.), Third Military Medical University (Army Medical University), Chongqing, China
| | - Yi Yilun
- College of Basic Medical Sciences (Y.Y.L), Third Military Medical University (Army Medical University), Chongqing, China
| | - Zheng Ji
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital (L.X., Z.J., C.W.), Third Military Medical University (Army Medical University), Chongqing, China
| | - Chen Wei
- Department of Urology, Urologic Surgery Center, Xinqiao Hospital (L.X., Z.J., C.W.), Third Military Medical University (Army Medical University), Chongqing, China
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Ding JA, Li PC, Yang J, Ni CF. Spontaneous massive hemorrhage caused by giant renal angiomyolipoma in a patient with tuberous sclerosis complex. Asian J Surg 2024; 47:1626-1627. [PMID: 38145913 DOI: 10.1016/j.asjsur.2023.12.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Jia-An Ding
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Pei-Cheng Li
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Jian Yang
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China
| | - Cai-Fang Ni
- Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, People's Republic of China.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Liao Z, Li J, Zhao Y, Wang Z, Wang X, Qiu D, Zhang Y. The association between computed tomography attenuation value of renal angiomyolipoma associated with tuberous sclerosis complex and response to everolimus. World J Urol 2024; 42:10. [PMID: 38183428 DOI: 10.1007/s00345-023-04708-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/30/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND The response to everolimus in patients with renal angiomyolipoma associated with tuberous sclerosis complex (TSC-RAML) varies among individuals. This study aims to identify potential factors associated with the response to everolimus. METHOD We retrospectively examined data encompassing age, gender, tumor size, computed tomography attenuation value (CT value), CT enhancement, and tumor reduction rate in patients with TSC-RAML undergoing everolimus in two previously registered clinical trials. RESULT A total of 33 participants (29.33 ± 6.63 years old, 20 females) were included. The correlation analysis conducted separately for tumors located in the left and right kidneys revealed significant negative correlations (P < 0.05) between tumor reduction rate and age, as well as tumor size. While significant positive correlations (P < 0.05) were observed between tumor reduction rate and unenhanced CT value as well as CT enhancement. Nonetheless, based on multiple linear regression analysis, unenhanced CT value emerged as the sole-independent predictor of tumor reduction rate among age, gender, tumor size, unenhanced CT value and CT enhancement for both left (coefficient = 0.00319, P < 0.0001) and right kidneys (coefficient = 0.00315, P = 0.0104). Notable reductions were observed in unenhanced CT value (- 3.81 vs - 24.70HU, P < 0.0001) and CT enhancement (48.16 vs 33.56HU, P < 0.0001) following a 3-month administration of everolimus. The decline in both unenhanced CT value and tumor size predominantly occurred within the initial 3 months, subsequently maintaining a relatively stable level throughout the treatment. CONCLUSION The unenhanced CT value of TSC-RAML showed an independent correlation with the response to everolimus, suggesting its potential as a predictor of everolimus efficacy in patients with TSC-RAML.
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Affiliation(s)
- Zhangcheng Liao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jiao Li
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xu Wang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dongxu Qiu
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yushi Zhang
- Department of Urology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Al-Kindi S, Al-Hajriy M, Al-Jabri A. Rupture of Renal Angiomyolipoma Post Fibrinolysis: A rare complication of fibrinolytic therapy. Sultan Qaboos Univ Med J 2023; 23:51-54. [PMID: 38161759 PMCID: PMC10754310 DOI: 10.18295/squmj.12.2023.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 01/03/2024] Open
Abstract
Angiomyolipoma is a common benign solid tumour that accounts for up to 3% of all renal tumours; most of the cases are sporadic. However, it can be part of other diseases. Angiomyolipomas are usually found incidentally through unrelated clinically indicated images but also, they can be diagnosed after complications have occurred. We report the case of retroperitoneal haemorrhage following the rupture of renal angiomyolipoma post-fibrinolysis, we are highlighting such a rare condition, the management options and the follow-up plan. The management of angiomyolipomas ranges from conservative treatment to surgical intervention depending on the patient's condition and the tumour's radiological features. Following-up on patients with angiomyolipomas depends on the symptoms and the tumour size. Till date, there is no reported cases of renal angiomyolipoma rupture post-fibrinolysis therapy as a treatment for myocardial infarction in non-percutaneous intervention capable facility.
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Affiliation(s)
| | | | - Adil Al-Jabri
- Cardiology, National Heart Centre, The Royal Hospital, Muscat, Oman
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9
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Han Z, Xue X, Wang J, Lu D. Tuberous sclerosis complex associated lymphangioleiomyomatosis. QJM 2023; 116:873-874. [PMID: 37286375 PMCID: PMC10593382 DOI: 10.1093/qjmed/hcad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Indexed: 06/09/2023] Open
Affiliation(s)
- Z Han
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - X Xue
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - J Wang
- Department of Gerontology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - D Lu
- Department of Respiratory, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Monich AG, Cunha MFMD, Barreto FC. mTOR inhibitors are the first-choice therapy for renal angiomyolipomas secondary to tuberous sclerosis. J Bras Nefrol 2023; 45:503-505. [PMID: 37497829 PMCID: PMC10726659 DOI: 10.1590/2175-8239-jbn-2023-0077en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Aline Grosskopf Monich
- Universidade Federal do Paraná, Departamento de Clínica Médica, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brazil
- Hospital Universitário Evangélico Mackenzie, Serviço de Nefrologia, Curitiba, PR, Brazil
| | - Mariana Faucz Munhoz da Cunha
- Universidade Federal do Paraná, Departamento de Pediatria, Serviço de Nefrologia Pediátrica, Curitiba, PR, Brazil
- Hospital Pequeno Príncipe, Serviço de Nefrologia Pediátrica, Curitiba, PR, Brazil
| | - Fellype Carvalho Barreto
- Universidade Federal do Paraná, Departamento de Clínica Médica, Programa de Pós-Graduação em Medicina Interna e Ciências da Saúde, Curitiba, PR, Brazil
- Universidade Federal do Paraná, Departamento de Clínica Médica, Serviço de Nefrologia, Curitiba, PR, Brazil
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Gau SY, Chen SL, Chang CS, Tsao TF, Tsai JD. Adverse Events of Everolimus in Patients with Tuberous Sclerosis Complex Treated for Renal Angiomyolipoma/Subependymal Giant Cell Astrocytoma. Int J Med Sci 2023; 20:1358-1362. [PMID: 37786437 PMCID: PMC10542024 DOI: 10.7150/ijms.88022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background: Although regarded as a potentially efficient approach to address tuberous sclerosis complex (TSC)-associated complications, the adverse event profile of everolimus has not yet been fully elucidated. The present study aimed to clarify the adverse event spectrum in patients with TSC who are using everolimus for common indications, in comparison to those who do not use everolimus. Materials and Methods: We recruited patients with TSC who were followed up annually at TSC integrated clinics or referred for medical assistance. Medical reviews and laboratory investigations were performed at baseline and annually by clinical physicians. The adverse events were assessed as per the National Cancer Institute Common Terminology Criteria for Adverse Events. Results: Common adverse events in everolimus users included hypercholesterolemia (55%), gingivostomatitis (50%), proteinuria (50%), and hyperglycemia (40%). Compared with everolimus nonusers, the occurrence of gingivostomatitis and proteinuria was significantly higher in everolimus users (gingivostomatitis, p=0.02; proteinuria, p=0.02). Among the everolimus users, 12 patients had level I CTCAE, and five had level II CTCAE. None of the everolimus users presented with CTCAE level III or higher. Conclusion: Patients with TSC who are everolimus users had a higher tendency to develop gingivostomatitis and proteinuria compared to nonusers. However, no differences were observed in the occurrence of other adverse events between everolimus users and nonusers.
