Search

The paper presents two clinical cases of patients with giant renal angiomyolipomas (AML), in one of whom its course was complicated by intratumoral hemorrhage. It describes key diagnostic criteria for computed tomography (CT), as well as the distinctive features of other neoplasms that should undergo a differential diagnosis. The similar clinical presentations and morphological characteristics of different renal neoplasms can cause certain diagnostic difficulties; however, the carefully collected historical data and distinctive criteria allow AML to be identified. Due to its high sensitivity and specificity, abdominal contrast-enhanced CT is an effective imaging technique in the detection and differential diagnosis of giant renal AML.

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.

Renal angiomyolipoma (AML), which is a rare solid kidney tumor with benign characteristics, also known as a renal hamartoma, can exhibit various clinical symptoms and severe consequences may arise if the lesion becomes large. A 58-year-old woman was admitted to a hospital, with general fatigue, abdominal swelling, and epigastric fullness. Upon examination, a large mass was palpated, which occupied almost the entire right abdomen. The abdominal computed tomography scan revealed a large right renal mass measuring 22 × 18 × 8 cm, which was exophytic and heterogeneous with a large fat component and an enhancing solid part. The tumor was successfully excised through a generous right subcostal incision with left-side extension. The total weight of the resected specimen was 2500 g, which appears to be the largest angiomyolipoma ever resected in Ethiopia. Renal AML, a benign tumor derived from mesenchymal components, is sometimes referred to as a "hamartoma" due to its variable makeup. The most common complaints of patients with renal AML are lower back pain, hematuria, and physical finding of hypotension (shock), though patients with giant AML, as in this case, may also experience gastrointestinal symptoms due to the mass' compression. Although treatment options requiring contemporary medical technologies and skilled manpower are difficult to offer in set ups of resource-limited countries, such as the one we reported from, giant renal angiomyolipoma can be treated safely with open nephrectomy. • Giant renal AML is a rare solid tumor. • Most renal AMLs are asymptomatic and identified incidentally with imaging. • Giant renal AMLs carry significant risk of bleeding. • Partial or total nephrectomy is recommended treatment for giant AMLs. [ABSTRACT FROM AUTHOR]

Introduction Herein we present a rare case of pontaneous rupture of a giant renal angiomyolipoma (AML), with symptoms of hypovolemic shock (Wunderlich’s syndrome), which was managed by urgent total nephrectomy. Presentation of case A 53 year old female was transferred to the emergency room with progressive acute painful swelling of the left lateral abdominal area, duration of 5 h. An emergent ultrasonic examination, revealed a heterogeneous—solid mass with maximum diameter of 23 cm, with probable origin from the left kidney. Due to worsening of the clinical status (hypovolemic shock), loss of consciousness and acute drop of haematocrit level to 17.8%, the patient was urgently intubated in the emergency room and transferred to the operating theater. A giant haemorrhagic mass was found originating from the left kidney, which removed en-block with the left kidney. The patient was transferred to the intensive care unit. Her recovery was uneventful. The histopathologic examination revealed a giant renal angiomyolipoma (25 × 18 × 8 cm) with extensive bleeding. Discussion Enlarged renal AMLs can rupture. This can be sudden and painful with manifestations of hypovolemic shock. The management of AMLs has been correlated with symptoms. Patients with life-threatening retroperitoneal haemorrhage, require urgent exploration as retroperitoneal bleeding can lead to severe complications, increasing morbidity. Conclusion In case of giant angiomyolipoma with intratumoral haemorrhage, and symptoms of Wunderlich’s syndrome, partial or total nephrectomy is a good treatment option in order to save the patient’s life. [ABSTRACT FROM AUTHOR]

Angiomyolipomas (AMLs) are one group of benign tumours that are distinguishable radiologically. Because AMLs are composed of different tissues which include fat, muscle, vascular elements, and even cartilage, the fat in particular, may be detected radiologically. Angiomyolipomas, particularly when they are small, warrant no treatment. They are resected only when they are over 4 cm or when they are symptomatic due to the risk of bleeding. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract A 60-year-old man was admitted to Hitachi General Hospital, Hitachi, Japan, with general fatigue and epigastric fullness. A large mass was palpated on whole abdomen and abdominal computed tomography scan showed a large lobulated fatty mass surrounding the right kidney, which indicated the existence of angiomyolipoma arising from the right kidney. The tumor was success-fully resected through a thoracoabdominal incision. The total weight of the resected specimen was 3500 g, apparently the largest angiomyolipoma resected by operation in Japan. [ABSTRACT FROM AUTHOR]