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The Role of Interventional Radiology Techniques in the Management of Renal Angiomyolipomas

  • Minimally Invasive Surgery (T Guzzo, Section Editor)
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Abstract

Purpose of Review

Although benign, renal angiomyolipoma (AML) may lead to serious complications without appropriate management. The purpose of this review is to describe the role of and evidence for interventional radiology techniques in the management of patients with AML.

Recent Findings

For patients with renal masses and non-diagnostic imaging studies, image-guided percutaneous biopsy is found to be highly accurate and useful in directing patient management. Once the diagnosis of AML has been made based on either imaging or biopsy, arterial embolization of tumors that are symptomatic or >4 cm has been demonstrated to reduce the risk of hemorrhage as well as tumor size. Percutaneous ablation devices have been proposed as alternative strategies but remain investigational.

Summary

The utility of interventional radiology techniques including percutaneous core needle biopsy and prophylactic super-selective arterial embolization is safe and effective management strategies for patients presenting with AML tumors.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Caliò A, Warfel KA, Eble JN. Pathological features and clinical associations of 58 small incidental angiomyolipomas of the kidney. Hum Pathol. 2016;58:41–6.

    Article  PubMed  Google Scholar 

  2. Mues AC, Palacios JM, Haramis G, Casazza C, Badani K, Gupta M, et al. Contemporary experience in the management of angiomyolipoma. J Endourol. 2010;24(11):1883–6.

    Article  PubMed  Google Scholar 

  3. Flum AS, Hamoui N, Said MA, Yang XJ, Casalino DD, McGuire BB, et al. An update on the diagnosis and management of renal angiomyolipoma. J Urol. 2016;195(April):834–46.

    Article  PubMed  Google Scholar 

  4. Prasad TV, Singh A, Das CJ, Seth A. An unusually large renal angiomyolipoma peeping into the right atrium. BMJ Case Reports. 2016 Jun;27:2016.

    Google Scholar 

  5. Lane BR, Aydin H, Danforth TL, Zhou M, Remer EM, Novick AC, et al. Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid. J Urol. 2008;180(3):836–43.

    Article  PubMed  Google Scholar 

  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. 2009;105(1):101–6.

    Article  PubMed  Google Scholar 

  7. Nelson CP, Sanda MG. Contemporary diagnosis and management of renal angiomyolipoma. J Urol. 2002;168(October):1315–25.

    Article  PubMed  Google Scholar 

  8. Seyam RM, Bissada NK, Kattan SA, Mokhtar AA, Aslam M, Fahmy WE, et al. Changing trends in presentation, diagnosis and management of renal angiomyolipoma: comparison of sporadic and tuberous sclerosis complex-associated forms. Urology. 2008;72(5):1077–82.

    Article  PubMed  Google Scholar 

  9. Davenport MS, Neville AM, Ellis JH, Cohan RH, Chaudhry HS, Leder RA. Diagnosis of renal angiomyolipoma with hounsfield unit thresholds: effect of size of region of interest and nephrographic phase imaging. Radiology. 2011;260(1):158–65.

    Article  PubMed  Google Scholar 

  10. Song S, Park BK, Park JJ. New radiologic classification of renal angiomyolipomas. Eur J Radiol. 2016;85(10):1835–42.

    Article  PubMed  Google Scholar 

  11. Schieda N, Hodgdon T, El-Khodary M, Flood TA, McInnes MDF. Unenhanced CT for the diagnosis of minimal-fat renal angiomyolipoma. AJR Am J Roentgenol. 2014;203(6):1236–41.

    Article  PubMed  Google Scholar 

  12. Lee Y, Kim JK, Shim WH, Sung YS, Cho KS, Shin JH, et al. Does computer-aided diagnosis permit differentiation of angiomyolipoma without visible fat from renal cell carcinoma on MDCT? Am J Roentgenol. 2015;205(3):W305–12.

    Article  Google Scholar 

  13. Kim JK, Park S-Y, Shon J-H, Cho K-S. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology. 2004;230(3):677–84.

    Article  PubMed  Google Scholar 

  14. Pierorazio PM, Patel HD, Johnson MH, Sozio SM, Sharma R, Iyoha E, et al. Distinguishing malignant and benign renal masses with composite models and nomograms: a systematic review and meta-analysis of clinically localized renal masses suspicious for malignancy. Cancer. 2016;122(21):3267–76.