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Affiliation(s)
- Shuo-Yan Gau
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medical Education, Chi Mei Medical Center, Tainan, Taiwan
| | - Sung-Lang Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Cheng-Siu Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Neurosurgery, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Teng-Fu Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Radiology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jeng-Dau Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
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13
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Wang T, Peng C, Ding X, Yang Y, Li J, Gu L, Wang B, Ma X. Renal angiomyolipoma with tumor thrombi: Clinical analysis of 18 cases in a single-center experience. Urol Oncol 2023; 41:328.e1-328.e8. [PMID: 37149431 DOI: 10.1016/j.urolonc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/03/2023] [Accepted: 04/04/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE To improve understanding of the clinical features of renal angiomyolipoma (AML) accompanied by tumor thrombus (TT). METHODS From January 2017 to February 2022, 18 patients with AML and TT were enrolled. We retrospectively analyzed them and there were 6 cases of epithelial AML (EAML) and 12 of classical AML (CAML). We compared the key variables between the two cohorts. RESULTS The mean age of the 18 cases was 42.0 (standard deviation [SD] 13.4) years and 14 (77.8%) were female. Eleven (61.1%) tumors were on the right side. Only two (11.1%) cases presented with flank pain. The mean follow-up time was 33.6 (IQR: 20.1-48.5) months. All participants were alive at the end of follow-up. One case developed lung metastases 21 months after operation but entered remission after 2 years of everolimus treatment. The imaging diagnoses of all CAML cases were consistent with the pathology, while all imaged EAML cases were diagnosed with carcinomas. Five EAML cases, but only one CAML case, exhibited necrosis (83.3 vs. 8.3%, P = 0.001). The Ki-67 index of the EAML group was significantly higher than that of the CAML group (7 vs. 2, P = 0.004). CONCLUSIONS Compared to CAML, EAML tended to be associated with a higher imaging misdiagnosis rate, and was more commonly associated with necrosis and a higher Ki-67 index. Surgery remains the prime treatment for nonmetastatic AML with TT; such cases have a relatively good prognosis despite the malignant potential.
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Affiliation(s)
- Tao Wang
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Cheng Peng
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Ding
- Department of Pathology, the first Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Yang Yang
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jinhang Li
- Department of Pathology, the first Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Liangyou Gu
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Baojun Wang
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Xin Ma
- Department of Urology, the third Medical Centre, Chinese PLA General Hospital, Beijing, China.
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14
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Aquilina J, Neves JB, El-Sheikh S, Tran-Dang MA, Walkden M, Barod R, Patki P, Mumtaz F, Bex A, Tran MGB. Epitheloid Angiomyolipomas of the Kidney: Rare Renal Tumors Associated With Poor Prognoses. Urology 2023; 176:102-105. [PMID: 37030580 DOI: 10.1016/j.urology.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE To demonstrate the clinical spectrum and challenges associated with clinical management of epitheloid angiomyolipomas (eAML). METHODS We retrospectively reviewed the surgical database of a high-volume tertiary kidney cancer center from 2015 to 2020 to identify cases with a final histological diagnosis of eAML. Descriptive analysis of all cases was conducted. RESULTS Five surgical cases of eAMLs were identified. Two of which have had no tumor recurrence since surgery, and three patients passed away due to disease progression. CONCLUSION eAML are rare renal tumors which the World Health Organisation (5th Edition, 2022) and International Classification of Diseases for Oncology classify as having unspecified, borderline, or uncertain behavior. Here, we report that can also demonstrate aggressive behavior with fatal consequences. Post-operative follow-up should be recommended for all, with shorter intervals for patients with poor prognostic factors.
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Affiliation(s)
- Julian Aquilina
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Joana B Neves
- UCL Division of Surgery and Interventional Science, London, United Kingdom; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Soha El-Sheikh
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Histopathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - My-Anh Tran-Dang
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Histopathology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Miles Walkden
- Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ravi Barod
- UCL Division of Surgery and Interventional Science, London, United Kingdom; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Prasad Patki
- UCL Division of Surgery and Interventional Science, London, United Kingdom; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Faiz Mumtaz
- UCL Division of Surgery and Interventional Science, London, United Kingdom; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Axel Bex
- UCL Division of Surgery and Interventional Science, London, United Kingdom; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Maxine G B Tran
- UCL Division of Surgery and Interventional Science, London, United Kingdom; Specialist Centre for Kidney Cancer, Royal Free London NHS Foundation Trust, London, United Kingdom
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15
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Zhuang J, Wu Q, Yang X, Cai L, Li K, Hua H, Bao M, Yu R, Liu P, Li P, Cao Q, Lu Q. Renal Lipoma-Like Angiomyolipoma of Tumour Thrombus Extending to the Confluence of Inferior Vena Cava with Right Atrium: A Rare Case Report and Literature Review. Urol Int 2023; 107:742-746. [PMID: 36889288 DOI: 10.1159/000529412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/22/2023] [Indexed: 03/10/2023]
Abstract
Angiomyolipoma (AML) complicated with tumour thrombus extending to the confluence of inferior vena cava (IVC) with right atrium is rarely observed. We report a female AML patient admitted to our centre on January 21, 2020, with complication of tumour thrombus extending to the confluence of IVC with right atrium and had no sign of difficult breathing. She underwent whole-abdominal enhanced CT for abdominal pain and was diagnosed with a possible renal AML with tumour thrombus. Open radical nephrectomy and thrombectomy of vena cava were performed. Intraoperative transoesophageal echocardiography indicated that the tumour thrombus has reached the confluence of IVC with right atrium. The operation took 255 min with an intraoperative haemorrhage of 800mL. The patient was discharged 7 days after surgery. Pathology revealed lipoma-like AML. Immunohistochemistry showed vimentin (+), EMA (-), HMB45 (+), S-100 (-), SMA (+), TFE-3 (-), melan A (+). After 2 years of follow-up, we found that the patient showed full recovery and had no recurrence. Therefore, lipoma-like AML should also be followed closely for recurrence and metastasis. When AML involves IVC tumour thrombus, open thrombectomy and radical nephrectomy are safe and effective methods.
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MESH Headings
- Humans
- Female
- Vena Cava, Inferior/diagnostic imaging
- Vena Cava, Inferior/surgery
- Vena Cava, Inferior/pathology
- Carcinoma, Renal Cell/surgery
- Angiomyolipoma/complications
- Angiomyolipoma/diagnostic imaging
- Angiomyolipoma/surgery
- Kidney Neoplasms/complications
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/surgery
- Thrombosis/diagnostic imaging
- Thrombosis/surgery
- Thrombosis/complications
- Venous Thrombosis/diagnostic imaging
- Venous Thrombosis/etiology
- Venous Thrombosis/surgery
- Thrombectomy/adverse effects
- Nephrectomy/methods
- Lipoma/complications
- Lipoma/diagnostic imaging
- Lipoma/surgery
- Heart Atria
- Leukemia, Myeloid, Acute/complications
- Leukemia, Myeloid, Acute/pathology
- Leukemia, Myeloid, Acute/surgery
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Affiliation(s)
- Juntao Zhuang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qikai Wu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao Yang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lingkai Cai
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kai Li
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongjin Hua
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meiling Bao
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruixi Yu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Peikun Liu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Cao
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qiang Lu
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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16
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Zhang H, Hu Z, Wang S, Wu K, Yang Q, Song X. Clinical features and outcomes of male patients with lymphangioleiomyomatosis: A review. Medicine (Baltimore) 2022; 101:e32492. [PMID: 36596036 PMCID: PMC9803497 DOI: 10.1097/md.0000000000032492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lymphangioleiomyomatosis (LAM) is a rare disease involving multiple systems, which is divided into sporadic LAM (S-LAM) and tuberous sclerosis complex-LAM, mostly affecting women who are in childbearing age stage. Data on male patients are limited and scattered. Therefore, it is necessary to conduct a systematic review to investigate the clinical features, diagnosis, treatment, and outcomes of LAM in male. METHODS We performed a literature review by searching for all the published reported cases of LAM in male during the past 35 years (April 1986-October 2021). RESULTS 36 male patients described in 26 references were included in this article. The median age of onset was 34 years (interquartile range: 1-79). The most common initial manifestations were cough, dyspnea, respite, and hemoptysis, with pulmonary complications such as pneumothorax and chylothorax. Five patients (13.9%) were asymptomatic at admission. Nearly half of the 36 male patients had thin-walled air-filled cysts that were visible throughout both lungs. Considering the abovementioned atypical clinical features, misdiagnosis was committed in 8 patients (22.2%). In addition, patients with tuberous sclerosis complex lymphangioleiomyomatosis often have no pulmonary manifestations at onset but present multiple extrapulmonary manifestations and have higher rates of renal angiomyolipomas than patients with S-LAM (P < 0.01). Eventually, 4 patients with S-LAM eventually died. CONCLUSION Physicians should increase the awareness of LAM in male. Early monitoring of various systems should be recommended to ensure early management and active follow-up. Tuberous sclerosis complex patients should immediately be tracked for the onset of LAM disease to improve prognosis.
