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Tuberous sclerosis is a multisystem neurocutaneous genetic disease that might be seen in one live birth in 6,000-10,000. Angiomyolipomas (AML) are the most common renal lesions that could be seen in 80% of tuberous sclerosis patients. Nephron-sparing surgery or selective arterial embolization are methods that could be used in the treatment of AML. Here in we present the case who has been admitted to our emergency department with retroperitoneal bleeding due to bilateral giant AML and treated with the endovascular method. A 55-year-old woman, who has been followed regularly in our hospital since 2016 with the diagnosis of tuberous sclerosis. The patient was admitted to the emergency department of our hospital with complaints of right upper quadrant pain and dizziness. On computed tomography, 4 cm of free fluid was observed at the posterior part of the right kidney posterior, consistent with hemorrhage. On renal angiography, selective arterial angioembolization (SAE) was performed on the inferior segmental artery, which is feeding the AML. Surgical intervention was not considered in the foreground because the patient has bilateral giant AML and would not be anephric. It was decided to begin the patient on everolimus (mTOR inhibitor) treatment. In the patient's first year follow-up, imaging was performed with non-contrast computed tomograpy. Computed tomograpy showed no size change in giant AML in both kidneys. Although the patient's creatinine levels increased to 3.04 mg/dL and urea to 148 mg/dL during the follow-ups, she did not need hemodialysis. AML, which is seen as a part of tuberous sclerosis, is one of the important causes of mortality in tuberous sclerosis, which causes life-threatening bleeding and requires surgical or endovascular treatments. Nephron-sparing surgery could be difficult in bilateral cases. Therefore, SAE should be considered an important treatment option in emergencies. [ABSTRACT FROM AUTHOR]

Paratesticular leiomyomas are rare tumors and originated from the subcutaneous smooth muscles and tunica dartos. Patients usually present with the complaint of a long-standing palpable painless mass and it is important to differentiate it from testicular masses. A 35-year-old male patient presented to our clinic with a palpabl mass, which he has realized since 15 year-old in scrotum that it growth 3-4 times over the last month. Physical examination revealed a palpable solid mass of approximately 3 cm, regular bordered, painless and localized inferiorly in the scrotum. Scrotal Doppler ultrasonography scan showed a 3x2.5 cm solid mass localized inferiorly in the scrotum, which has an internal blood supply. The inguinal exploration was planned due to malignancy risk. When the inguinal exploration was performed, we observed that the paratesticular mass was not connected with the testis. The mass, which was adherent to the scrotal skin, was excised together with the scrotal skin tissue with a safe surgical margin. In the pathology report, it was diagnosed as leiomyoma. The treatment for the vast majority of scrotal masses is radical inguinal orchiectomy. Testis preserving surgical procedures performing is critical for protecting both the fertility and the hormonal level of patients who have benign scrotal masses. Although physical examination suggests malignant neoplasms in patients presenting with a paratesticular mass, it should be kept in mind that benign neoplasms may also be present. [ABSTRACT FROM AUTHOR]