Objective： To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol （PVA） particles on symptomatic renal angiomyolipoma and to present the mid-term results from ...Objective： To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol （PVA） particles on symptomatic renal angiomyolipoma and to present the mid-term results from our single-center site. Methods： We performed a retrospective review of the seven patients who underwent embolization with a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma in our center between February 2011 and December 2013. Medical records and follow-up results were reviewed and analyzed. Results： Seven patients underwent eight episodes of embolization using a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma. One patient required a subsequent embolization of the right kidney 9 months after the initial embolization of the left kidney. No nephrectomy was required in any of these cases during follow-up. None had recurrence of tumor bleeding or rupture during follow-up. Decreased tumor size was achieved in six patients （85.7%） during the mid-term follow-up. Conclusions： Embolization with a mixture of lipiodol and PVA particles is an effective and safe treatment for symptomatic renal angiomyolipoma. Based on the durable mid-term results of the present study, a mixture of lipiodol and PVA particles is recommended for embolization.展开更多
BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine out...BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.展开更多
Fat-poor renal angiomyolipoma (fpAML) and renal cell carcinoma (RCC) are difficult to differentiate and misdiagnosis can lead to unnecessary nephrectomy. We experienced a case showing a “collapsed shape” which refle...Fat-poor renal angiomyolipoma (fpAML) and renal cell carcinoma (RCC) are difficult to differentiate and misdiagnosis can lead to unnecessary nephrectomy. We experienced a case showing a “collapsed shape” which reflected a fpAML tissue type. A renal tumor was incidentally discovered in a 42-year-old female during an abdominal ultrasound. RCC was suspected according to CT and MRI imaging results, and a partial nephrectomy was performed. However, the pathologic diagnosis was fpAML. Upon reevaluation of preoperative images, morphological change to the tumor due to contact with surrounding tissues: the collapsed shape was observed and could be identified by CT, which is the gold standard test for differentiating renal tumors. In cases where the collapsed shape is observed in a renal tumor, fpAML should be considered.展开更多
Bleeding from renal angiomyolipoma in pregnancy can be catastrophic to both mother and fetus. Selective arterial embolisation is considered more superior than conventional surgery in these patients. Our case report ex...Bleeding from renal angiomyolipoma in pregnancy can be catastrophic to both mother and fetus. Selective arterial embolisation is considered more superior than conventional surgery in these patients. Our case report exemplifies how a bleeding angiomyolipoma was halted with embolisation in our pregnant patient.展开更多
A 50 yr man presented with fatigue and fever. He was found to have a 7.2 cm left renal mass. Radical nephrectomy was done. The mass was HMB-45 negative renal angiomyolipoma. This patient did not have tuberous sclerosi...A 50 yr man presented with fatigue and fever. He was found to have a 7.2 cm left renal mass. Radical nephrectomy was done. The mass was HMB-45 negative renal angiomyolipoma. This patient did not have tuberous sclerosis. His fever resolved after the tumor excision. This case is unique because of the unusual morphology and histology of the tumor. It reiterates that getting rid of inflammatory cytokines being produced by the tumor will cause resolution of fever.展开更多
Renal angiomyolipoma is a type of benign tumor that occurs sporadically in addition to being associated with tuberous sclerosis. Preoperative embolization of large tumors is important to avoid excessive blood loss dur...Renal angiomyolipoma is a type of benign tumor that occurs sporadically in addition to being associated with tuberous sclerosis. Preoperative embolization of large tumors is important to avoid excessive blood loss during surgery. We reported a patient with a 5505-g giant renal angiomyolipoma in a solitary kidney. The patient was treated with preoperative embolization and radical nephrectomy without complications. This type of treatment for an enormous angiomyolipoma can reduce the risk of uncontrolled hemorrhage caused by rupture of the tumor during the operation and should be considered for the treatment of similar tumors.展开更多
Though rare,angiomyolipomas(AMLs)are the most common mesenchymal tumors of kidney.In general,AMLs can always be associated with two conditions affecting other organ systems:tuberous sclero-sis complex(TSC)and sporadic...Though rare,angiomyolipomas(AMLs)are the most common mesenchymal tumors of kidney.In general,AMLs can always be associated with two conditions affecting other organ systems:tuberous sclero-sis complex(TSC)and sporadic lymphangioleiomyoma-tosis.This article presents a case of renal AML occurring in a 14-year-old girl with a definite diagnosis of TSC.She had been diagnosed with TSC at the age of three,and a schedule for close observation was disobeyed.At this time,she underwent a series of examinations:physical examina-tion,ultrasonography,angiography,computed tomography(CT),and magnetic resonance imaging(MRI)scans.The physical examination showed adenoma sebaceum in a butterfly paranasal distribution,and a mass was palpated in the left upper quadrant.There were no neurological deficits.Imaging studies(including ultrasonography,angiography,CT,and MRI)of the abdomen showed a large heterogeneous mass arising from the left kidney.Partial nephrectomy was performed.The pathological diagnosis was hemorrhagic renal AML.No recurrence was found in the three-year follow-up.We concluded that schedule of close observation on patients with TSC should be strictly abided by for the high morbidity of AMLs.The specific risks of renal AMLs are spontaneous hemorrhage and rupture.Treatment options for AMLs include conservative and interventional(total/partial nephrectomy,cryoptherapy,and embolization)treatments.展开更多
