[Diagnosis and treatment of renal angiomyolipoma].
Norio IizukaFujio MasudaMakoto MikiYukihiko OhishiGyojiro NakadaT OnishiYoshinori MoriMarie SuzukiT Machida
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We have hitherto reported 6 cases of renal angiomyolipoma. Recently, we encountered two more such cases. Case 1 is a 34-year-old woman with fever as the chief complaint. DIP revealed a tumor mass in the right upper pelvic pole. This mass showed a strong echo level on ECHO and adipose tissue of low density on CT scan. Therefore, the patient was diagnosed as having renal angiomyolipoma. Since liposarcoma was not ruled out by the examination of frozen sections during operation, nephrectomy was performed. Case 2 is a 40-year-old woman. Diagnosed as having bilateral renal angiomyolipoma, she underwent right nephrectomy 14 years ago. Two years ago, she had heavy hematuria, and had embolization of the left renal artery. She has had no bleeding since the embolization. We are of the view that ECHO and CT can are very useful for diagnosis of renal angiomyolipoma, and embolization for heavy hematuria, a complication, should be performed first of all.Keywords:
Angiomyolipoma
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We have hitherto reported 6 cases of renal angiomyolipoma. Recently, we encountered two more such cases. Case 1 is a 34-year-old woman with fever as the chief complaint. DIP revealed a tumor mass in the right upper pelvic pole. This mass showed a strong echo level on ECHO and adipose tissue of low density on CT scan. Therefore, the patient was diagnosed as having renal angiomyolipoma. Since liposarcoma was not ruled out by the examination of frozen sections during operation, nephrectomy was performed. Case 2 is a 40-year-old woman. Diagnosed as having bilateral renal angiomyolipoma, she underwent right nephrectomy 14 years ago. Two years ago, she had heavy hematuria, and had embolization of the left renal artery. She has had no bleeding since the embolization. We are of the view that ECHO and CT can are very useful for diagnosis of renal angiomyolipoma, and embolization for heavy hematuria, a complication, should be performed first of all.
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Introduction. Angiomyolipomas are the most common benign tumor of the kidney, associated with Tuberous Sclerosis in 20% of cases and arising sporadically in 80% of cases. Renal angiomyolipomas are neoplasms of mesenchymal origin with varying proportions of vasculature, smooth muscle spindle cells, and adipocytes, making management of such neoplasms a challenging endeavor. Possible management options include partial or radical nephrectomy and segmental renal artery embolization. Case Presentation. A 61-year-old woman admitted for a large retroperitoneal hemorrhage was discovered to have a giant, sporadic, 3818.3 g, 30.0 × 26.5 × 18.0 cm left perinephric angiomyolipoma. Given her hemodynamic instability upon presentation, she underwent segmental arterial embolization, followed by an open left partial nephrectomy. Ten-month follow-up revealed no noticeable loss of renal function. Discussion. Literature review revealed occasional renal angiomyolipomas of comparable size, with all angiomyolipomas larger than this requiring treatment with radical nephrectomy. Conclusion. We show that nephron-sparing surgery may be considered in the treatment of even the largest of renal angiomyolipomas.
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Objective To investigate the safety and feasibility of selective renal arterial embolization combined with laparoscopic partial nephrectomy in treatment of renal angiomyolipoma with spontaneous rupture. Method Retrospective analysis was conducted based on the clinical data of 23 cases of renal angiomyolipoma with spontaneous rupture from January 2009 to August 2014, and the mean tumor size of the patients was 5.5 cm. Retroperitoneal laparoscopic nephron-sparing surgery was performed 24 ~ 72 h after selective renal artery embolization. The operative time, intraoperative blood loss, complications and hospital stay were analyzed. Result All the operations were performed successfully. No one required additional open surgery. The mean operating time and blood loss was 123 min and 90 ml, respectively. The mean hospital stay was 9.2d. 2 cases suffered urinary fistula posteroperatively but recovered after conservative treatment. After the procedure, total renal function was normal and no other serious complications occurred. During the follow-up lasting for 6 months to 4 years, no tumor recurrence was found. Conclusion Selective renal arterial embolization combined with laparoscopic partial nephrectomy is feasible and safe for renal angiomyolipoma with spontaneous rupture in well selected and prepared patients by experienced operators.
