Pathophysiology and management aspects of adrenal angiomyolipomas

Abstract

Angiomyolipomas are benign mesenchymal tumours originating from the kidney and adrenals. They are rare tumours that can be sporadic and isolated or occur as a part of tuberous sclerosis. These tumours have a high content in the cells, which is pathognomonic for diagnosis using ultrasonography, computed tomography and magnetic resonance imaging. Atypical angiomyolipomas occur with excessive smooth muscle cells and less adipose tissue, and are sensitive to immunohistochemistry studies. Most of these lesions are detected incidentally but some can cause back and abdominal pains if large in size. Larger lesions are also vulnerable to spontaneous or traumatic rupture, causing large retropertitoneal bleeds. Surgery should be considered as the definitive management for larger lesions to avoid associated complications. There have been no reports of any malignant change being reported in any of the lesions but a long follow-up period is still required, given the unknown clinical progression of these rare tumours.

Anterior Transabdominal Laparoscopic Adrenalectomy, without Ligatures, for a Symptomatic Right Adrenal Myelolipoma with Intratumoral Hemorrhage

“…Last but not least, some advanced laparoscopic technical equipment is required for this type of surgery (energy platform, sealing sectioning devices. (4,18,19) The use of the Maryland device allows for a safe and easy intervention with simpler exposure and sectioning of vascular elements. Applying the device two times extends the coagulation possibilities to larger vessels (7-10 mm in diameter), both venous and arterial.…”

HMB-45 Negative Adrenal Angiomyolipoma With A Synchronous Adrenal Adenoma – An Unusual Association

“…Isolated neoplasms are usually asymptomatic. 20 to 50% have been reported to be associated with tuberous sclerosis in various literatures [1][2][3] . Though commonly benign, metastasis have been reported.…”

“…The most widely accepted theory states that this tumour is a metaplastic change in the reticuloendothelial cells of the adrenal blood capillaries in response to various stimuli such as necrosis, infection or stress. 1 These tumours have a heterogeneous cell composition and consists of adipose tissue, vascular component and smooth muscle cells. It should be noted that any one of these components may predominate as in our case.…”

Angiomyolipoma of the Adrenal Gland: A Report of Two Cases and Review of the Literature

“…Also, because it is a vascular tumor, adrenal angiomyolipoma can present with hemorrhage [ 13 , 15 ]. Because of its proximity to the kidney, hemorrhage associated with adrenal angiomyolipoma may be misdiagnosed as a primary renal neoplasm or perinephric hematoma [ 17 ]. One of the previously reported cases showed intense uptake of fluorine-18-fluorodeoxyglucose (FDG) in positron emission tomography (PET)/CT by adrenal angiomyolipoma, which gave a false impression of malignancy [ 4 ].…”