From 1989.15 cases of renal angiomyolipoma (AML) have been diagnosed by ultrasonography, CT scanning and digital subtraction angiography (DSA) at our hospital. In 8 patients with uneven hyperechoes on B-mode ultrasono...From 1989.15 cases of renal angiomyolipoma (AML) have been diagnosed by ultrasonography, CT scanning and digital subtraction angiography (DSA) at our hospital. In 8 patients with uneven hyperechoes on B-mode ultrasonography (B-US)(8/15) and 7 with low density of fat on CT scanning (7/12)accurate diagnosis was established preoperatively. DSA revealed the 'berry-like'pseudoaneurysms in the arterial phase (14 cases), the defined lucent area in the nephrogram phase (10 cases) and the 'onion-peel appearances' during venous phases (8 cases),correct diagnosis was achieved in all patients. 8 cases were surgically treated and 7 treated by subselective embolization of renal artery. Effects in all cases were good. The diagnostic value of B-US. CT scanning, DSA and interventional treatment of AML was discussed. It was believed that the diagnosis with DSA was a technique with high specificity, and embolization therapy was simple and effective for AML.展开更多
BACKGROUND Giant renal angiomyolipomas(AMLs)may lead to complications including flank pain,hematuria,hypertension,retroperitoneal hemorrhage and even death.Giant AMLs which grow around renal hilar vessels and the uret...BACKGROUND Giant renal angiomyolipomas(AMLs)may lead to complications including flank pain,hematuria,hypertension,retroperitoneal hemorrhage and even death.Giant AMLs which grow around renal hilar vessels and the ureter are rare.Most previous reports on the treatment of giant renal AMLs have focused on open surgery or a transperitoneal approach,with few studies on the retroperitoneal approach for large AMLs.We here report a case of giant renal hilum AML successfully treated with robot-assisted laparoscopic nephron sparing surgery the retroperitoneal approach,with a one-year follow-up.CASE SUMMARY A 34-year-old female patient was diagnosed with renal AML 11 years ago and showed no discomfort.The tumor gradually increased in size to a giant AML over the years,which measured 63 mm×47 mm×90 mm and was wrapped around the right hilum.Therefore,a robotic laparoscopic partial nephrectomy(LPN)via the retroperitoneal approach was performed.The patient had no serious postoperative complications and was discharged soon after the operation.At the one-year follow-up,the patient's right kidney had recovered well.CONCLUSION Despite insufficient operating space via the retroperitoneal approach,LPN for giant central renal AMLs can be completed using a well-designed procedure with the assistance of a robotic system.展开更多
The kidney is affected in about 80-85% of tuberous sclerosis complex （TSC） patients. Renal manifestations in TSC patients include an increased incidence of epithelial cysts and tumors, such as multiple renal angiomy...The kidney is affected in about 80-85% of tuberous sclerosis complex （TSC） patients. Renal manifestations in TSC patients include an increased incidence of epithelial cysts and tumors, such as multiple renal angiomyolipomas （AMLs）, renal cell carcinoma （RCC）, and oncocytoma. The coexistence of RCC and renal AML within same tumor masses, namely collision tumor, is very rare, and about six cases have been reported. Here, we present a case of a young male with TSC and multiple AMLs, containing RCC with eosinophilic morphology.展开更多
文摘Objective： To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol （PVA） particles on symptomatic renal angiomyolipoma and to present the mid-term results from our single-center site. Methods： We performed a retrospective review of the seven patients who underwent embolization with a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma in our center between February 2011 and December 2013. Medical records and follow-up results were reviewed and analyzed. Results： Seven patients underwent eight episodes of embolization using a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma. One patient required a subsequent embolization of the right kidney 9 months after the initial embolization of the left kidney. No nephrectomy was required in any of these cases during follow-up. None had recurrence of tumor bleeding or rupture during follow-up. Decreased tumor size was achieved in six patients （85.7%） during the mid-term follow-up. Conclusions： Embolization with a mixture of lipiodol and PVA particles is an effective and safe treatment for symptomatic renal angiomyolipoma. Based on the durable mid-term results of the present study, a mixture of lipiodol and PVA particles is recommended for embolization.
