Nephron-sparing Surgery without Angioembolization in Giant Angiomyolipoma: Is it Feasible?

Ankur Arya, Hardev Bhatyal, Vineet Narang, Suruchi Agarwal
2018 Journal of Urological Surgery  
Öz Introduction Renal angiomyolipoma (AML) is a benign tumor composed of adipose tissue, abnormal blood vessels and smooth muscle. AML is usually diagnosed incidentally on ultrasound but symptoms may vary from flank pain, palpable flank mass and hematuria to life-threatening hemorrhage (52%-91%) especially in those larger than 4 cm. Giant AML is usually managed by transarterial embolization (TAE), partial nephrectomy or total nephrectomy as described in the literature. Our case represents the
more » ... se represents the largest AML with a dimension of up to 40 cm which was managed by nephron-sparing surgery in the form of partial nephrectomy without prior embolization. Case Presentation A 35-year-old female patient presented with bloating sensation and increasing abdomen girth since last 3 years. Ultrasound Literatürde çeşitli boyutlarda renal anjiyomiyolipom olguları bildirilmiştir ve 10 cm'den daha büyük olanlar için dev AML terimi genel ortak görüştür. Olgumuz, son üç yıldır artan karın şişliği ile başvurdu. Kontrastlı batın tomografisi hem sol böbrekte küçük ve çok odaklı hem de sağ böbreğin üst ve orta bölümünden köken alan büyük boyutlarda anjiyomiyolipomlar saptadı. Sağ böbreğin orta ve üst bölümüne uygulanan parsiyel nefrektomiye ek olarak alt kutuptaki küçük odaklara da enükleasyon uygulanarak, nefron koruyucu cerrahi yapıldı. Cerrahi örnek 40 cm × 20 cm × 15 cm boyutlarında ve 7000 g ağırlığında olup, histopatolojik açıdan AML olduğu doğrulandı. Bu, 40 cm'ye kadar bir boyuta sahip en büyük AML olgusudur ve öncesinde anjiyoembolizasyon olmaksızın nefron koruyucu cerrahi yapılmıştır. Boyutu genellikle 10 cm'den büyük olan AML, literatürde dev AML olarak kabul edilir. Anahtar Kelimeler: Anjiyoembolizasyon, Dev anjiyomiyolipom, Nefron koruyucu cerrahi, Renal anjiyomiyolipom, Nefrektomi Varying sizes of renal angiomyolipoma (AML) have been reported in the literature, with the general consensus that a size greater than 10 cm can be termed a giant AML. Our patient presented with increasing abdomen girth since last 3 years. Contrast-enhanced computed tomography scan of the abdomen confirmed the presence of "AML" arising from the upper and mid pole of the right kidney with similar small foci in the contralateral kidney. The patient underwent nephron-sparing surgery with preserving the right lower pole with enucleation of multiple small foci in the right kidney. The surgical specimen, which was confirmed to be AML histopathologically, was 40 cm × 20 cm × 15 cm in size and 7000 g in weight. This represents the case of the largest AML with a dimension of up to 40 cm and managed by nephron-sparing surgery without prior angioembolization. AML larger than 10 cm is usually considered to be giant AML in the literature.
doi:10.4274/jus.1504 fatcat:gtv3ayw7arai3ololktu3olini