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Objectives : With developments in interventional radiology, selective renal artery angiography and super-selective embolization is gradually being used as an alternative treatment modality for angiomyolipoma of the kidney instead of nephrectomy or partial nephrectomy. It has been suggested that the use of steroids around the time of embolization may reduce or avoid post-embolization syndrome. Our aim is to report two cases of angiomyolipoma of kidney that were treated electively and as an emergency procedure with a review of the literature. Methods : Detailed clinical records of the two patients were obtained from their case notes, ALS records of clinic letters and discharge summaries, PACS system for records of all radiological procedures, computerized results of all laboratory tests in order to document the presentation, investigation, management and outcome of management of the patients. Literature was reviewed on embolization of angiomyolipoma of the kidney. Results : Two patients with angiomyolipoma of the kidney, (the first patient a lady with an enlarging angiomyolipoma of the right kidney and the second patient a lady who had spontaneous haemorrhage into a large angiomyolipoma of her right kidney), underwent selective right renal artery angiography and supers-selective embolization of the feeding vessels of their angiomyolipomas. The first patient was given steroid cover (Hydrocortisone and prednisolone) for two weeks in order to reduce or minimise the development of post-embolization syndrome. The second patient was not given any steroid cover. The first patient was discharged home on the first day after her embolization procedure and she did not develop any complications. The second patient who was not given any steroid cover developed post-embolization syndrome which eventually resolved after about six weeks. Literature review indicates that post-embolization syndrome is common after embolization. There is some evidence in the literature to suggest that the use of a short course of steroids around the time of embolization procedure reduces or prevents the development of post-embolization syndrome. Conclusions: Selective renal artery angiography can be used to diagnose a non-bleeding-angiomyolipoma, as well as bleeding enlarged angiomyolipoma of kidney. Super-selective renal artery embolization of a large angiomyolipoma of the kidney is a useful alternative to partial nephrectomy or full nephrectomy; it has the advantage of not requiring general anaesthesia and it is associated with less morbidity than nephrectomy or partial nephrectomy. Our limited experience and literature review would suggest that perhaps the use of steroids around the time of embolization may reduce the incidence of post-embolization syndrome.
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The case of surgical treatment of giant sporadic angiomyolipoma of the kidney is presented. By definition, an angiomyolipoma is a highly active vascular benign tumor consisting of endothelial cells, smooth muscles and adipose tissue. The diagnostic standard includes ultrasound diagnostics and computed tomography. The presented patient has in the lower segment of the left kidney, a giant subcapsular lipoma with a pronounced angiomatous component, 64×40×82 mm in size. The main method of treatment for this disease is surgical. In this case, the minimally invasive surgical intervention was chosen as the first stage: superselective embolization of the branches of the left renal artery. Selective angiography revealed a symptom of pathological neovascularization. Through the microcatheter, embolization of the branches of the left renal artery by embospheres was performed. In the postoperative period, the patient noted a decrease in the intensity of the pain syndrome, up to its complete disappearance. In the case of formations larger than 4-5 cm in diameter, embolization can be considered as the first stage of the surgical operation. Further reduction of the education in volume can allow the second stage of surgical treatment to be performed — laparoscopic kidney resection. Angiomyolipoma of the kidney of this size is a rather rare pathology. Similar formations make up approximately 0.3–3% in the population and the methods of their treatment are not always unambiguous. Therefore, we believe that each clinical case is very important and interesting in its own way and is also valuable in terms of accumulating experience in the treatment of such patients.
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Interventional radiology
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In a patient who had undergone right nephrectomy for renal carcinoma 20 years earlier, anuria developed following left renal artery embolism. Nine days later, renal artery embolectomy was successfully performed. This represents the longest reported anuric interval between the onset of symptoms and successful treatment. Intraoperative, intra-arterial instillation of human fibrinolysin seemed to facilitate the removal of thrombotic material from the distal renal artery branches. Renal artery occlusion is reversible, at least occasionally, after prolonged nonfunction.