    Article  PubMed  Google Scholar 

  15. Sasiwimonphan K, Takahashi N, Leibovich BC, Carter RE, Atwell TD, Kawashima A. Differentiation of angiomyolipoma without visible fat from renal cell. Radiology. 2012;263(1):160–8.

    Article  PubMed  Google Scholar 

  16. Schieda N, Kielar AZ, Al Dandan O, McInnes MDF, Flood TA. Ten uncommon and unusual variants of renal angiomyolipoma (AML): radiologic-pathologic correlation. Clin Radiol. 2015;70(2):206–20.

    Article  CAS  PubMed  Google Scholar 

  17. Outwater EK, Blasbalg R, Siegelman ES, Vala M. Detection of lipid in abdominal tissues with opposed-phase gradient-echo images at 1.5 T: techniques and diagnostic importance. Radiographics. 1998;18(6):1465–80.

    Article  CAS  PubMed  Google Scholar 

  18. Jinzaki M, Silverman SG, Akita H, Nagashima Y, Mikami S, Oya M. Renal angiomyolipoma: a radiological classification and update on recent developments in diagnosis and management. Abdom Imaging. 2014;39(3):588–604.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sun D, Wei C, Li Y, Lu Q, Zhang W, Hu B. Contrast-enhanced ultrasonography with quantitative analysis allows differentiation of renal tumor histotypes. Sci Rep. 2016;6(October):35081.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Leão RRN, Richard PO, Jewett MAS. The role of biopsy for small renal masses. Int J Surg. 2016; In press

  21. Marconi L, Dabestani S, Lam TB, Hofmann F, Stewart F, Norrie J, et al. Systematic review and meta-analysis of diagnostic accuracy of percutaneous renal tumour biopsy. Eur Urol. 2016;69(4):660–73.

    Article  PubMed  Google Scholar 

  22. • Jeon HG, Seo SI, Jeong BC, Jeon SS, Lee HM, Choi HY, et al. Percutaneous kidney biopsy for a small renal mass: a critical appraisal of results. J Urol. 2016;195(3):568–73. The authors in this study report a large, multicenter trial concluding that renal mass biopsies are safe and accurate in the diagnosis of unknown renal lesions.

    Article  PubMed  Google Scholar 

  23. Rimon U, Duvdevani M, Garniek A, Golan G, Bensaid P, Ramon J, et al. Large renal angiomyolipomas: digital subtraction angiographic grading and presentation with bleeding. Clin Radiol. 2006;61(6):520–6.

    Article  CAS  PubMed  Google Scholar 

  24. Oesterling JE, Fishman EK, Goldman SM, Marshall FF. The management of renal angiomyolipoma. J Urol. 1986 Jun;135(6):1121–4.

    CAS  PubMed  Google Scholar 

  25. Yamakado K, Tanaka N, Nakagawa T, Kobayashi S, Yanagawa M, Takeda K. Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture. Radiology. 2002;225(1):78–82.

    Article  PubMed  Google Scholar 

  26. Faddegon S, So A. Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization. Can Urol Assoc J. 2011;5(6):E138–41.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Meyer A, Woldu SL, Weinberg AC, Thoreson GR, Pierorazio P, Matulay JT, et al. Predicting renal parenchymal loss after nephron sparing surgery. J Urol. 2015;194(3):658–63.

    Article  PubMed  Google Scholar 

  28. Montag S, Rais-Bahrami S, Seideman CA, Rastinehad AR, Vira MA, Kavoussi LR, et al. Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings. BJU Int. 2011;107(9):1460–6.

    Article  PubMed  Google Scholar 

  29. Ghoneim TP, Thornton RH, Solomon SB, Adamy A, Favaretto RL, Russo P. Selective arterial embolization for pseudoaneurysms and arteriovenous fistula of renal artery branches following partial nephrectomy. J Urol. 2011;185(6):2061–5.