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Affiliation(s)
- Haoyu Zhang
- Department of Respiratory and Critical Care Medicine, the first College of Clinical Medicine science, China Three Gorges University, Yichang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People’s Hospital., Wuhan, Hubei, China
| | - Zhigang Hu
- Department of Respiratory and Critical Care Medicine, the first College of Clinical Medicine science, China Three Gorges University, Yichang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People’s Hospital., Wuhan, Hubei, China
| | - Sufei Wang
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Kanhao Wu
- Department of Respiratory and Critical Care Medicine, the first College of Clinical Medicine science, China Three Gorges University, Yichang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People’s Hospital., Wuhan, Hubei, China
| | - Qiaoyu Yang
- Department of Respiratory and Critical Care Medicine, the first College of Clinical Medicine science, China Three Gorges University, Yichang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People’s Hospital., Wuhan, Hubei, China
| | - Xinyu Song
- Department of Respiratory and Critical Care Medicine, the first College of Clinical Medicine science, China Three Gorges University, Yichang, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, Yichang Central People’s Hospital., Wuhan, Hubei, China
- * Correspondence: Xinyu Song, Department of Respiratory and Critical Care Medicine, the first College of Clinical Medicine science, Three Gorges University, NO. 183 Yiling Road, Yichang 443003. People’s Republic of China (e-mail: )
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17
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Liu H, Xiao E. Renal angiomyolipoma with inferior vena cava and right atrial embolism: A case report and literature review. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:1763-1768. [PMID: 36748389 PMCID: PMC10930266 DOI: 10.11817/j.issn.1672-7347.2022.220044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 02/08/2023]
Abstract
Renal angiomyolipoma (AML) with renal vein, inferior vena cava (IVC), and right atrial embolism is a rare solid tumor, whose etiology and pathogenesis are still unclear. Moreover, it is often misdiagnosed. One patient with renal AML complicated with renal vein, IVC, and right atrial embolism was admitted to the Second Xiangya Hospital of Central South University, who was a 35-year-old female, without any previous medical history, presented with right low back pain for more than 3 years. Computed tomography (CT) scan showed irregular lobulated fatty density mass in the right kidney, renal vein, IVC, and right atrium. The contrast-enhanced scan showed no enhancement of fat components at each phase and mild enhancement of solid components. Radical resection of the right kidney and removal of tumor thrombus were performed, and there was no recurrence 1 year after the operation. It is rare for renal AML to grow along the renal vein, IVC, and extend to the right atrium. Imaging examination is extremely important, and the CT findings of this case are characteristic, but the diagnosis eventually depends on pathological and immunohistochemical examinations.
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Affiliation(s)
- Huan Liu
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
| | - Enhua Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, China.
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18
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Koh JS, Oh S, Chung C. Pulmonary lymphangioleiomyomatosis and renal angiomyolipoma in a patient with systemic lupus erythematosus: A case report. Medicine (Baltimore) 2022; 101:e30554. [PMID: 36197220 PMCID: PMC9509188 DOI: 10.1097/md.0000000000030554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The co-incidence of systemic lupus erythematosus (SLE) and tuberous sclerosis with pulmonary lymphangioleiomyomatosis (LAM) and renal angiomyolipoma (AML) is rare. In such patients, the rupture of renal AML may result in fatal circumstances, but this may be preventable. METHODS A 22-year-old Asian woman with SLE was admitted to our hospital with severe left-flank pain. Imaging studies showed the bilateral rupture of multiple renal AMLs. RESULTS The patient underwent emergency selective transcatheter embolization (TE) of the left renal artery. After TE and massive hydration, the patient complained of dyspnea and postembolization syndrome with fever. The chest computed tomography (CT) revealed pulmonary LAM, pulmonary edema with bilateral pleural effusions, and pneumonic consolidation. After the emergency procedure, the patient was treated with intravenous administration of antibiotics, diuretics, and nonsteroidal anti-inflammatory drugs for 10 days. The patient recovered favorably and was discharged 20 days after the treatment. She was diagnosed with renal AML and pulmonary LAM along with facial angiofibromas as well as tuberous sclerosis complex (TSC), although she had no TSC1 or TSC2 gene mutations. CONCLUSION Although rare, SLE may coexist with TSC, along with LAM and AML, with a risk of AML rupture. The activation of the mTOR signaling pathway is shared between SLE and TSC. Thus, in patients with SLE, clinicians should consider imaging studies, such as kidney sonography and chest CT, to screen for possible manifestation of AML and LAM.
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Affiliation(s)
- Jeong Suk Koh
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, 301-721, Republic of Korea
| | - Sina Oh
- College of Medicine, Chungnam National University, Daejeon 35015, Republic of Korea
| | - Chaeuk Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, 301-721, Republic of Korea
- Infection Control Convergence Research Center, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea
- * Correspondence: Chaeuk Chung, Division of Pulmonology, Department of Internal Medicine, Chungnam National University, 282, Munhwaro, Jung-gu, Daejeon 35015, Republic of Korea (e-mail: )
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19
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Deng S, Shi W, Cai Y, Tang Y, Liu W, Yin P, Chen C, Meng L, Dong H, Huang J, Liu Y. Tuberous sclerosis complex with skin lesions as the initial presentation: A case report and multidisciplinary discussion. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2022; 47:973-980. [PMID: 36039596 PMCID: PMC10930287 DOI: 10.11817/j.issn.1672-7347.2022.210452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Indexed: 06/15/2023]
Abstract
We reported a case of tuberous sclerosis complex with facial angiofibroma as the initial presentation and conducted a multidisciplinary discussion. The patient, a young female, was admitted to the Department of Dermatology for cosmetic purpose. After the examination, she was found to have multiple system involvement, including a large renal angiomyolipoma pressing on the liver. She never had any subjective symptom. After consultation by the multidisciplinary team of tuberous sclerosis complex, the patient was treated with everolimus orally and followed up regularly. It is suggested that dermatologists should pay attention to the systemic involvement of patients with tuberous sclerosis complex. Early intervention can prolong the life of patients and improve their life quality. Multidisciplinary collaboration for lifelong disease management is the key to enhance the diagnosis and treatment for tuberous sclerosis complex and enhance the prognosis of patients.
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Affiliation(s)
- Sihan Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
| | - Wei Shi
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008.
| | - Yi Cai
- Department of Urology, Xiangya Hospital, Central South University, Changsha 410008
| | - Yongjun Tang
- Department of Respiratory and Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008
| | - Weiping Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008
| | - Ping Yin
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha 410008
| | - Chen Chen
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha 410008
| | - Li Meng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
| | - Huixi Dong
- Mental Health Center, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008
| | - Yu Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008
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20
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Abstract
Mechanistic target of rapamycin (mTOR) inhibitors are macrocyclic lactone antibiotics derived from Streptomyces hygroscopicus that prevent T lymphocyte activation and B cell differentiation. Unlike calcineurin inhibitors (CNIs) that inhibit cytokine production, mTOR inhibitors block the cytokine signal transduction to arrest cells in the G1 to S phase. This class of drugs is commonly used for post-transplantation and cancer management because of its immunosuppressive and antiproliferative properties, respectively. The potential uses of mTOR inhibitors are heavily explored because of their impact on cell growth and proliferation. However, mTOR inhibitors have a broad range of effects that can result in adverse reactions, but side effects can occur with other immunosuppressive agents as well. Thus, the performance of mTOR inhibitors is compared to the outcomes and adverse effects of other immunosuppressive drugs or the combination of other immunosuppressants and mTOR inhibitors. Because mTOR regulates many downstream pathways, mTOR inhibitors can affect these pathways to manage various diseases. Sirolimus (rapamycin) is approved by the Food and Drug Administration (FDA) to treat post-renal transplantation and lymphangioleiomyomatosis (LAM). Everolimus is approved by the FDA to treat postmenopausal advanced hormone receptor-positive, HER2-negative breast cancer in women, progressive neuroendocrine tumors of pancreatic origin (PNET), advanced renal cell carcinoma (RCC), renal angiomyolipoma (AML) and tuberous sclerosis complex (TSC), and subependymal giant cell astrocytoma (SEGA) associated with TSC as well as renal and liver transplantation. Temsirolimus is approved by the FDA to treat advanced RCC. Opportunities to use mTOR inhibitors as therapy for other transplantation, metabolic disease, and cancer management are being researched. mTOR inhibitors are often called proliferation signal inhibitors (PSIs) because of their effects on proliferation pathways.
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Affiliation(s)
- Denise Wang
- Mount Sinai Icahn School of Medicine, New York, NY, USA.
| | - Howard J Eisen
- Pennsylvania State University College of Medicine/Milton S. Hershey Medical Center, Hershey, PA, USA
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21
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El Aoufir O, Zerda I, Slaoui A, El Khamlichi A, Iben Attya A, Jiddane M, Fikri M. Haemorrhagic renal angiomyolipoma embolization. J Med Vasc 2021; 46:254-257. [PMID: 34862021 DOI: 10.1016/j.jdmv.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/02/2021] [Indexed: 06/13/2023]
Affiliation(s)
- O El Aoufir
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - I Zerda
- Department of Urology B, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - A Slaoui
- Department of Urology B, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - A El Khamlichi
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - A Iben Attya
- Department of Urology B, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - M Jiddane
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
| | - M Fikri
- Department of Radiology, Vascular Radiology Unit, Specialties Hospital, Ibn Sina University Hospital Center, Mohamed V University, Rabat, Morocco.
