Contemporary Diagnosis and Management of Renal Angiomyolipoma

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Oct 2002Contemporary Diagnosis and Management of Renal Angiomyolipoma Caleb P. Nelson and Martin G. Sanda Caleb P. NelsonCaleb P. Nelson and Martin G. SandaMartin G. Sanda View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64440-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present a comprehensive resource that summarizes contemporary advances relevant to the clinical management of renal angiomyolipoma. Materials and Methods: A MEDLINE search was done using the key words angiomyolipoma, hemangioma or lipoma and kidney neoplasm, and therapeutic embolization. References from these articles were reviewed to identify additional relevant source material. We identified 13 series published since 1986 comprising 336 patients as well as 24 reports of therapeutic embolization for angiomyolipoma, comprising 76 patients. To our knowledge we report the largest compilation series to date. Results: Angiomyolipoma is generally benign, although an uncommon subtype (epithelioid angiomyolipoma) may behave more aggressively. Tuberous sclerosis associated angiomyolipoma tends to be larger, multiple and more likely to cause spontaneous hemorrhage than the sporadic entity. Tumors that hemorrhage tend to be larger. Computerized tomography or magnetic resonance is usually sufficient for diagnosis. Biopsy is rarely useful. Primary indications for intervention include symptoms such as pain or bleeding or suspicion of malignancy. Prophylactic intervention is justifiable for large tumors, in females of childbearing age or in patients in whom followup or access to emergency care may be inadequate. Recent advances that have affected management include improved understanding of tuberous sclerosis complex and angiomyolipoma genetics, the identification of molecular markers that facilitate histopathological diagnosis, and the refinement of embolization and partial nephrectomy techniques. Conclusions: Although some cases of angiomyolipoma may require complete nephrectomy, most can be managed by conservative nephron sparing approaches. Ongoing research into the molecular biology and clinical behavior of angiomyolipoma may improve our ability to manage these lesions. References 1 : Angiomyolipoma of the kidney. J Urol1951; 65: 525. Link, Google Scholar 2 : Atlas of Genitourinary Pathology. Washington, D. C: Army Institute of Pathology1946. Google Scholar 3 : Demonstration eines grossen Angio-Myo-Lipoms der Niere. Dtsch Med Wochenschr1900; 26: 290. Google Scholar 4 : Extrarenal angiomyolipoma. J Surg Oncol1984; 25: 89. Google Scholar 5 : Renal angiomyolipomas of the perinephric space. J Urol1992; 147: 447. Link, Google Scholar 6 : Extrarenal retroperitoneal angiomyolipoma: nonoperative management. J Urol2000; 163: 234. Link, Google Scholar 7 : Angiomyolipoma of the bladder wall. J Urol2000; 163: 901. Link, Google Scholar 8 : Involvement of spleen by renal angiomyolipoma. Metastases or multicentricity? J Urol1983; 130: 328. Link, Google Scholar 9 : Die Nierentumoren bei der Tuberosen Hirnsklerose. Zeigl Beitr Pathol Anat Allg Pathol1911; 50: 235. Google Scholar 10 : Renal angiomyolipoma: optimal treatment based on size and symptoms. Clin Nephrol1998; 49: 281. Google Scholar 11 : Renal angiomyolipoma: current concepts of diagnosis and management. AUA Update Series1992; vol. 11. Google Scholar 12 : Management of renal angiomyolipoma: a report of 53 cases. BJU Int1999; 83: 215. Google Scholar 13 : Management of renal angiomyolipoma: analysis of 15 cases. Eur Urol1998; 33: 572. Google Scholar 14 : Renal angiomyolipoma—experience of 20 years in Taiwan. Eur Urol1997; 32: 175. Google Scholar 15 : Radiological parameters of bleeding renal angiomyolipoma. Scand J Urol Nephrol1996; 30: 265. Google Scholar 16 : Outcome analysis of 42 cases of renal angiomyolipoma. J Urol1994; 152: 1988. Link, Google Scholar 17 : Management of renal angiomyolipoma: a report of 14 cases and review of the literature. Is nonsurgical treatment adequate for this tumor? Eur Urol1994; 25: 183. Google Scholar 18 : The evolution of renal angiomyolipomas in patients with tuberous sclerosis. J Urol1994; 152: 35. Link, Google Scholar 19 : The natural history of renal angiomyolipoma. J Urol1993; 150: 1782. Link, Google Scholar 20 : Renal angiomyolipoma: report of 24 cases. Br J Urol1990; 66: 585. Google Scholar 21 : Angiomyolipoma: clinical metamorphosis and concepts for management. J Urol1988; 139: 20. Link, Google Scholar 22 : Diagnosis and treatment of renal angiomyolipoma. Urol Int1987; 42: 201. Google Scholar 23 : Renal angiomyolipoma: 6 case reports and literature review. J Urol1986; 135: 349. Link, Google Scholar 24 : Giant bilateral renal angiomyolipomas associated with tuberous sclerosis. Urology2001; 57: 554. Google Scholar 25 : Selective arterial embolization in the management of symptomatic renal an