    Article  PubMed  Google Scholar 

  30. Bissler J, Cappell K, Charles H, Song X, Liu Z, Prestifilippo J, et al. Rates of interventional procedures in patients with tuberous sclerosis complex-related renal angiomyolipoma. Curr Med Res Opin. 2015;31(8):1501–7.

    Article  PubMed  Google Scholar 

  31. Bishay VL, Crino PB, Wein AJ, Malkowicz SB, Trerotola SO, Soulen MC, et al. Embolization of giant renal angiomyolipomas: technique and results. J Vasc Interv Radiol. 2010;21(1):67–72.

    Article  PubMed  Google Scholar 

  32. Ginat DT, Saad WEA, Turba UC. Transcatheter renal artery embolization: clinical applications and techniques. Tech Vasc Interv Radiol. 2009;12(4):224–39.

    Article  PubMed  Google Scholar 

  33. Patatas K, Robinson GJ, Ettles DF, Lakshminarayan R. Patterns of renal angiomyolipoma regression post embolisation on medium- to long-term follow-up. Br J Radiol. 2013;86(20120633)

  34. Sauk S, Zuckerman DA. Renal artery embolization. Semin Intervent Radiol. 2011;28(4):396–406.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Huang Q, Zhai R-Y. Embolization of symptomatic renal angiomyolipoma with a mixture of lipiodol and PVA, a mid-term result. Chin J Cancer Res. 2014;26(4):399–403.

    PubMed  PubMed Central  Google Scholar 

  36. Chick CM, Tan BS, Cheng C, Taneja M, Lo R, Tan YH, et al. Long-term follow-up of the treatment of renal angiomyolipomas after selective arterial embolization with alcohol. BJU Int. 2010;105(3):390–4.

    Article  PubMed  Google Scholar 

  37. Thulasidasan N, Sriskandakumar S, Ilyas S, Sabharwal T. Renal angiomyolipoma: mid- to long-term results following embolization with Onyx. Cardiovasc Intervent Radiol. 2016; doi:10.1007/s00270-016-1432-0.

    PubMed  Google Scholar 

  38. Villalta JD, Sorensen MD, Durack JC, Kerlan RK, Stoller ML. Selective arterial embolization of angiomyolipomas: a comparison of smaller and larger embolic agents. J Urol. 2011;186(3):921–7.

    Article  PubMed  Google Scholar 

  39. Soulen MC, Faykus MH, Shlansky-Goldberg RD, Wein a J, Cope C. Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Interv Radiol. 1994;5(4):587–91.

    Article  CAS  PubMed  Google Scholar 

  40. Planché O, Correas JM, Mader B, Joly D, Méjean A, Hélénon O. Prophylactic embolization of renal angiomyolipomas: evaluation of therapeutic response using CT 3D volume calculation and density histograms. J Vasc Interv Radiol. 2011;22(10):1388–95.

    Article  PubMed  Google Scholar 

  41. Ramon J, Rimon U, Garniek A, Golan G, Bensaid P, Kitrey ND, et al. Renal angiomyolipoma: long-term results following selective arterial embolization. Eur Urol. 2009;55(5):1155–62.

    Article  PubMed  Google Scholar 

  42. Incedayi M, Turba UC, Arslan B, Sabri SS, Saad WEA, Matsumoto AH, et al. Endovascular therapy for patients with renal angiomyolipoma presenting with retroperitoneal haemorrhage. Eur J Vasc Endovasc Surg. 2010;39(6):739–44.

    Article  CAS  PubMed  Google Scholar 

  43. Chan CK, Yu S, Yip S, Lee P. The efficacy, safety and durability of selective renal arterial embolization in treating symptomatic and asymptomatic renal angiomyolipoma. Urology. 2011;77(3):642–8.

    Article  PubMed  Google Scholar 

  44. Chang Y-H, Wang L-J, Chuang C-K, Wong Y-C, Wu C-T, Hsieh M-L. The efficacy and outcomes of urgent superselective transcatheter arterial embolization of patients with ruptured renal angiomyolipomas. J Trauma. 2007;62(6):1487–90.

    Article  PubMed  Google Scholar 

  45. Murray TE, Doyle F, Lee M. Transarterial embolization of angiomyolipoma: a systematic review. J Urol. 2015;194(3):635–9.