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22
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Wang D, Liu M, Li Y, Xie M. Right renal angiomyolipoma with intracardiac extension and pulmonary embolism. J Clin Ultrasound 2021; 49:516-519. [PMID: 33325037 DOI: 10.1002/jcu.22968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/04/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Angiomyolipoma is the most common benign mesenchymal neoplasm of the kidney. Despite its benign nature, it may, in rare instances, invade the inferior vena cava and right cardiac chambers. A tumor thrombus in the pulmonary artery is an extremely rare but potentially fatal complication. We report a rare case of 53-year-old woman showing a right renal angiomyolipoma with intracardiac extension and pulmonary embolism. The patient underwent open radical right nephrectomy and thrombectomy of the inferior vena cava and pulmonary artery. Our case highlights that close attention to these complications is important to determine the surgical plan.
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Affiliation(s)
- Dan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Manwei Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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23
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Hatano T, Endo K, Tamari M. Efficacy and safety of low-dose everolimus treatment for renal angiomyolipoma associated with tuberous sclerosis complex. Int J Clin Oncol 2020; 26:163-168. [PMID: 32990779 DOI: 10.1007/s10147-020-01792-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and efficacy of low-dose everolimus treatment in patients with tuberous sclerosis complex (TSC)-associated angiomyolipoma (AML) with renal dysfunction or low body weight. METHODS We investigated a total of 50 adult patients underwent everolimus treatment for AML associated with TSC. For patients with renal dysfunction (serum creatinine level ≥ 1.5 mg/dl) or low body weight (body weight < 35 kg), 5 mg of everolimus was administered daily (low-dose group). For patients without renal dysfunction or low body weight, 10 mg of everolimus was administered daily (conventional-dose group). The treatment effects and adverse events were compared between the two groups. RESULTS There were 20 patients in the low-dose group, and 30 in the conventional-dose group. The average reduction rate of the AML volume in the low-dose group was 52%, whereas it was 60% in the conventional-dose group. No significant differences were found in the average reduction rate between the groups (P = 0.24). The average blood everolimus trough levels were 7.7 ± 3.1 ng/mL in the low-dose group and 12.2 ± 5.7 ng/mL in the conventional-dose group. The level was significantly higher in the conventional-dose group than in the low-dose group (P = 0.004). The incidences of stomatitis and irregular menstruation were significantly lower in the low-dose group than in the conventional-dose group (P = 0.009, P = 0.045, respectively). CONCLUSIONS The present study demonstrates that low-dose everolimus treatment is safe and effective for TSC-associated AML. This treatment was well tolerated and adverse events were mild in all cases.
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Affiliation(s)
- Takashi Hatano
- Department of Urology, Seirei Yokohama Hospital, Kanagawa, Japan.
- Department of Urology, JR Tokyo General Hospital, 2-1-3 Yoyogi Shibuya-ku, Tokyo, 151-8528, Japan.
| | - Katsuhisa Endo
- Department of Urology, JR Tokyo General Hospital, 2-1-3 Yoyogi Shibuya-ku, Tokyo, 151-8528, Japan
| | - Mayumi Tamari
- Research Center for Medical Science, Division of Molecular Genetics, The Jikei University School of Medicine, Tokyo, Japan
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24
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Affiliation(s)
- Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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25
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Abstract
The purpose of this study is to analyze the risk factors of sporadic renal hamartoma and establish a risk scoring system, and to intervene in patients with high-risk sporadic renal hamartoma who are prone to rupture and bleeding as soon as possible.Retrospective univariate and multivariate logistic analyzes were conducted for clinical data of 332 sporadic renal hamartoma patients to screen out independent risk factors of tumor rupture. Score of each independent risk factor was calculated. (Calculation formula: the risk coefficient of each factor = the beta regression coefficient of each factor/the minimum value of the beta regression coefficient of all factors, the value of the smallest beta regression coefficient corresponding to all the factors was assigned 1 point. The score of each factor was equal to the risk coefficient of each variable was taken as an integer value by rounding.) The total score was equal to the sum of all factors. Then the area under the receiver operating characteristics (AUC) curve was compared between high risk factors and scoring system. Finally, the scoring system was evaluated by the area under the curve (AUC) and the Hosmer-Lemeshow method in an independent cohort of 130 patients.Factors such as symptoms at presentation, tumor size, tumor blood supply, and tumor growth pattern were significant predictors of sporadic renal angiomyolipoma rupture in both the univariate and multivariate analyses; these predictors were included in the scoring system to predict sporadic renal angiomyolipoma rupture. There were no significant differences in AUCs between high risk factors and scoring system (z = 0.6434, P = .583, AUC = 0.913, and 0.903 for high risk factors and scoring system, respectively). The sporadic renal angiomyolipoma patients who scored >6 points were prone to rupture. AUROC of the scoring system in the validation set was 0.854(95%CI:0.779, 0.928). Using the Hosmer-Lemeshow method, the value of X was 2.916, P = .893, suggesting the scoring system fitted well.A scoring system based on clinical features is simple and effective in predicting sporadic angiolipoma rupture and hemorrhage. When the score is higher than 6 points, the probability of hamartoma rupture and hemorrhage is significantly increased and early intervention is needed.
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Affiliation(s)
- Xiao-feng Xu
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Xian-hui Hu
- The Urinary Surgical Department of Chengdu First People's Hospital, Chengdu
| | - Qi-ming Zuo
- The Urinary Surgical Department of Liangping People's Hospital, Chongqing, China
| | - Jiao Zhang
- The Urinary Surgical Department of Liangping People's Hospital, Chongqing, China
| | - Hao-yu Xu
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Yao Zhang
- Department of Urology, the First Affiliated Hospital of Chongqing Medical University, Chongqing
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Shaikh H, Nechanská B. Wunderlichs syndrome in patient with sporadic bilateral angiomyolipomas - case report. Rozhl Chir 2020; 99:548-551. [PMID: 33445926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We present the case report of bilateral renal angiomyolipomas in a 70-year-old patient. Spontaneous bleeding into the retroperitoneum and hemodynamic instability required an acute surgical revision with a left-sided nephrectomy. The contralateral angiomyolipoma was selectively embolized in the second period and subsequently resected.
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27
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Hes NN, El Idrissi A, Dzelili M. [A woman with acute flank pain]. Ned Tijdschr Geneeskd 2019; 163:D3815. [PMID: 31580031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 55-year-old woman presented at the Emergency Department with flank pain. She was pale, hemodynamically unstable, and had a palpable mass in her right flank. CTA of the abdomen revealed a bleeding from an angiomyolipoma of the right kidney, which was successfully treated by selective coiling of the supplying renal artery.
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Affiliation(s)
- Nicole N Hes
- Amsterdam UMC, afd. Spoedeisende Hulp, Amsterdam
- Contact: N.N. Hes
| | - A El Idrissi
- Amsterdam UMC, afd. Spoedeisende Hulp, Amsterdam
| | - Mahi Dzelili
- Amsterdam UMC, afd. Spoedeisende Hulp, Amsterdam
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28
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Machado I, Marhuenda A, Trallero M, Caballero M, Santos J, Cruz J, Estevan R. [Hepatic epithelioid angiomyolipoma/PEComa and focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma]. Rev Esp Patol 2019; 52:250-255. [PMID: 31530409 DOI: 10.1016/j.patol.2018.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/06/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
Abstract
Hepatic perivascular epithelioid cell tumors (PEComas) are uncommon mesenchymal neoplasms. PEComas concurrent with other hepatic lesions is a very rare occurrence, with only two previously reported cases. We report a primary hepatic PEComa associated with focal nodular hyperplasia in a patient with a previous history of cutaneous melanoma. Diagnostic imaging studies suggested a hepatic adenoma and the patient underwent a segmentectomy. The tumor was mainly composed of epithelioid cells, adipose tissue and smooth muscle fibers intermixed with blood vessels. The neoplastic cells were diffusely immunoreactive for HMB-45, Melan-A and smooth muscle actin, but not for Hepatocyte, S100, MITF or BRAF. Molecular studies were negative for BRAFV600 mutation. The final diagnosis was hepatic epithelioid angiomyolipoma/PEComa. The differential diagnosis of hepatic PEComa is discussed.