文摘BACKGROUND Hypovolemic shock can lead to life-threatening organ dysfunction,and adequate fluid administration is a fundamental therapy.Traditionally,parameters such as vital signs,central venous pressure,and urine output have been used to estimate intravascular volume.Recently,pulse pressure variation(PPV)and non-invasive cardiac monitoring devices have been introduced.In this case report,we introduce a patient with massive active bleeding from giant renal angiomyolipoma(AML).During emergent nephrectomy,we used non-invasive cardiac monitoring with CSN-1901(Nihon Kohden,Tokyo,Japan)and PPV to evaluate the patient's intravascular volume status to achieve optimal fluid management.CASE SUMMARY A 30-year-old male patient with giant AML with active bleeding was referred to the emergency room complaining of severe abdominal pain and spontaneous abdominal distension.AML was diagnosed by computed tomography,and emergent nephrectomy was scheduled.Massive bleeding was expected so we decided to use non-invasive cardiac monitoring and PPV to assist fluid therapy because they are relatively easy and fast compared to invasive cardiac monitoring.During the surgery,6000 mL of estimated blood loss occurred.Along with the patient's vital signs and laboratory results,we monitored cardiac output,cardiac output,stroke volume,stroke volume index with a non-invasive cardiac monitoring device,and PPV using an intra-arterial catheter to evaluate intravascular volume status of the patient to compensate for massive bleeding.CONCLUSION In addition to traditional parameters,non-invasive cardiac monitoring and PPV are useful methods to evaluate patient's intravascular volume status and provideguidance for intraoperative management of hypovolemic shock patients.
文摘Fat-poor renal angiomyolipoma (fpAML) and renal cell carcinoma (RCC) are difficult to differentiate and misdiagnosis can lead to unnecessary nephrectomy. We experienced a case showing a “collapsed shape” which reflected a fpAML tissue type. A renal tumor was incidentally discovered in a 42-year-old female during an abdominal ultrasound. RCC was suspected according to CT and MRI imaging results, and a partial nephrectomy was performed. However, the pathologic diagnosis was fpAML. Upon reevaluation of preoperative images, morphological change to the tumor due to contact with surrounding tissues: the collapsed shape was observed and could be identified by CT, which is the gold standard test for differentiating renal tumors. In cases where the collapsed shape is observed in a renal tumor, fpAML should be considered.
文摘Bleeding from renal angiomyolipoma in pregnancy can be catastrophic to both mother and fetus. Selective arterial embolisation is considered more superior than conventional surgery in these patients. Our case report exemplifies how a bleeding angiomyolipoma was halted with embolisation in our pregnant patient.
文摘A 50 yr man presented with fatigue and fever. He was found to have a 7.2 cm left renal mass. Radical nephrectomy was done. The mass was HMB-45 negative renal angiomyolipoma. This patient did not have tuberous sclerosis. His fever resolved after the tumor excision. This case is unique because of the unusual morphology and histology of the tumor. It reiterates that getting rid of inflammatory cytokines being produced by the tumor will cause resolution of fever.