    Article  PubMed  Google Scholar 

  46. Lee SY, Hsu HH, Chen YC, Huang CC, Wong YC, Wang LJ, et al. Embolization of renal angiomyolipomas: short-term and long-term outcomes, complications, and tumor shrinkage. Cardiovasc Intervent Radiol. 2009;32(6):1171–8.

    Article  PubMed  Google Scholar 

  47. •• Hocquelet A, Cornelis F, Le Bras Y, Meyer M, Tricaud E, Lasserre AS, et al. Long-term results of preventive embolization of renal angiomyolipomas: evaluation of predictive factors of volume decrease. Eur Radiol. 2014;24(8):1785–93. These authors show that prophylactic embolization is a safe procedure with high success rates at preventing hemorrhage and causing tumor shrinkage over long-term follow-up.

    Article  CAS  PubMed  Google Scholar 

  48. Chatziioannou A, Gargas D, Malagari K, Kornezos I, Ioannidis I, Primetis E, et al. Transcatheter arterial embolization as therapy of renal angiomyolipomas: the evolution in 15 years of experience. Eur J Radiol. 2012;81(9):2308–12.

    Article  CAS  PubMed  Google Scholar 

  49. Lee SY, Hsu HH, Chen YC, Huang CC, Wong YC, Wang LJ. Evaluation of renal function of angiomyolipoma patients after selective transcatheter arterial embolization. Am J Med Sci. 2009;337(2):103–8.

    Article  PubMed  Google Scholar 

  50. Lenton J, Kessel D, Watkinson AF. Embolization of renal angiomyolipoma: immediate complications and long-term outcomes. Clin Radiol. 2008;63(8):864–70.

    Article  CAS  PubMed  Google Scholar 

  51. Rimon U, Duvdevani M, Garniek A, Golan G, Bensaid P, Ramon J, et al. Ethanol and polyvinyl alcohol mixture for transcatheter embolization of renal angiomyolipoma. Am J Roentgenol. 2006;187(3):762–8.

    Article  Google Scholar 

  52. Sheth RA, Feldman AS, Walker TG. Renoduodenal fistula after transcatheter embolization of renal angiomyolipoma. Cardiovasc Intervent Radiol. 2015;38(1):232–5.

    Article  PubMed  Google Scholar 

  53. Warncke JC, Brodie KE, Grantham EC, Catarinicchia SP, Tong S, Kondo KL, et al. Pediatric renal angiomyolipomas in tuberous sclerosis complex. J Urol. 2016; doi:10.1016/j.juro.2016.09.082.

    PubMed  Google Scholar 

  54. Boorjian SA, Sheinin Y, Crispen PL, Lohse CM, Kwon ED, Leibovich BC. Hormone receptor expression in renal angiomyolipoma: clinicopathologic correlation. Urology. 2008;72(4):927–32.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Preece P, Mees B, Norris B, Christie M, Wagner T, Dundee P. Surgical management of haemorrhaging renal angiomyolipoma in pregnancy. Int J Surg Case Rep. 2015;7:89–92.

    Article  PubMed Central  Google Scholar 

  56. Myoen S, Mitsuzuka K, Saito H, Ota H, Takase K, Arai Y. Spontaneous rupture of a renal angiomyolipoma at 25 weeks of pregnancy treated with transarterial embolization: a case report and review of the literature. Int J Urol. 2015;22(7):710–2.

    Article  CAS  PubMed  Google Scholar 

  57. Kira S, Sawada N, Miyamoto T, Mitsui T, Zakoji H, Takeda M. Hemorrhagic renal angiomyolipoma in pregnancy effectively managed by immediate cesarean section and elective transcatheter arterial embolization: a case report. J Endourol Case Reports. 2016;2(1):65–7.

    Article  Google Scholar 

  58. Venkatesan AM, Wood BJ, Gervais DA. Percutaneous ablation in the kidney. Radiology. 2011;261(2):375–91.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Castle SM, Gorbatiy V, Ekwenna O, Young E, Leveillee RJ. Radiofrequency ablation (RFA) therapy for renal angiomyolipoma (AML): an alternative to angio-embolization and nephron-sparing surgery. BJU Int. 2012;109(3):384–7.