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Affiliation(s)
- Isidro Machado
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, España.
| | - Ana Marhuenda
- Departamento de Radiología, Instituto Valenciano de Oncología, Valencia, España
| | - Marta Trallero
- Servicio de Cirugía, Instituto Valenciano de Oncología, Valencia, España
| | - María Caballero
- Servicio de Cirugía, Instituto Valenciano de Oncología, Valencia, España
| | - Jesús Santos
- Departamento de Radiología, Instituto Valenciano de Oncología, Valencia, España
| | - Julia Cruz
- Departamento de Patología, Instituto Valenciano de Oncología, Valencia, España
| | - Rafael Estevan
- Servicio de Cirugía, Instituto Valenciano de Oncología, Valencia, España
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29
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Ho TH, Yang FC, Cheng KC, Lin CC, Lee JT. Wunderlich syndrome, spontaneous ruptured renal angiomyolipoma and tuberous sclerosis. QJM 2019; 112:283-284. [PMID: 30629244 DOI: 10.1093/qjmed/hcz004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 12/20/2018] [Indexed: 11/15/2022] Open
Affiliation(s)
- T-H Ho
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
| | - F-C Yang
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
| | - K-C Cheng
- Department of Emergency Medicine, Taichung Veterans General Hospital, Puli Branch, No. 1, Rongguang Road, Puli Township, Nantou County 545, Taiwan, Republic of China
| | - C-C Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
| | - J-T Lee
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu 114, Taipei, Taiwan, Republic of China
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Abstract
Trans-radial access offers several unique advantages and is being used more frequently for interventional radiology procedures. We report the use of trans-radial arterial access to embolize a large bleeding angiomyolipoma in a 30-year-old pregnant patient presenting in the first trimester. Trans-radial approach was chosen to minimize the effects of radiation on the fetus. Subsequent postprocedural pregnancy course was uneventful with stability of the angiomyolipoma and no further hemorrhage. This case highlights the benefits of trans-radial embolotherapy in gravid patients to reduce the risk of radiation exposure to the fetus.
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Affiliation(s)
| | - Ifechi Momah-Ukeh
- Department of Radiology, MedStar Georgetown University Hospital, Washington D.C., USA
| | - Alexander Y Kim
- Department of Radiology, MedStar Georgetown University Hospital, Washington D.C., USA
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31
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Harašta J, Huml K. Retroperitoneal bleeding caused by spontaneus rupture of renal angiomyolipoma following cesarean section treated with selective embolisation. Ceska Gynekol 2019; 84:298-302. [PMID: 31818114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe management of a spontaneus rupture of renal angiomyolipoma after cesarean section. DESIGN Case report. SETTING Department of Gynaecology and Obstetrics, Hospital Šternbek; Department of Obstetrics and Gynaecology, Palacky University and University Hospital, Olomouc. CASE REPORT 29-year-old patient underwent acute cesarean section at 35 weeks of gestation for pPROM, placenta praevia marginalis, suspicion of placenta accreta by ultrasound and MRI and transverse position of the fetus. The next morning was found out a spontaneus rupture of renal angiomyolipoma causing progressive anemisation. We describe the following management. CONCLUSION Incidention of tumors complicating gravidity may occur more often due to changes in population characteristics. Methods of interventional radiology are ordinarily used for severe hemorrage postpartum or for prophylactic occlusion of illiac arteries before cesarean section with morbidly adherent placenta. We show here usage of selective embolisation in not so common obstetrical complications.
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32
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Sohlberg E, Sun A, Massoudi R, Prado K, Skinner E. Giant renal angiomyolipoma in a solitary kidney. Can J Urol 2018; 25:9614-9616. [PMID: 30553288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
While renal angiomyolipomas (AMLs) generally remain small and asymptomatic, larger AMLs are more common in tuberous sclerosis patients. Giant AMLs over 20 cm are a rare entity and little is known about their management. We present a unique case of a 48-year-old woman with tuberous sclerosis and a 39 cm AML arising from a solitary kidney, after undergoing nephrectomy for a prior AML. Giant renal AMLs can occur in patients with tuberous sclerosis and resection should be considered even for large tumors. Renal sparing is often difficult and patients should be counseled about potential need for postoperative hemodialysis.
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Affiliation(s)
- Ericka Sohlberg
- Department of Urology, Stanford University, Stanford, California, USA
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33
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Khan AA, Saquib S, Hafeez R, Kadri S. Large Aneurysm in Renal Angiomyolipoma. J Coll Physicians Surg Pak 2018; 28:S160-S161. [PMID: 30173683 DOI: 10.29271/jcpsp.2018.09.s160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/07/2018] [Indexed: 06/08/2023]
Abstract
Large aneurysms seen in renal angiomyolipoma are usually more common in patients with tuberous sclerosis in comparison with sporadic cases and they are more prone to hemorrhage ranging from renal hematoma to life-threatening perirenal hemorrhages. We present a case of 13-year female patient who was referred to Civil Hospital, Karachi, with bilateral flank pain, cutaneous nodule and low intelligence. Her color doppler ultrasound revealed pseudoaneurysm in left kidney on the background of bilateral renal angiomyolipomas. Contrast enhanced CT scan confirmed various radiological manifestations of tuberous sclerosis including subependymal tubers, bilateral angiomyolipomas, and pseudoaneurysm associated with perinephric hemorrhage in left kidney.
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Affiliation(s)
- Ateeque Ahmed Khan
- Department of Radiology, Civil Hospital and Dow University of Health Sciences, Karachi
| | - Samiya Saquib
- Department of Radiology, Civil Hospital and Dow University of Health Sciences, Karachi
| | - Rabia Hafeez
- Department of Radiology, Civil Hospital and Dow University of Health Sciences, Karachi
| | - Sarosh Kadri
- Department of Radiology, Civil Hospital and Dow University of Health Sciences, Karachi
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Abstract
Epithelioid angiomyolipoma is a recently recognized tumor entity. We report a case of epithelioid angiomyolipoma of the kidney that occurred in a 70-year-old female. The patient presented with massive abdominal hemorrhage and shock. There was no history of tuberous sclerosis complex. The tumor consisted of smooth muscle, adipocytes, small-to-medium-sized hyalinized blood vessels and numerous pleomorphic epithelioid cells with clear to eosinophilic cytoplasm. Mitosis was exceptional and no glandular pattern was recognizable. Immunohistochemically the epithelioid cells were strongly positive for HMB45 and CD68, focally positive for S-100, actin and vimentin, and negative for epithelial markers including epithelial membrane antigen and cytokeratins. Previous reports in the English literature suggest that epithelioid angiomyolipoma may have malignant potential. In our case, at six months from surgery the patient is alive and well without evidence of relapse or metastasis.
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Affiliation(s)
- B Lebe
- Department of Pathology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.
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35
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Csanaky G, Szereday Z, Magyarlaki T, Méhes G, Herbert T, Buzogány I. Renal Angiomyolipoma: Report of three cases with Regional Lymph Node Involvement and/or with Renal Cell Carcinoma. Tumori 2018; 81:469-74. [PMID: 8804480 DOI: 10.1177/030089169508100619] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background Angiomyolipomas (AMLs) are benign hamartoid tumors which frequently occur in tuberous sclerosis (TS). They may be manifest at different organ sites such as kidneys, lymph nodes, liver and lung and may be associated with renal cell carcinoma (RCC). The nature of multiple organ involvement in AML (metastasis versus multicentric synchronous tumors), the malignant transformation and the relation of AML to RCC have not been sufficiently clarified. Study design Three cases of renal AMLs in patients with tuberous sclerosis associated with lymphangioleiomyomatosis of the paraaortic lymph nodes and/or with RCC are reported. The concise clinical history of the patients as well as the findings of histology, immunohistochemistry and quantitative DNA analysis are presented. Results The multicentric form of AML and coincidence of renal AML and RCC were observed in 2 patients. AML and RCC were found within the same focus in one of the cases. RCCs were either aneuploid or “near diploid”, whereas one of the multicentric AMLs showed a discordant DNA ploidy pattern, namely aneuploidy in the kidney and diploidy in the lymph nodes. Conclusions The presented cases (all of them underwent periaortic lymphadenectomy) suggest that lymph node involvement in renal AML may be more frequent than expected (1-2% of all AMLs) on the basis of the few reported cases. The discordant DNA ploidy (renal versus lymph node lesions) observed in one of the cases with multicentric AML implies synchronous tumor growth at different sites rather than metastatic disease. The intimate coexistance of RCC and AML (RCC revealed by immunohistochemistry within a larger mass of renal AML) may indicate that malignant transformation of an AML should only be accepted, if such a coincidence is unequivocally excluded.
