A Rare Case of a Giant Renal Angiomyolipoma

Galanis, I.; Kabaroudis, A.; Papaziogas, B.; Patsas, A.; Koutelidakis, J; Papaziogas, T.

doi:10.1046/j.1563-2563.2003.03013.x

Cited by 7 publications

(4 citation statements)

References 16 publications

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“…Therefore, PN is often recommended for larger RAMLs, but most treated ones have been reported below 10 cm according to two recent reviews (1,2). RN is finally adopted due to the considerable challenges, rendering a higher rate of surgical kidney removal (27)(28)(29)(30)(31)(32). It could be supported by our data that intraoperative kidney removal was performed in 54.8% of all giant RAML patients.…”

Section: Discussionsupporting

confidence: 52%

Deep Learning Plus Three-Dimensional Printing in the Management of Giant (>15 cm) Sporadic Renal Angiomyolipoma: An Initial Report

et al. 2021

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ObjectiveTo evaluate the feasibility and effectivity of deep learning (DL) plus three-dimensional (3D) printing in the management of giant sporadic renal angiomyolipoma (RAML).MethodsThe medical records of patients with giant (>15 cm) RAML were retrospectively reviewed from January 2011 to December 2020. 3D visualized and printed kidney models were performed by DL algorithms and 3D printing technology, respectively. Patient demographics and intra- and postoperative outcomes were compared between those with 3D-assisted surgery (3D group) or routine ones (control group).ResultsAmong 372 sporadic RAML patients, 31 with giant ones were eligible for analysis. The median age was 40.6 (18–70) years old, and the median tumor size was 18.2 (15–28) cm. Seventeen of 31 (54.8%) had a surgical kidney removal. Overall, 11 underwent 3D-assisted surgeries and 20 underwent routine ones. A significant higher success rate of partial nephrectomy (PN) was noted in the 3D group (72.7% vs. 30.0%). Patients in the 3D group presented a lower reduction in renal function but experienced a longer operation time, a greater estimated blood loss, and a higher postoperative morbidity. Subgroup analysis was conducted between patients undergoing PN with or without 3D assistance. Despite no significant difference, patients with 3D-assisted PN had a slightly larger tumor size and higher nephrectomy score, possibly contributing to a relatively higher rate of complications. However, 3D-assisted PN lead to a shorter warm ischemia time and a lower renal function loss without significant difference. Another subgroup analysis between patients under 3D-assisted PN or 3D-assisted RN showed no statistically significant difference. However, the nearness of tumor to the second branch of renal artery was relatively shorter in 3D-assisted PN subgroup than that in 3D-assisted RN subgroup, and the difference between them was close to significant.Conclusions3D visualized and printed kidney models appear to be additional tools to assist operational management and avoid a high rate of kidney removal for giant sporadic RAMLs.

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Section: Discussionsupporting

confidence: 52%

Deep Learning Plus Three-Dimensional Printing in the Management of Giant (>15 cm) Sporadic Renal Angiomyolipoma: An Initial Report

et al. 2021

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“…12,13 Giant renal AMLs are exceedingly uncommon and review of literature showing few cases of giant renal AMLs, all of which required radical nephrectomy for definitive treatment, with variable outcome. [14][15][16][17][18][19] Several cases of giant renal AMLs excised using partial nephrectomy have been reported. [20][21][22][23][24][25][26][27][28][29][30] Exophytic renal AMLs of large size may be easily confused with malignant conditions on CT imaging, such as well-differentiated forms of perirenal liposarcomas.…”

Section: Discussionmentioning

confidence: 99%

Outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas

et al. 2021

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Aim: To study the outcome of simultaneous angioembolization and nephron sparing surgery in large renal angiomyolipomas. Materials and methods: A prospective study of carried out from 2016 to 2019. A total of 15 patients were included in the study with a lesion (angiomyolipoma) more than 10 cm in size, suitable for nephron sparing surgery. The workup of the patients included history, baseline blood investigations, ultrasonography, and CT urography including angiographic films. All the patients were taken up for selective of angioembolization of the feeding vessels of the AML carried out by the interventional radiologist followed by nephron sparing surgery in the same sitting. The short term outcomes studied were warm ischemia time, average blood loss, and length of post-operative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen and functional outcome by assessing the function of the preserved renal parenchyma. Results: Twelve out of fifteen cases were female. The mean age was 42.25 years. All the patients had lesion more than 10 cm with seven tumors located at the lower pole, four at mid-pole, and four at upper pole. Eight patients had low complexity score on RENAL score (i.e. 4–6), five patients medium complexity score (i.e. 7–9), and two had high complexity score (i.e. ⩾10). Average blood loss was 200 ml, warm ischemia time was 18.46 min and postoperative stay was 3.55 days. All the 15 specimens sent for histopathology were confirmed as AML (angiomyolipomas) with margins free of tumor. Follow up CECT done at 4 months postoperatively revealed functioning residual renal parenchyma with prompt excretion of contrast. Conclusion: Large AML’s are also amenable to nephron sparing surgery. However patient should always be warned about the possibility of total nephrectomy. Selective angioembolization helps in reducing the blood supply and risk of torrential bleeding thus facilitates in the removal of the tumor and increasing the chances of nephron sparing surgery.

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“… 5 In practise this remains difficult to implement as evidenced by a case described by Galanis et al . 6 who reported a very large unilateral AML (31 × 16.5 × 8.5 cm) for which a complete nephrectomy was performed. 6 More recent evidence suggests that aneurysm size is more important than tumour size in determining risk of bleeding.…”

Section: Discussionmentioning

confidence: 99%

“… 6 who reported a very large unilateral AML (31 × 16.5 × 8.5 cm) for which a complete nephrectomy was performed. 6 More recent evidence suggests that aneurysm size is more important than tumour size in determining risk of bleeding. A total of 14.3% of patients with lesions studied by Yamakado et al ., with minimal vascularity (few small stretched vessels), presented with haemorrhage versus 50% of those displaying marked vascularity (multiple, large tortuous vessels).…”

Section: Discussionmentioning

confidence: 99%