Contemporary Experience in the Management of Angiomyolipoma

Mues, Adam C.; Palacios, Jorge Moreno; Haramis, George; Casazza, Cristin; Badani, Ketan K.; Gupta, Mantu; McKiernan, James M.; Benson, Mitchell C.; Landman, Jaime

doi:10.1089/end.2010.0223

Cited by 65 publications

(69 citation statements)

References 16 publications

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“…As a benign lesion, most renal AMLs are asymptomatic, have a slow and consistent growth rate and minimal morbidity (19). They often do not require any intervention.…”

Section: Introductionmentioning

confidence: 99%

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Bardin¹,

Chevallier²,

Bertaut³

et al. 2017

Quant. Imaging Med. Surg.

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Background: Angiomyolipoma (AML) is the most common renal benign tumor. Treatment should be considered for symptomatic patients or for those at risk for complications, especially retroperitoneal bleeding which is correlated to tumor size, grade of the angiogenic component and to the presence of tuberous sclerosis complex (TSC). This study reports our single-center experience with the use of selective arterial embolization (SAE) in the management of symptomatic and asymptomatic renal AMLs. Methods:In this retrospective mono-centric study, all demographic and imaging data, medical records, angiographic features, outpatient charts and follow-up visits of patients who underwent prophylactic or emergency SAE for AMLs between January 2005 and July 2016 were reviewed. Tumor size and treatment outcomes were assessed at baseline and after the procedure during follow-up. Computed tomography (CT), magnetic resonance imaging (MRI) or ultrasonography was used to evaluate AML shrinkage. Renal function was measured pre-and post-procedure.Results: Twenty-three patients (18 females, 5 males; median age, 45 years; range, 19-85 years) who underwent SAE either to treat bleeding AML (n=6) or as a prophylactic treatment (n=17) were included.Overall, 34 AMLs were embolized. TSC status was confirmed for 6 patients. Immediate technical success rate was 96% and 4 patients benefitted from an additional procedure. Major complications occurred in 3 patients and minor post-embolization syndrome (PES) in 14 patients. The mean AML size reduction rate was 26.2% after a mean follow-up was 20.5 months (range, 0.5-56 months), and only non-TSC status was significantly associated with better shrinkage of tumor (P=0.022). Intralesional aneurysms were significantly more frequent in patients with hemorrhagic presentation (P=0.008). There was no change in mean creatinine level after SAE.Conclusions: SAE is a safe and effective technique to manage renal AMLs as a preventive treatment as well as in emergency setting, with significant reduction in tumor size during follow-up. A multidisciplinary approach remains fundamental, especially for TSC patients. In addition to size, the presence of intralesional aneurysms should be considered in any prophylactic treatment decision.

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“…As a benign lesion, most renal AMLs are asymptomatic, have a slow and consistent growth rate and minimal morbidity (19). They often do not require any intervention.…”

Section: Introductionmentioning

confidence: 99%

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Bardin¹,

Chevallier²,

Bertaut³

et al. 2017

Quant. Imaging Med. Surg.

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“…3 Angiomyolipomata are benign, however size increase of 0.088-0.427 cm/year is reported, and can result in mass effect. 4,5 Distorted vascular architecture can additionally predispose angiomyolipoma to active retroperitoneal hemorrhage. 6 Angiomyolipoma has a prevalence of 0.02-0.1% in males, and 0.22-0.29% in females.…”

Section: Introductionmentioning

confidence: 99%

Transarterial Embolization of Angiomyolipoma: A Systematic Review

2015

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“…Several retrospective series have shown the feasibility of AS for AML. [52][53][54][55] The identification of clinical predictors showing the need for delayed active treatment, thus allowing to minimize the risk of spontaneous complications, would be extremely useful in AS protocols. With the aim to answer this relevant question, Ouzaid et al reported outcomes from a retrospective cohort of 130 patients diagnosed with AML on computed tomography imaging and managed with AS at the Glickman Urological and Kidney Institute.…”

Section: As For Benign Tumor (Angiomyolipoma)mentioning

confidence: 99%

“…56 These results are comparable with those reported in the smaller series by De Luca et al 53 Conversely, Mues et al did not find statistically significant correlations between clinical predictors (such as tumor dimension, growth rate or symptoms) and the need for active treatment. 52 In that study, among 91 patients diagnosed with AML, 48 were placed on AS as primary management. At a median follow up of 54.8 months, AS failed only in three patients because of retroperitoneal bleeding or fast growth rate (0.7 cm/year).…”

Section: As For Benign Tumor (Angiomyolipoma)mentioning

confidence: 99%

“…In the other group of patients who remained on AS, the mean growth rate was very low (0.09 cm/year), and no relevant complications were found. 52 These studies, even if necessarily biased from a low level of evidence deriving from their retrospective design, currently represent the only available reports showing the feasibility and safety of AS for AML. According to the reported outcomes, active surveillance protocols for such benign lesions with habitual benign behavior can be advisable in selected patients, such as those with tumor size smaller than 4 cm, asymptomatic disease and slow growing tumors, and should be considered the standard for all uncomplicated AML at presentation.…”

Section: As For Benign Tumor (Angiomyolipoma)mentioning

confidence: 99%

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Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

et al. 2015

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The widespread use of abdominal imaging has led to an increasing detection of small renal masses, and approximately 20-30% of those tumors will prove to be benign, with low metastatic potential if not immediately treated. In elderly or comorbid patients diagnosed with small renal masses, competing cause mortality seems to exceed cancer-specific mortality at short-and intermediate-term follow up. In these cases, surgery might represent an overtreatment, and an expectant management, such as active surveillance, might be proposed. According to the current available evidence, active surveillance is a safe and reasonable option for patients with renal tumors 4 cm (cT1a) and short life expectancy. A few studies with short-term follow up reported the preliminary results of active surveillance even in cT1b-cT2 tumors, with acceptable risk of disease progression and mortality, even if this approach should be considered in this setting only for highly-selected and wellinformed patients. Furthermore, surveillance protocols can be proposed in selected patients with uncomplicated benign tumors, such as angiomyolipomas, in which active surveillance should be considered the initial standard management. At present, reliable clinical predictors of a tumor's growth rate and aggressiveness are not available. Renal tumor biopsy is useful in the clinical work-up of patients who are candidates for active surveillance, in order to improve patient selection based on tumor histological characterization. Despite the proof of safety offered by expectant management for small renal masses in selected patients, further prospective studies with longer follow up are required in order to confirm the indications and long-term oncological outcomes of active surveillance protocols for renal tumors.

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Contemporary Experience in the Management of Angiomyolipoma

Cited by 65 publications

References 16 publications

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Selective arterial embolization of symptomatic and asymptomatic renal angiomyolipomas: a retrospective study of safety, outcomes and tumor size reduction

Transarterial Embolization of Angiomyolipoma: A Systematic Review

Active surveillance for clinically localized renal tumors: An updated review of current indications and clinical outcomes

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