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Affiliation(s)
- G Csanaky
- Department of Pathology, University Medical School of Pécs, Hungary
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36
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Abstract
BACKGROUND Renal angiomyolipoma (AML) is a common benign tumor of the kidney. The main complication of AML is retroperitoneal hemorrhage caused by AML rupture, which can be severe and life threatening. The risk of AML rupture used to be determined by tumor size. However, these criteria have been challenged by series of clinical studies and case reports, suggesting prediction AML rupture based on tumor size is not always reliable. METHODS The authors searched PubMed using "angiomyolipoma," "AML," and "rupture" and reviewed relevant studies. The authors investigated the risk factors of AML rupture using the retrieved literature. The authors also summarized current modalities to evaluate and manage AML. RESULTS It is established that risk of AML rupture is associated with lesion size. However, genetic abnormality, aneurysm formation, and pregnancy are also risk factors for tumor rupture. Thus, the prediction of AML rupture should be based on a more comprehensive risk assessment system. The management of renal AML and tumor rupture was also discussed in the present paper. CONCLUSION The risk of AML rupture is associated with but not exclusive to lesion size. Any decision to intervene AML must be based on multiple factors including risk, symptoms, and auxiliary findings.
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Affiliation(s)
- Chenyang Wang
- Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, Guangdong
| | - Xinyuan Li
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Linglong Peng
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Xin Gou
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
| | - Jing Fan
- Department of Urology, Chongqing Medical University First Affiliated Hospital, Chongqing, China
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37
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Yamamichi G, Abe T, Ishizuya Y, Fujita K, Uemura M, Kiuchi H, Imamura R, Miyagawa Y, Ono Y, Higashihara H, Osuga K, Nonomura N. [A Case of Bilateral Angiomyolipoma Accompanied by Tuberous Sclerosis Complex Successfully Treated with Transcatheter Arterial Embolization Using Functional Kidney Mapping Images Consisting of SPECT-CT and Contrast Enhanced CT Images]. Hinyokika Kiyo 2018; 64:49-53. [PMID: 29684949 DOI: 10.14989/actauroljap_64_2_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Renal angiomyolipoma (AML) and aneurysm are common in tuberous sclerosis complex (TSC) and represent the main causes of morbidity in adults with TSC. Herein, we report a 22-year-old woman with TSC-associated AMLs and renal aneurysms. She was referred to our hospital for the treatment of multiple renal aneurysms larger than 5 mm in diameter. The previous hospital considered that transcatheter arterial embolization (TAE) of bilateral renal aneurysms would cause deterioration of renal function. To estimate the impact of TAE on renal function, we superimposed contrast enhanced computed tomography (CT) over single-photon emission CT (SPECT)-CT. This fusion image, referred to as functional kidney mapping image, revealed the location of renal arteries and aneurysms, and normal renal parenchyma simultaneously. Functional kidney mapping image was useful to distinguish the AML region from the normal renal parenchyma, and revealed that the planned embolization site was a non-functioning parenchyma. Therefore, TAE for her multiple renal aneurysms was successfully performed without deterioration of her renal function.
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Affiliation(s)
- Gaku Yamamichi
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Toyofumi Abe
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Yu Ishizuya
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Kazutoshi Fujita
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Motohide Uemura
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Hiroshi Kiuchi
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Ryoichi Imamura
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Yasushi Miyagawa
- The Department of Urology, Osaka University Graduate School of Medicine
| | - Yusuke Ono
- The Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Hiroki Higashihara
- The Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Keigo Osuga
- The Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Norio Nonomura
- The Department of Urology, Osaka University Graduate School of Medicine
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38
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Bissler JJ, Franz DN, Frost MD, Belousova E, Bebin EM, Sparagana S, Berkowitz N, Ridolfi A, Kingswood JC. The effect of everolimus on renal angiomyolipoma in pediatric patients with tuberous sclerosis being treated for subependymal giant cell astrocytoma. Pediatr Nephrol 2018; 33:101-109. [PMID: 28993887 PMCID: PMC5700234 DOI: 10.1007/s00467-017-3806-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/04/2017] [Accepted: 09/05/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with tuberous sclerosis complex (TSC) often have multiple TSC-associated hamartomas, particularly in the brain and kidney. METHODS This was a post hoc analysis of pediatric patients being treated for subependymal giant cell astrocytomas (SEGAs) during the phase 3, randomized, double-blind, placebo-controlled EXIST-1 trial. Patients were initially randomly assigned to receive everolimus 4.5 mg/m2/day (target blood trough 5-15 mg/dl) or placebo and could continue in an open-label extension phase. Angiomyolipoma response rates were analyzed in patients aged <18 years with ≥1 target angiomyolipoma lesion at baseline. Response was defined as the proportion of patients with a ≥50% reduction in the sum volume of target renal angiomyolipomata from baseline, in the absence of new target angiomyolipomata, a >20% increase in kidney volume from nadir, and angiomyolipoma-related bleeding ≥ grade 2. Tolerability was also assessed. RESULTS Overall, this analysis included 33 patients. Renal angiomyolipoma response was achieved by 75.8% of patients (95% confidence interval, 57.7-88.9%), with sustained mean reductions in renal angiomyolipoma volume over nearly 4 years of treatment. In addition, most (≥80%) achieved clinically relevant reductions in angiomyolipoma volume (≥50%), beginning at week 24 and continuing for the remainder of the study. Everolimus was generally well tolerated in this subgroup, with most adverse events being grade 1 or 2 in severity. CONCLUSIONS Although everolimus is currently not indicated for this use, this analysis from EXIST-1 demonstrates its long-term efficacy and safety for the treatment of renal angiomyolipoma in pediatric patients undergoing treatment for TSC-associated SEGA.
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Affiliation(s)
- John J Bissler
- Division of Nephrology, St Jude Children's Research Hospital and Le Bonheur Children's Hospital, University of Tennessee Health Science Center, 49 North Dunlap Street, Memphis, TN, 38163, USA.
| | - David N Franz
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Elena Belousova
- Moscow Research Institute of Pediatrics and Pediatric Surgery, Moscow, Russia
| | - E Martina Bebin
- University of Alabama School of Medicine, Birmingham, AL, USA
| | | | - Noah Berkowitz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Rottenstreich A, Herzberg S, Zigron R, Parkes I, Safrai M, Levin G. Massive hematuria at pregnancy caused by ruptured angiomyolipoma: A case report. Eur J Obstet Gynecol Reprod Biol 2017; 221:196-198. [PMID: 29254628 DOI: 10.1016/j.ejogrb.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 12/13/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Amihai Rottenstreich
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
| | - Shmuel Herzberg
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
| | - Roy Zigron
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
| | - Ilana Parkes
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
| | - Myriam Safrai
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel
| | - Gabriel Levin
- Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel.
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40
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Brakemeier S, Vogt L, Adams L, Zukunft B, Diederichs G, Hamm B, Budde K, Makowski MR. Treatment effect of mTOR-inhibition on tissue composition of renal angiomyolipomas in tuberous sclerosis complex (TSC). PLoS One 2017; 12:e0189132. [PMID: 29232371 PMCID: PMC5726644 DOI: 10.1371/journal.pone.0189132] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
Abstract
Purpose Tuberous sclerosis complex (TSC)-associated renal angiomyolipoma (AML) have a high lifetime risk of acute bleeding. MTOR-inhibitors are a promising novel treatment for TSC-AML, however adequate response to therapy can be difficult to assess. Early changes in MRI signal may serve as a novel early indicator for a satisfactory response to mTOR-inhibitor therapy of AML. Materials and methods Thirty-eight patients with the definite diagnosis of tuberous sclerosis receiving everolimus therapy and n = 19 patients without specific therapy were included. 1.5 Tesla MRI was performed including sequences with a selective fat suppression. Patients were investigated prior to the initiation of therapy (baseline) and after <3 months (n = 21 patients), 3 to 6 months (n = 32) and 18 to 24 months (n = 28). Signal and size changes of renal AMLs were assessed at all different timepoints. Signal-to-noise-ratio (SNR), contrast-to-noise-ratio (CNR) and size of angiomyolipomas were evaluated. Results Signal changes in 273 AMLs were evaluated. A significant and strong decrease of the CNR of AMLs following the initiation of therapy was measured in the fat-suppressed MR sequence at all time points, compared to the baseline: From 7.41±6.98 to 3.84±6.25 (p ≤ 0.05p = 0.002), 3.36±6.93 (p<0.0001), and 2.50±6.68 (p<0.0001) after less than 3 months, 3–6 months or 18–24 months of everolimus treatment, respectively. Also, a significant, however less pronounced, reduction of angiomyolipoma size in the different groups was measured (from baseline 2022.2±2657.7 mm2 to 1854.4±1670.9 mm2 (p = 0.009), 1875.5±3190.1 mm2 (p<0.001), and 1365.8 ± 1628.8 mm2 (p<0.0001) after less than 3 months, 3–6 months or 18–24 months of everolimus treatment, respectively). No significant changes in CNR (p>0.05) and size (p>0.05) were measured in the control group. Conclusion mTOR inhibitor therapy in TSC patients results in an early and pronounced fatty transformation of AMLs on MRI. Fatty transformation could represent a novel early indicator of response to therapy in this patient collective.