文摘Renal angiomyolipoma is a type of benign tumor that occurs sporadically in addition to being associated with tuberous sclerosis. Preoperative embolization of large tumors is important to avoid excessive blood loss during surgery. We reported a patient with a 5505-g giant renal angiomyolipoma in a solitary kidney. The patient was treated with preoperative embolization and radical nephrectomy without complications. This type of treatment for an enormous angiomyolipoma can reduce the risk of uncontrolled hemorrhage caused by rupture of the tumor during the operation and should be considered for the treatment of similar tumors.
文摘Though rare,angiomyolipomas(AMLs)are the most common mesenchymal tumors of kidney.In general,AMLs can always be associated with two conditions affecting other organ systems:tuberous sclero-sis complex(TSC)and sporadic lymphangioleiomyoma-tosis.This article presents a case of renal AML occurring in a 14-year-old girl with a definite diagnosis of TSC.She had been diagnosed with TSC at the age of three,and a schedule for close observation was disobeyed.At this time,she underwent a series of examinations:physical examina-tion,ultrasonography,angiography,computed tomography(CT),and magnetic resonance imaging(MRI)scans.The physical examination showed adenoma sebaceum in a butterfly paranasal distribution,and a mass was palpated in the left upper quadrant.There were no neurological deficits.Imaging studies(including ultrasonography,angiography,CT,and MRI)of the abdomen showed a large heterogeneous mass arising from the left kidney.Partial nephrectomy was performed.The pathological diagnosis was hemorrhagic renal AML.No recurrence was found in the three-year follow-up.We concluded that schedule of close observation on patients with TSC should be strictly abided by for the high morbidity of AMLs.The specific risks of renal AMLs are spontaneous hemorrhage and rupture.Treatment options for AMLs include conservative and interventional(total/partial nephrectomy,cryoptherapy,and embolization)treatments.
文摘From 1989.15 cases of renal angiomyolipoma (AML) have been diagnosed by ultrasonography, CT scanning and digital subtraction angiography (DSA) at our hospital. In 8 patients with uneven hyperechoes on B-mode ultrasonography (B-US)(8/15) and 7 with low density of fat on CT scanning (7/12)accurate diagnosis was established preoperatively. DSA revealed the 'berry-like'pseudoaneurysms in the arterial phase (14 cases), the defined lucent area in the nephrogram phase (10 cases) and the 'onion-peel appearances' during venous phases (8 cases),correct diagnosis was achieved in all patients. 8 cases were surgically treated and 7 treated by subselective embolization of renal artery. Effects in all cases were good. The diagnostic value of B-US. CT scanning, DSA and interventional treatment of AML was discussed. It was believed that the diagnosis with DSA was a technique with high specificity, and embolization therapy was simple and effective for AML.
文摘BACKGROUND Giant renal angiomyolipomas(AMLs)may lead to complications including flank pain,hematuria,hypertension,retroperitoneal hemorrhage and even death.Giant AMLs which grow around renal hilar vessels and the ureter are rare.Most previous reports on the treatment of giant renal AMLs have focused on open surgery or a transperitoneal approach,with few studies on the retroperitoneal approach for large AMLs.We here report a case of giant renal hilum AML successfully treated with robot-assisted laparoscopic nephron sparing surgery the retroperitoneal approach,with a one-year follow-up.CASE SUMMARY A 34-year-old female patient was diagnosed with renal AML 11 years ago and showed no discomfort.The tumor gradually increased in size to a giant AML over the years,which measured 63 mm×47 mm×90 mm and was wrapped around the right hilum.Therefore,a robotic laparoscopic partial nephrectomy(LPN)via the retroperitoneal approach was performed.The patient had no serious postoperative complications and was discharged soon after the operation.At the one-year follow-up,the patient's right kidney had recovered well.CONCLUSION Despite insufficient operating space via the retroperitoneal approach,LPN for giant central renal AMLs can be completed using a well-designed procedure with the assistance of a robotic system.
文摘The kidney is affected in about 80-85% of tuberous sclerosis complex （TSC） patients. Renal manifestations in TSC patients include an increased incidence of epithelial cysts and tumors, such as multiple renal angiomyolipomas （AMLs）, renal cell carcinoma （RCC）, and oncocytoma. The coexistence of RCC and renal AML within same tumor masses, namely collision tumor, is very rare, and about six cases have been reported. Here, we present a case of a young male with TSC and multiple AMLs, containing RCC with eosinophilic morphology.
