The Natural History of Renal Angiomyolipoma

Abstract

Of 35 patients with 48 angiomyolipomas 24 patients were followed clinically to determine the natural history of angiomyolipoma. Average patient age at presentation was 50 years (range 17 to 74) and of the patients 94% were women, 17% had tuberous sclerosis and 25% overall had bilateral disease. The patients could be divided into 2 distinct groups based on tumor size of 4 cm. or less and greater than 4 cm. Those with tumors less than 4 cm. were less likely to be symptomatic (24%) and patients with angiomyolipomas greater than 4 cm. were more often symptomatic (52%). No surgery was required for tumors less than 4 cm. but for 30% of the tumors greater than 4 cm. surgical intervention was necessary. Unlike any previously reported large series this study included radiological and historical followup available for 24 patients with angiomyolipoma with a mean followup time of 4 years (range 0.5 to 14). Moreover, to our knowledge we report for the first time documented growth during the study period of 27% of angiomyolipomas less than 4 cm. (4 of 15 tumors) and 46% of angiomyolipomas greater than 4 cm. (6 of 13 tumors). All patients with tumors less than 4 cm. were asymptomatic and only 1 required surgery. In contrast, tumors greater than 4 cm. were more frequently symptomatic (46%) and required surgery (54%). Patients with tuberous sclerosis and angiomyolipomas were distinctly different from patients with angiomyolipoma only, since they tended to present at a younger age, had a higher incidence of bilateral renal involvement, were more symptomatic, had larger tumors that were more likely to grow, and frequently required surgery. Based on this study, a modified approach to the current management of angiomyolipoma is recommended.

Recent Strategies for the Management of Renal Angiomyolipoma: A Review of Diagnostic and Therapeutic Approaches

“…Despite the diagnostic potential of ultrasound, its overall reliability is not extensively confirmed as a confident tool to distinguish AMLs. This does not mean, however, that ultrasound images cannot be utilized to follow AML progression (22). Conversely, CT with high sensitivity, specificity, negative (NPV), and positive predictive (PPV) values exhibits fat density in the range of -10 and -100 HU (Hounsfield units).…”

Embolisation of Bleeding Renal Angiomyolipoma in Pregnancy

“…In the former group, these tumours are often bilateral, have multicentric foci and tend to bleed more often than sporadic variant [3,4]. Steiner et al demonstrated that this group have worse outcome with faster growth rates (67% versus 21%) and earlier need for operating intervention (50% versus 28%) [5].…”

Nefrectomía Radical Laparoscópica en Angiomiolipoma Renal Con Invasión De Vena Renal

“…Las lesiones mayores de 4 cm pueden causar dolor, ser palpables, e incluso presentarse como una emergencia médica dado que son la causa más frecuente de rotura renal espontánea [5][6][7][8] . La indicación de tratamiento se hace en lesiones que crecen, se hacen sintomáticas o el diagnóstico es dudoso.…”