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Affiliation(s)
- Susanne Brakemeier
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
- * E-mail:
| | - Lars Vogt
- Department of Radiology, Charité, Berlin, Germany
| | - Lisa Adams
- Department of Radiology, Charité, Berlin, Germany
| | - Bianca Zukunft
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
| | | | - Bernd Hamm
- Department of Radiology, Charité, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité, Berlin, Germany
| | - Marcus R. Makowski
- Department of Radiology, Charité, Berlin, Germany
- King’s College London, Division of Imaging Sciences, London, United Kingdom
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Sun P, Liu J, Charles H, Hulbert J, Bissler J. Outcomes of angioembolization and nephrectomy for renal angiomyolipoma associated with tuberous sclerosis complex: a real-world US national study. Curr Med Res Opin 2017; 33:821-827. [PMID: 28112545 DOI: 10.1080/03007995.2017.1286307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To examine outcomes of clinical procedures for renal angiomyolipoma associated with tuberous sclerosis complex (TSC) based on US national health claims databases. METHODS This retrospective cohort study selected two cohorts of TSC patients, who underwent either embolization or nephrectomy (either partial or complete) for renal angiomyolipoma in the years from 2000 through 2011. Based on claims diagnosis codes, we estimated the prevalence rates of 10 angiomyolipoma-related conditions and 50 embolization- or nephrectomy-related conditions in the pre- and post-baseline periods respectively, and made cross-year and cross-period comparison of these rates with repeated measures analysis methods. RESULTS The embolization cohort (N = 4280) and the nephrectomy cohort (N = 3842) had mean baseline ages of 50.7 and 51.7 years with 52.5% and 51.3% males, respectively. After the intervention, the embolization cohort had statistically significant reductions (all p < .05) in gross hematuria (-27.7%), retroperitoneal hemorrhage (-8.4%), and abdominal mass (-6.9%), and increases in hypertension (15.5%), renal mass or unspecified disorder of kidney and ureter (13.8%), anemia (5.1%), and renal insufficiency (3.3%). Similarly, the nephrectomy cohort saw statistically significant reductions (all p < .05) in gross hematuria (-30.6%), flank pain (-7.5%), and abdominal mass (-6.4%), but increases in hypertension (11.9%), renal insufficiency (10.4%), and anemia (7.6%). Embolization was associated with post-procedure increases in renal mass or unspecified kidney/ureter disorder (13.9%), other disorders of kidney and ureter (3.4%), non-acute renal insufficiency (3.1%), flank pain (3.7%), renal insufficiency (3.2%), etc. (all p < .05). Nephrectomy was associated with post-procedure increases in postoperative ileus (5.3%), pain and headache (4.8%), paralytic ileus (3.6%), etc. (all p < .05). CONCLUSIONS Both embolization and nephrectomy were effective, but associated with increases in certain angiomyolipoma-related conditions. Further, the embolization effect on gross hematuria, retroperitoneal hemorrhage, and abdominal mass might subside after the intervention year.
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Affiliation(s)
- Peter Sun
- a Kailo Research Group , Indianapolis , IN , USA
| | - Jamae Liu
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | | | - John Bissler
- e Le Bonheur Children's Hospital and the University of Tennessee , Memphis , TN , USA
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Song X, Liu Z, Cappell K, Gregory C, Said Q, Prestifilippo J, Charles H, Hulbert J, Bissler J. Healthcare utilization and costs in patients with tuberous sclerosiscomplex-related renal angiomyolipoma. J Med Econ 2017; 20:388-394. [PMID: 27998195 DOI: 10.1080/13696998.2016.1272461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To quantify healthcare utilization and costs in patients with tuberous sclerosis complex (TSC) and renal angiomyolipoma (AML) in a matched cohort of patients without TSC or AML. METHODS Administrative data from the MarketScan Research Databases were used to select patients with TSC and renal AML during January 1, 2000-March 31, 2013 from the Commercial database and January 1, 2000-June 30, 2012 from the Medicaid database. Patients were required to have at least 30 days of follow-up from initiation into the study, and were followed until inpatient death, end of insurance coverage, or the end of study. Age, calendar year, and payer-matched controls that had no TSC and no AML were selected. All-cause annualized healthcare utilization and costs were calculated by service category. RESULTS A total of 218 patients under 18 years and 377 patients 18 years and older with TSC-renal AML were selected from the Commercial database, and matched to 654 and 1,131 controls, respectively. Thirty-eight patients under 18 years and 110 patients 18 years or older with TSC-renal AML were selected from the Medicaid database, and matched to 54 and 212 controls, respectively. Within the Commercial cohort, and across both age groups, TSC-renal AML patients utilized more healthcare services than their matched controls. Within the Medicaid cohort, in both age groups, utilization was higher in TSC-renal AML patients vs control patients for inpatient admissions, emergency room visits, physician office visits, and hospital-based outpatient visits. Across age groups and in both the Commercial and Medicaid cohorts, the annual average total costs were significantly higher in TSC-renal AML patients compared to control patients (p < 0.05 for all). Healthcare costs ranged from $29,240-$48,499 for TSC-renal AML patients and from $2,082-$10,864 for control patients. CONCLUSIONS Compared to controls, TSC-renal AML patients incurred substantially higher annual healthcare utilization and costs.
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Affiliation(s)
- Xue Song
- a Truven Health Analytics Inc. , an IBM Company, Cambridge , MA , USA
| | - Zhimei Liu
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - Katherine Cappell
- a Truven Health Analytics Inc. , an IBM Company, Cambridge , MA , USA
| | | | - Qayyim Said
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | | | | | - John Bissler
- e LeBonheur Children's Hospital and St. Jude Children's Research Hospital , Memphis , TN , USA
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Tan P, Xu H, Jiang Y, Yang L, Zou Y, Liu L, Liu N, Cao D, Fan Y, Li Q, Wei Q. Microsatellite analysis for differentiating the origin of renal angiomyolipoma and involved regional lymph node. Sci Rep 2017; 7:362. [PMID: 28336972 PMCID: PMC5428456 DOI: 10.1038/s41598-017-00460-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 02/27/2017] [Indexed: 02/05/2023] Open
Abstract
Renal angiomyolipoma (AML) with the regional lymph node (LN) involved leads to a question of metastasis versus multicentric origin when their histology are similar. As the genomic instability is a common feature of cancer, we hypothesized that independently arising neoplasms in an individual patient would exhibit measurable genomic variation, facilitating the discrimination of tumor lineage and relatedness. Our study enrolled 12 patients who were diagnosed with nodal-involved renal AML at West China Hospital. Genomic DNA from kidney and lymph node lesion from individuals was analyzed through PCR-based analysis which using six microsatellite markers to identify discordant allelic variation. The results showed all 12 patients underwent surgical treatment and none suffered local recurrence or distant metastasis during the follow-up. Ten patients of the included cases showed a consistent trend that all corresponding to six microsatellite markers were detected in DNA from renal AMLs but were reduced or not observed in DNA from the paired LN. With this technique, a possible lineage relationship cannot be excluded between renal AMLs and LN. Thus when enlarged LN were found in images, active surveillance should be taken into consider; if enlarged LN were found intraoperatively, LN resection might be necessary to demonstrate their pathological nature.
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Affiliation(s)
- Ping Tan
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Huan Xu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yong Jiang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yan Zou
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Liangren Liu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Nian Liu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Yu Fan
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qiyuan Li
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
- Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Kobayashi M, Saito M, Akihama S, Kumazawa T, Igarashi R, Yamamoto R, Takayama K, Tsuruta H, Inoue T, Narita S, Tsuchiya N, Satoh S, Habuchi T. [Tuberous Sclerosis Complex Detected by Spontaneous Rupture of a Giant Renal Angiomyolipoma : A Case Report]. Hinyokika Kiyo 2017; 63:111-114. [PMID: 28331168 DOI: 10.14989/actauroljap_63_3_111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
A woman in her 30s was admitted with abdominal pain and nausea. CT scan revealed a spontaneous rupture of the right giant renal angiomyolipoma, and trans-arterial embolization was performed successfully. With further examination, she was found to be affected with tuberous sclerosis complex (TSC) and she finally wastreated with everolimusfor prevention of recurrent spontaneous-rupture of renal angiomyolipoma.
