Summary
Background: Angiomyolipomas (AMLs) account for about 5 % of all renal tumours. Their benign nature frequently allows them to gain excessive size before diagnosis. AMLs larger than 4 cm in diameter are more likely to become symptomatic due to intratumoral or perinephric haemorrhages.
Methods: We report a case of a giant angiomyolipoma of the kidney in a 32-year-old woman.
Results: The patient presented to our hospital with a 2-month history of an intermittent, vague pain and a palpable mass of the right abdomen. CT and MRI revealed an excessive mass of soft tissues originating in the right kidney. The tumour extended from the caudate lobe of the liver to the right ovary, originating in the central renal parenchyma. A fat tissue component of the internal structure was apparent. Consequent MR angiography showed that the mass received blood supply from the right renal artery, as well as from the right iliac artery. The patient was treated with radical nephrectomy. The tumour weighed approximately 1.5 kg; its size was 31×16.5×8.5 cm.
Conclusions: AMLs can be treated conservatively, as long as they do not exceed 4 cm in diameter. Giant AMLs are usually symptomatic and the treatment of choice is total nephrectomy. To our knowledge, our case is one of the largest AMLs ever reported in the literature.
Zusammenfassung
Grundlagen: Angiomyolipome (AML) stellen 5 % aller Nierentumoren dar. Ihre gutartige Natur erlaubt ihnen häufig enorme Größe zu erreichen, bevor sie diagnostiziert werden. AML größer als 4 cm im Durchmesser können mit steigender Frequenz als intratumorale oder perirenale Blutung symptomatisch werden.
Methodik: Wir beschreiben den Fall einer 32-jährigen Patientin mit einem gigantischen Angiomyolipom der rechten Niere.
Ergebnisse: Die Patientin präsentierte sich in unserer Klinik mit intermittierenden Bauchschmerzen seit 2 Monaten und eine tastbare Masse im rechten Unterbauch. CT and MRI zeigten einen Weichteiltumor, der von der Leber bis zum rechten Ovar hinreichte und der von der rechten Niere zu wachsen schien. Die Masse schien auch fettige Elemente zu besitzen. Die MR-Angiographie zeigte, daß der Tumor sowohl von der rechten Nierenarterie als auch von der rechten iliakalen Arterie versorgt wurde. Die Patientin wurde einer radikalen Nephrektomie unterzogen. Der Tumor wog etwa 1,5 kg und war 31×16,5×8,5 cm groß.
Schlußfolgerungen: AML können konservativ behandelt werden solange sie kleiner als 4 cm im Durchmesser sind. Gigantische AML sind symptomatisch, und das Verfahren der Wahl ist die totale Nephrektomie. Unser Fall ist einer der größten AML, die bislang in der Literatur beschrieben wurden.
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Galanis, I., Kabaroudis, A., Papaziogas, B. et al. A rare case of a giant renal angiomyolipoma. Eur Surg 35, 58–60 (2003). https://doi.org/10.1046/j.1563-2563.2003.03013.x
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DOI: https://doi.org/10.1046/j.1563-2563.2003.03013.x