Bilateral giant angiomyolipomas revealed after massive retroperitoneal hemorrhage – A case report

Sladjana Petrović; Aleksandar Tasić; Dragan Mihailović; Nikola Živković; Marija Vitanović; Dragan Stojanov

doi:10.2298/3172

Sladjana Petrović Center for Radiology, Clinical Center, Faculty of Medicine, University of Niš, Serbia
Aleksandar Tasić Center for Radiology, Clinical Center, Faculty of Medicine, University of Niš, Serbia
Dragan Mihailović Institut for Pathology, Clinical Center, Faculty of Medicine, University of Niš, Serbia
Nikola Živković Institut for Pathology, Clinical Center, Faculty of Medicine, University of Niš, Serbia
Marija Vitanović Department of Radiology, General Hospital, Pirot, Serbia
Dragan Stojanov Center for Radiology, Clinical Center, Faculty of Medicine, University of Niš, Serbia

DOI: https://doi.org/10.2298/3172

Keywords: kidney neoplasms, angiomyolipoma, diagnosis, differential,

Abstract

Introduction. Angiomyolipomas (AML) are benign neoplasms composed of fat, smooth muscle and thick-walled blood vessels in varying proportions. These tumors have a significant female predominance. Case report. We reported a 61-year-old man with spontaneous rupture of AML. Computerized tomography revealed a change in morphology of both kidneys. Multiple lesions of fat density with dilated blood vessels were found in the left kidney. The right retroperitoneum was obliterated with a giant heterogeneous mass originating from the right kidney with a massive hemorrhage, active extravasations, compression of inferior the vena cava and intraperitoneal collections. After radical nephrectomy, histological examination revealed that the tumor was composed of relative proportions of fat, smooth muscle and blood vessels. We incidentally found small renal adenoma. Conclusion. The true nature of AML is unclear, but they are usually classified as hamartomas. Angiomyolipomas are generally benign lesions, although the epithelioid angiomyolipoma, a subtype that occurs in about 3% of cases, can behavior aggressively.

References

Steiner MS, Goldman SM, Fishman EK, Marshall FF. The natural history of renal angiomyolipoma. J Urol 1993; 150(6): 1782−6.

Oesterling JE, Fishman EK, Goldman SM, Marshall FF. The man-agement of renal angiomyolipoma. J Urol 1986; 135(6): 1121−4.

Hanna RM, Dahniya MH, Al-Marzouk N, Grexa E. Extrarenal angiomyolipomas of the perinephric space in tuberose sclero-sis. Australas Radiol 1997; 41(4): 339−41.

Nelson CP, Sanda MG. Contemporary diagnosis and manage-ment of renal angiomyolipoma. J Urol 2002; 168(4 Pt 1): 1315−25.

Koh KB, George J. Radiological parameters of bleeding renal an-giomyolipoma. Scand J Urol Nephrol 1996; 30(4): 265−8.

Chen SS, Lin AT, Chen KK, Chang LS. Renal angiomyolipoma: experience of 20 years in Taiwan. Eur Urol 1997; 32(2): 175−8.

Lemaitre L, Robert Y, Dubrulle F, Claudon M, Duhamel A, Danjou P, et al. Renal angiomyolipoma: growth followed up with CT and/or US. Radiology 1995; 197(3): 598−602.

Rao PN, Osborn DE, Barnard RJ, Best JJ. Symptomatic renal an-giomyolipoma. Br J Urol 1981; 53(3): 212−5.

Koike H, Müller SC, Hohenfellner R. Management of renal angi-omyolipoma: a report of 14 cases and review of the literature. Is nonsurgical treatment adequate for this tumor. Eur Urol 1994; 25(3): 183−8.

Fujii Y, Ajima J, Oka K, Tosaka A, Takehara Y. Benign renal tumors detected among healthy adults by abdominal ultraso-nography. Eur Urol 1995; 27(2): 124−7.

Hajdu SI, Foote FW. Angiomyolipoma of the kidney: report of 27 cases and review of the literature. J Urol 1969; 102(4): 396−401.

Skolarus TA, Serrano MF, Berger DA, Bullock TL, Yan Y, Humph-rey PA, et al. The distribution of histological subtypes of renal tumors by decade of life using the 2004 WHO classification. J Urol 2008; 179(2): 439−43.

Blute ML, Malek RS, Segura JW. Angiomyolipoma: clinical me-tamorphosis and concerns. J Urol 1988; 139(1): 20−4.

Berglund RK, Bernstein M, Manion MT, Touijer KA, Russo P. Inci-dental angiomyolipoma resected during renal surgery for an enhancing renal mass. BJU Int 2009; 104(11): 1650−4.

Simmons JL, Hussain SA, Riley P, Wallace DM. Management of renal angimyolipoma in poatients with tuberous sclerosis com-plex. Oncol Rep 2003; 10(1): 237−41.

Zhang JQ, Fielding JR, Zou KH. Etiology of spontaneous perirenal hemorrhage: a meta-analysis. J Urol 2002; 167(4): 1593−6.

Mongha R, Bansal P, Dutta A, Das RK, Kundu AK. Wunderlich's syndrome with hepatic angiomyolipoma in tuberous sclerosis. Indian J Cancer 2008; 45(2): 64−6.

Dickinson M, Ruckle H, Beaghler M, Hadley HR. Renal angiomyo-lipoma: optimal treatmeni based on size and symptoms. Clin Nephrol 1998; 49(5): 281−6.

Kato I, Inayama Y, Yamanaka S, Ohshiro H, Gomi K, Shirai S, et al. Epithelioid angiomyolipoma of the kidney. Pathol Int 2009; 59(1): 38−43.

Makhlouf HR, Remotti HE, Ishak KG. Expression of KIT (CD117) in Angiomyolipoma. Am J Surg Pathol 2002; 26(4): 493−7.

Mete O, Kwast TH. Epithelioid angiomyolipoma: a morphologi-cally distinct variant that mimics a variety of intra-abdominal neoplasms. Arch Pathol Lab Med 2011; 135(5): 665−70.

Faraji H, Nguyen BN, Mai KT. Renal epithelioid angiomyoli-poma: a study of six cases and a meta-analytic study. Devel-opment of criteria for screening the entity with prognostic sig-nificance. Histopathology 2009; 55(5): 525−34.

Chan SY, Chan WK. Huge renal angiomyolipomas in tuberous sclerosis complex. Nephrology 2005; 10(4): 382−6.

Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C, et al. Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. BJU Int 2010; 105(1): 101−6.

Morelli L, Pusiol T, Piscioli I, Larosa M, Pozzoli GL, Monica B. Concurrent occurrence of three primary neoplasms with dif-ferent hystotype in the same kidney, associated with an ade-noma of the omolateral adrenal gland: first case report. Int J Urol 2006; 13(9): 1236−9.

Linder B, Hong Y, Jarrett T. Intra-renal adrenal adenoma: a compelling addition to the differential diagnosis of renal mass. Int J Urol 2009; 16(11): 912−4.