Clinical and Histopathological Features of Renal Angiomyolipomas: Series of 21 Patients

Abstract

Angiomyolipoma (AML) of the kidney is a benign tumor that may be misdiagnosed preoperatively as renal cell carcinoma (RCC). This study analyzes patients with renal angiomyolipoma which were diagnosed between 2005-2011. Their clinical and histopathological features were evaluated retrospectively. Demographics of patients, clinical history, clinical diagnosis and pathologic characteristics of the specimen were assessed. 19 of patients were female. Ages ranged from 15 to 68 years. In 13 patients the lesions were discovered incidentally. A single case of tuberous sclerosis (TS) was confirmed in a patient with bilateral lesions. It is important to recognize their characteristic imaging findings and be aware of not mistakenly diagnosed as renal cell carcinoma. Preoperative correct diagnosis is required especially to decide nephron sparing procedures for treatment.

Keywords

• Angiomyolipoma,Kidney,Prognosis

Renal Anjiomiyolipomaların Klinik ve Histopatolojik Özellikleri: 21 Olguluk Seri

Abstract

Renal anjiomiyolipoma, preoperatif olarak renal hücreli karsinoma ile karışabilen böbreğin benign tümörüdür. Çalışmamızda 2005 – 2011 yılları arasında, renal anjiomiyolipoma tanısı almış olgular, retrospektif olarak incelenerek, klinik ve histopatolojik özellikleri ortaya konuldu. Hasta kayıtlarından elde edilen bilgiler, klinik hikâyeleri, klinik tanısı ve cerrahi materyalin histopatolojik özellikleri not edildi. Olguların 19’ u kadındı. Yaş aralığı 15 - 68 arasındaydı. 13 vakada lezyonlar rastlantısal olarak saptandı. Bilateral lezyonu olan bir vakanın tuberosklerozis olduğu belirlendi. Renal anjiomiyolipomaların karakteristik görüntüleme bulgularını ve renal hücreli karsinoma ile karışabileceğini bilmek önemlidir. Özellikle preoperatif olarak bu tümörleri tanımak nefron koruyucu tedavi seçeneklerini değerlendirmek açısından gereklidir.

Keywords

• Anjiomiyolipoma,Böbrek,Prognoz

References

1. 1. Lopez-Beltran A, Scarpelli M, Montironi R, Kirkali Z. 2004 WHO classification of the renal tumors of the adults. Eu-rUrol2006; 49: 798-805.
2. 2. Halpenny D, Snow A, McNeill G, Torreggiani WC. The radio-logical diagnosis and treatment of renal angiomyolipoma-current status.ClinRadiol2010; 65:99-108.
3. 3. Islam AH, Ehara T, Kato H, et al. Angiomyolipoma of kidney involving the inferior vena cava. Int J Urol 2004; 11: 897-902.
4. 4. Lenton J, Kessel D, Watkinson AF. Embolization of renal angiomyolipoma: immediate complications and long-term out-comes. ClinRadiol 2008; 63:864-870.
5. 5. Eble JN. Angiomyolipoma of kidney.SeminDiagnPathol1998; 15: 21-40.
6. 6. Hafron J, Fogarty JD, Hoenig DM, et al. Imaging characteris-tics of minimal fat renal angiomyolipoma with histologic corre-lations. Urology 2005; 66:1155-1159.
7. 7. Winterkorn EB, Daouk GH, Anupindi S, Thiele EA. Tuberous sclerosis complex and renal angiomyolipoma: case report and review of the literature. PediatrNephrol 2006; 21:1189-1193.
8. 8. Tan YS, Yip KH, Tan PH, Cheng WS. A right renal angiomyo-lipoma with IVC thrombus and pulmonary embo-lism.IntUrolNephrol2010; 42:305-308.

9. 9. Yang L, Feng XL, Shen S, et al. Clinicopathological analysis of 156 patients with angiomyolipoma originating from different organs. OncolLett2012;3:586–90.
10. 10. Bonetti F, Pea M, Martignoni G, et al. The perivascular epithe-lioid cell and related lesions. AdvAnatPathol 1997;4:343–58.
11. 11. Folpe AL, Goodman ZD, Ishak KG, et al. Clear cell myomela-nocytic tumor of the Falciform ligament/ligamentum teres: a novel member of the perivascular epithelioid clear cell family of tumors with a predilection for children and young adults. Am J SurgPathol2000;24:1239–46.
12. 12. Pea M, Bonetti F, Zamboni G, et al. Melanocyte-marker-HMB-45 is regularly expressed in angiomyolipoma of the kidney. Pathology1991;23:185–8.
13. 13. Oesterling JE, Fishman EK, Goldman SM, Marshall FF. The management of renal angiomyolipoma. J Urol 1986; 135:1121-1124.
14. 14. Berglund RK, Bernstein M, Manion MT, Touijer KA, Russo P. Incidental angiomyolipoma resected during renal surgery for an enhancing renal mass. BJU Int 2009; 104:1650-1654.
15. 15. Milner J, McNeil B, Alioto J, et al. Fat poor renal angiomyo-lipoma: patient, computerized tomography and histological findings. J Urol 2006; 176: 905–909.
16. 16. Willatt J, Francis IR. Imaging and management of the inci-dentally discovered renal mass. Cancer Imaging 2009; 9: 30-37
17. 17. Siegel CL, Middleton WD, Teefey SA, McClennan BL. Angi-omyolipoma and renal cell carcinoma: US differentiation. Ra-diology 1996;198:789–93.
18. 18. Amin MB. Epithelioid angiomyolipoma. In: Eble JN, Sauter G, Epstein JI, (eds). World Health Organization classification of tumors. Pathology and genetics of tumors of the urinary system and male genital organs. Lyon: IARC Press;2004. 68–9.
19. 19. Lane BR, Aydin H, Danforth TL, et al. Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid. J Urol 2008;180:836–43.
20. 20. Brimo F, Robinson B, Guo C, et al. Renal epithelioid angiom-yolipoma with atypia: a series of 40 cases with emphasis on clinicopathologic prognostic indicators of malignancy. Am J SurgPathol 2010;34:715–22.
21. 21. Varma S, Gupta S, Talwar J, Forte F, Dhar M. Renal epithelioid angiomyolipoma: a malignant disease. J Nephrol2011;24:18–22.
22. 22. Lin WY, Chuang CK, Ng KF, Liao SK. Renal angiomyolipoma with lymph node involvement: a case report and literature re-view. Chang Gung Med J 2003; 26: 607– 610.