Outcome analysis of 42 cases of renal angiomyolipoma.
Angiomyolipomas were found in 42 kidneys in 23 female and 8 male patients at our medical center. Angiomyolipoma was diagnosed by computerized tomography (CT) alone in 55% of the cases, and by a combination of ultrasound and CT in 36%. Nine of 11 patients with bilateral angiomyolipoma had associated tuberous sclerosis. Treatment consisted of observation in 22 patients, selective arterial embolization in 6, partial nephrectomy in 6 and nephrectomy in 8. A total of 17 patients who were observed had tumors smaller than 4 cm. and 4 h had angiomyolipoma of 4 to 10 cm. With a mean followup of 3.8 years, no observation patient had subsequent renal hemorrhage and only 1 (tumor larger than 10 cm.) had radiographic progression. Despite progression, the latter patient remained asymptomatic for 18 years. Selective arterial embolization (3 tumors 4 to 10 cm. and 3 larger than 10 cm.) resulted in preservation of renal function at a mean of 1 year. All patients treated with partial nephrectomy (6 tumors 4 to 10 cm.) maintained stable renal function without recurrence during a mean 4.7-year followup. Similarly, all individuals who underwent nephrectomy (4 tumors smaller than 4 cm., 3 tumors 4 to 10 cm. and 1 tumor larger than 10 cm.) have stable renal function. We recommend renal conservation for patients with renal angiomyolipoma using a strategy of observation for small asymptomatic tumors, partial nephrectomy for moderate size tumors and selective arterial embolization of large tumors not amenable to partial nephrectomy.
Department of Surgery, University of Michigan Medical Center, Ann Arbor.
M J
MJ
Kennelly
H B
HB
Grossman
K J
KJ
Cho
D000293:Adolescent; D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D016896:Treatment Outcome