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Renal angiomyolipoma in Indian population - a single center experience and review of literature

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Author(s): Gogoi Sanjay | Kumar Anant | Mehta Bhavna | Srivastava Aneesh | Mandhani Anil

Journal: Indian Journal of Urology
ISSN 0970-1591

Volume: 18;
Issue: 1;
Start page: 1;
Date: 2001;
Original page

Keywords: Angiomyolipoma; Kidney; Tuberous Sclerosis.

ABSTRACT
Introduction: Angiomyolipoma is an under-reported entity from the Indian subcontinent. This study was undertaken to analyze our decade long experience in the management of renal angiomyolipoma (AML). Material and Methods: A total of 12 patients with 20 AML attended our center between July 1989 & December 1999. The mean age at presentation was 46.6 years with a female to male ratio of 2:1. Majority had solitary unilateral disease and bilateral lesions were seen in 2 patients. 25% of patients had associated tuberous sclerosis. A review of all imaging studies and repeat histopathological analysis was undertaken to evaluate the diagnostic pitfalls and tumor characteristics. Results: 83.3% of our patients were symptomatic with loin pain being the predominant symptom (33.3%). 3 cases presented with large palpable lumps. I patient presented with a hemorrhagic shock (Wunderlich′s syndrome). 2 of our patients were asymptonnatic (one detected during obstetrical USG and other during live donor nephrectomy). Renal USG and CT scan were highly suggestive of AML in 66.7% and 80% of patients respectively. The mean tumor attenuation value on CT scan was -53.4 H. U. Histopathologically multicentricity was a predominant finding in tuberous sclerosis. Mean tumor size was 7.4 cm with an equal number of patients in group I (< 4 cnn) and group II (> 4 cm). Of the group I patients treated conservatively; 75% could be managed for a mean duration of 33.3 months without aggravation of symptoms or any major complications. 50% of group II patients elected, for conservative management. All of these patients required surgical intervention at a mean duration of 7 months, one on account of major complication (spontaneous bleeding). Conclusion: Our experience validates the presently accepted recommendation of conservative management in renal AML less than 4 cm in size with regard to probability of complications. However we found a poor correlation between tumor size and severity of symptoms and early intervention may be judiciously offered for relief of symptoms.
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