    Article  PubMed  Google Scholar 

  60. Tan YK, Best SL, Olweny E, Park S, Trimmer C, Cadeddu JA. Radiofrequency ablation of incidental benign small renal mass: outcomes and follow-up protocol. Urology. 2012;79(4):827–30.

    Article  PubMed  Google Scholar 

  61. Zhi-yu H, Ping L, Xiao-ling Y, Zhi-gang C, Fang-yi L, Jie Y. Ultrasound-guided percutaneous microwave ablation of sporadic renal angiomyolipoma: preliminary results. Acta Radiol. 2015;56(1):56–62.

    Article  Google Scholar 

  62. Martin J, Athreya S. Meta-analysis of cryoablation versus microwave ablation for small renal masses: is there a difference in outcome? Diagn Interv Radiol. 2013;19(6):501–7.

    PubMed  Google Scholar 

  63. Byrd GF, Lawatsch EJ, Mesrobian HG, Begun F, Langenstroer P. Laparoscopic cryoablation of renal angiomyolipoma. J Urol. 2006;176(4):1512–6.

    Article  PubMed  Google Scholar 

  64. Caviezel A, Terraz S, Schmidlin F, Becker C, Iselin CE. Percutaneous cryoablation of small kidney tumours under magnetic resonance imaging guidance: medium-term follow-up. Scand J Urol Nephrol. 2008;42(5):412–6.

    Article  PubMed  Google Scholar 

  65. Kuusk T, Biancari F, Lane B, Tobert C, Campbell S, Rimon U, et al. Treatment of renal angiomyolipoma: pooled analysis of individual patient data Endourology and technology. BMC Urol. 2015; 15(123): doi: 10.1186/s12894-015-0118-2.

  66. Johnson SC, Graham S, D’Agostino H, Elmajian DA, Shingleton WB. Percutaneous renal cryoablation of angiomyolipomas in patients with solitary kidneys. Urology. 2009;74(6):1246–9.

    Article  PubMed  Google Scholar 

  67. Krueger DA, Northrup H, Northrup H, Krueger DA, Roberds S, Smith K, et al. Tuberous sclerosis complex surveillance and management: recommendations of the 2012 International Tuberous Sclerosis Complex Consensus Conference. Pediatr Neurol. 2013;49(4):255–65.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Patel HD, Riffon MF, Joice GA, Johnson MH, Chang P, Wagner AA, et al. A prospective, comparative study of quality of life among patients with small renal masses choosing active surveillance and primary intervention. J Urol. 2016;196(5):1356–62.

    Article  PubMed  Google Scholar 

  69. Ouzaid I, Autorino R, Fatica R, Herts BR, McLennan G, Remer EM, et al. Active surveillance for renal angiomyolipoma: outcomes and factors predictive of delayed intervention. BJU Int. 2014;114(3):412–7.

    PubMed  Google Scholar 

  70. Kothary N, Soulen MC, Clark TWI, Wein AJ, Shlansky-Goldberg RD, Crino PB, et al. Renal angiomyolipoma: long-term results after arterial embolization. J Vasc Interv Radiol. 2005;16:45–50.

    Article  PubMed  Google Scholar 

  71. Sheth RA, Feldman AS, Paul E, Thiele EA, Walker TG. Sporadic versus tuberous sclerosis complex-associated angiomyolipomas: predictors for long-term outcomes following transcatheter embolization. J Vasc Interv Radiol. 2016;27(10):1542–9.

    Article  PubMed  Google Scholar 

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  1. Department of Radiology, Division of Interventional Radiology, Hospital of University of Pennsylvania Medical Center, 1 Silverstein, 3400 Spruce St., Philadelphia, PA, 19104, USA

    Ryan M. Kiefer & S. William Stavropoulos

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  1. Ryan M. Kiefer
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Correspondence to S. William Stavropoulos.

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Ryan M. Kiefer declares no potential conflicts of interest.

S. William Stavropoulos reports personal fees from Bard and Cook and grants from Cook, B. Braun, and Sillajen.

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Kiefer, R.M., Stavropoulos, S. The Role of Interventional Radiology Techniques in the Management of Renal Angiomyolipomas. Curr Urol Rep 18, 36 (2017). https://doi.org/10.1007/s11934-017-0687-6

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