title: Management of renal angiomyolipomas associated with tuberous sclerosis complex.
abstract: OBJECTIVE
  Intensive management is generally recommended for angiomyolipomas associated with tuberous sclerosis complex (TSC), which are known to have a more aggressive nature than sporadic tumors. In this study we evaluated the management of these tumors.
  
  
  METHODS
  The records of 6 men and 6 women with TSC and a mean age of 28.8 years) with angiomyolipomas treated from 1984 to 2000 were retrospectively analyzed. All patients had bilateral multiple tumors (mean size 6.6 cm). There were 10 lesions classified as small (less than 4 cm), 6 medium (4 to 10 cm) and 8 large lesions (10 cm or greater). Computerized tomography was repeated annually for followup observation and semiannually after embolization.
  
  
  RESULTS
  Excluding from study 3 tumors treated prophylactically intervention was required in 20%, 50% and 100% of small, medium and large tumors, respectively. Among 14 tumors followed by observation, 8 grew and 4 required intervention. Uncontrollable hemorrhage did not develop in any patient. While some tumors showed remarkable growth in decade 3, growth did not exceed 1.5 cm per year. Embolization was performed in 11 tumors and tumors shrank in 10. Although 1 patient experienced renal atrophy, all patients but 1 are alive without renal failure with a mean followup of 60 months.
  
  
  CONCLUSIONS
  Although asymptomatic angiomyolipomas associated with TSC grow gradually, severe hemorrhage is rare and most tumors can be managed conservatively with annual computerized tomography. Embolization is the first choice of intervention but should be reserved until symptoms develop.
authors.affiliation: Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan. harachan@med.hokudai.ac.jp
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Hidenori
authors.initials: H
authors.lastname: Katano
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
authors.forename: Tadashi
authors.initials: T
authors.lastname: Shimizu
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Koyanagi
mesh_terms: D000293:Adolescent; D000328:Adult; D018207:Angiomyolipoma / Q000150:complications / Q000628:therapy*; D002404:Catheterization; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014402:Tuberous Sclerosis / Q000150:complications*