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You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (PD46)1 Apr 2019PD46-10 CLINICAL OUTCOME AND CHARACTERISTICS OF 41 PATIENTS UNDERWENT SELECTIVE ARTERY EMBOLIZATION FOR POSTOPERATIVE BLEEDING FOLLOWING 2076 PARTIAL NEPHRECTOMY Doo Yong Chung*, Jong Soo Lee, Ahmad Almujalhem, Ali Raheem, Ki don Chang, Jin Hyeong Jeon, Don Gu Lee, Jang Hwan Kim, Sung Jun Hong, Byung Ha Chung, Young deuk Choi, and Koon Ho Rha Doo Yong Chung*Doo Yong Chung* More articles by this author , Jong Soo LeeJong Soo Lee More articles by this author , Ahmad AlmujalhemAhmad Almujalhem More articles by this author , Ali RaheemAli Raheem More articles by this author , Ki don ChangKi don Chang More articles by this author , Jin Hyeong JeonJin Hyeong Jeon More articles by this author , Don Gu LeeDon Gu Lee More articles by this author , Jang Hwan KimJang Hwan Kim More articles by this author , Sung Jun HongSung Jun Hong More articles by this author , Byung Ha ChungByung Ha Chung More articles by this author , Young deuk ChoiYoung deuk Choi More articles by this author , and Koon Ho RhaKoon Ho Rha More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000556754.00876.2aAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Partial nephrectomy (PN) represents the current surgical standard for T1 tumors. With the wider application of nephron-sparing surgery, potentially life-threatening postoperative hemorrhage complication has be reported. Selective artery embolization (SAE) is a good treatment in these patients. We aimed to evaluate characteristics and clinical outcomes in patients undergoing SAE. METHODS: A retrospective review of our institutional PN database from July 2005 to October 2018 was performed. Of them, we evaluated patients who underwent SAE after PN. Patients’ characteristics and clinical outcomes were analyzed. RESULTS: A total of 2,076 cases underwent PN were evaluated. SAE was performed in 41 (1.97%) patients who underwent Open PN (19/1171, 1.62%), laparoscopic PN (4/60, 6.67%), Robot assisted PN (18/845, 2.37%), respectively. The median period from PN to SAE was 12 days (interquartile range 8-24). The most common symptom of 31(75.61%) patients presented with gross hematuria. Other symptoms were flank pain (3/41, 7.32%). Asymptomatic 7 patients represented pseudoaneurysm in follow up CT. The main reason for SAE on angiography was pseudoanuerysm (32/41, 78.05%). And there were arteriovenous fistula (5/41, 12.20%), contrast extravasation (4/41, 9.76%). SAE was performed using endovascular coils or n-butyl-2-cyanoacrylate (NBCA). Technical and clinical successes were achieved in all patients (100%). There were no episodes of bleeding recurrence during the follow-up period. The embolization group and the control group showed 89.8% and 92.2% eGFR preservation after PN, respectively. There was no statistical difference between the two groups. (p=0.376) There was no statistically significant difference in surgical methods and baseline characteristics such as age, BMI, eGFR (estimated glomerular filtration rate) between two groups. In the embolization group, feature of renal tumors showed endophytic (28/41, 68.29%) and posterior. (25/41, 60.98%). But R.E.N.A.L score and PADUA score did not differ between the two groups. CONCLUSIONS: SAE is a successful method of controlling postoperative bleeding while preserving renal function after PN. Urologists should also pay attention to renorrhaphy of PN for renal masses located endophytic and posterior. Source of Funding: none seoul, Korea, Republic of© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e835-e836 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Doo Yong Chung* More articles by this author Jong Soo Lee More articles by this author Ahmad Almujalhem More articles by this author Ali Raheem More articles by this author Ki don Chang More articles by this author Jin Hyeong Jeon More articles by this author Don Gu Lee More articles by this author Jang Hwan Kim More articles by this author Sung Jun Hong More articles by this author Byung Ha Chung More articles by this author Young deuk Choi More articles by this author Koon Ho Rha More articles by this author Expand All Advertisement PDF downloadLoading ...
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