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Affiliation(s)
- Mizuki Kobayashi
- The Department of Urology, Akita University Graduate School of Medicine
| | - Mitsuru Saito
- The Department of Urology, Akita University Graduate School of Medicine
| | - Susumu Akihama
- The Department of Urology, Akita University Graduate School of Medicine
| | | | - Ryoma Igarashi
- The Department of Urology, Akita University Graduate School of Medicine
| | - Ryohei Yamamoto
- The Department of Urology, Akita University Graduate School of Medicine
| | - Koichiro Takayama
- The Department of Urology, Akita University Graduate School of Medicine
| | - Hiroshi Tsuruta
- The Department of Urology, Akita University Graduate School of Medicine
| | - Takamitsu Inoue
- The Department of Urology, Akita University Graduate School of Medicine
| | - Shintaro Narita
- The Department of Urology, Akita University Graduate School of Medicine
| | | | - Shigeru Satoh
- Center for Kidney Disease and Transplantation, Akita University Hospital
| | - Tomonori Habuchi
- The Department of Urology, Akita University Graduate School of Medicine
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45
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Giannubilo SR, D'Eusanio S, Ciavattini A. Cesarean Section Revealing an Unsuspected Renal Angiomyolipoma in a Woman with Severe Hypertension During Pregnancy: A Case Report. J Reprod Med 2017; 62:211-214. [PMID: 30230799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Renal angiomyolipomas are uncommon during pregnancy, but it is important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, renal artery compression, and renovascular hypertension. CASE A 42-year-old woman was admitted at 34 weeks of gestation for severe abdominal pain in the right flank associated with severe hypertension. During the postadmission immediate cesarean section for fetal compromise, abdominal exploration revealed a massive retroperitoneal hematoma (around 30 cm) up to the cecal region until the lower edge of the liver. The diagnosis was the rupture of a renal angiomyolipoma causing renovascular hypertension. CONCLUSION Renovascular hypertension should be considered in patients who present with accelerated hypertension, particularly if the hypertension is resistant to medical therapy and not associated with laboratory features of preeclampsia/eclampsia.
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46
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Alves C, Pruijma M, Rotman S, Bonny O. [Chronic kidney diseases do not always pass unnoticed]. Rev Med Suisse 2016; 12:382-386. [PMID: 27039602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Kidney diseases are frequent, but most of the time, they develop unnoticed. This paucity of symptoms may lead to delayed diagnosis with important consequences on their outcome. Nevertheless, specific systemic signs such as skin lesions, joint pain or electrolytes disturbances may sometimes alert the clinician and direct the diagnosis to an underlying nephropathy. A high awareness of clinicians is warranted to recognize these red flags and diagnose these diseases early, as illustrated by two clinical cases discussed in this article.
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Wang Q, Juan YH, Li Y, Xie JJ, Liu H, Huang H, Liu Z, Zheng J, Saboo US, Saboo SS, Liang C. Multidetector Computed Tomography Features in Differentiating Exophytic Renal Angiomyolipoma from Retroperitoneal Liposarcoma: A Strobe-Compliant Observational Study. Medicine (Baltimore) 2015; 94:e1521. [PMID: 26376398 PMCID: PMC4635812 DOI: 10.1097/md.0000000000001521] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the multidetector computed tomography (CT) imaging features in differentiating exophytic renal angiomyolipoma (AML) from retroperitoneal liposarcoma. We retrospectively enrolled 42 patients with confirmed exophytic renal AML (31 patients) or retroperitoneal liposarcoma (11 patients) during 8 years period to assess: renal parenchymal defect at site of tumor contact, supply from branches of renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, hemorrhage, non-fat-containing intratumoral nodules with postcontrast enhancement, calcification, renal sinus enlargement, anterior displacement of kidneys, and other associated AML. Renal parenchymal defect, renal arterial blood supply, tumoral vessel through the renal parenchyma, dilated intratumoral vessels, intratumoral/perirenal hemorrhage, renal sinus enlargement, and associated AML were seen only or mainly in exophytic renal AML (all P value < 0.05); however, non-fat-attenuating enhancing intratumoral nodules, intratumoral calcification, and anterior displacement of the kidney were more common in liposarcoma (all P value < 0.05). AMLs reveal renal parenchymal defect at the site of tumor contact, supply from renal artery, tumoral vessel extending through the renal parenchyma, dilated intratumoral vessels, intratumoral and/or perirenal hemorrhage, renal sinus enlargement, and associated AML. Non-fat-attenuating enhancing intratumoral nodules, intratumoral calcifications, and anterior displacement of kidney were more commonly seen in liposarcoma.
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Affiliation(s)
- Qiushi Wang
- From the Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, GuangZhou, GuangDong, China (QW, J-JX, HL, HH, ZL, JZ, CL); Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (Y-HJ); Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan (Y-HJ); Department of General Surgery, Guangdong General Hospital, Guangdong Academy of Medical Sciences, GuangZhou, GuangDong, China (YL); Schepens Eye Research Institute, Harvard Medical School, Boston, MA (USS); and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX (SSS)
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Zhou G, Hu W, Bao H, Zhang Q. A rare case of xanthogranulomatous pyelonepheritis with hepatic angiomyolipoma. Int J Clin Exp Pathol 2015; 8:11819-11822. [PMID: 26617933 PMCID: PMC4637749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 08/21/2015] [Indexed: 06/05/2023]
Abstract
Xantogranulomatous pyelonephritis (XGP) is a rare and chronic variant of pyelonephritis typically associated with obstruction and infection. Xantogranulomatous pyelonephritis can infiltrate liver and connect with hepatic dysfunction. Here we report on a 52-year-old female with a liver mass and a left renal mass detected by uitrasonography and magnetic resonance imaging. Right lobectomy and partial nephrectomy were successively performed. Subsequent pathologic examination indicated hepatic angiomyolipoma and xanthogranulomatous pyelonepheritis, respectively. To the best of our knowledge, this is the first case of such rare combination.
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Affiliation(s)
- Gongting Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Fu-Xue Xiang, Wenzhou 325000, Zhejiang, P. R. China
| | - Weijian Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Fu-Xue Xiang, Wenzhou 325000, Zhejiang, P. R. China
| | - Haili Bao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Fu-Xue Xiang, Wenzhou 325000, Zhejiang, P. R. China
| | - Qiyu Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University Fu-Xue Xiang, Wenzhou 325000, Zhejiang, P. R. China
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Bro L, Kromann CB, Wennewik GE, Andersen M. [Renal angiomyolipoma with spontaneous retroperitoneal bleeding]. Ugeskr Laeger 2015; 177:V06140322. [PMID: 26320358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Angiomyolipoma (AML) is a benign tumour composed predominantly of blood vessels, smooth muscle tissue and adipose tissue. It is a rare disorder found in 0.1% of men and 0.22% of women. AML is most often manifested as a solitary tumour, but can also be found with multiple lesions in various organs. AML is predominantly asymptomatic, but may present with different symptoms depending on the size and position. Patients often have flank pain and microscopic or macroscopic haematuria. AML can also debut with spontaneous atraumatic bleeding in the retroperitoneum, Wunderlich's syndrome.
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Affiliation(s)
- Lasse Bro
- Urologisk Afdeling, Sydvestjysk Sygehus, Finsensgade 35, 6700 Esbjerg.
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50
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Celik SU, Kocaay AF, Sevim Y, Cetinkaya OA, Atman ED, Alacayir I. Renal Angiomyolipoma With Caval Extension and Pulmonary Fat Embolism: A Case Report. Medicine (Baltimore) 2015; 94:e1078. [PMID: 26252271 PMCID: PMC4616609 DOI: 10.1097/md.0000000000001078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/04/2015] [Indexed: 01/20/2023] Open
Abstract
Renal angiomyolipoma (AML) is a rare benign tumor of the kidney. Occasionally, it may extend into the renal vein or the inferior vena cava (IVC), but so far of pulmonary embolism in patients with renal AML was rarely reported. Here, a case of symptomatic pulmonary embolism secondary to AML that was placed IVC filter before the operation and then treated with radical nephrectomy is reported.This case highlights the rare possibility of renal vein and IVC involvement with symptomatic pulmonary fat embolism in renal AML, which may potentially result in fatal complications if not appropriately and cautiously managed with surgical intervention.
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Affiliation(s)
- Suleyman Utku Celik
- From the Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey (SUC, AFK, OAC, IA); Kayseri Training and Research Hospital, Department of General Surgery, Kayseri, Turkey (YS); and Ankara University School of Medicine, Department of Radiology, Ankara, Turkey (EDA)
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