Embolization of symptomatic renal angiomyolipoma with a mixture of lipiodol and PVA, a mid-term result

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.

Anesthetics management of a renal angiomyolipoma using pulse pressure variation and non-invasive cardiac output monitoring: A case report

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.

Renal Angiomyolipoma：Diagnosis with B－ultrasonography，CT Scanning，DSA and Its Interventional Treatment

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.

Successful robot-assisted partial nephrectomy for giant renal hilum angiomyolipoma through the retroperitoneal approach: A case report

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.

Value of Apparent Diffusion Coefficient(ADC) of Diffusion eighted Magnetic Resonance Imaging in Common Renal Disease Diagnosis

Objective：To find the value of the apparent diffusion coefficient （ADC） of diffusion weighted magnetic resonance imaging of common renal diseases. Methods： There were 30 healthy subjects and 81 patients with renal lesions （56 cases of renal carcinoma, 18 lesions of 12 cases of renal angiomyolipomal and 21 lesions of 13 cases of renal cysts）. Conventional magnetic resonance imaging and diffusion weighted magnetic resonance imaging were carried out. We measured the average ADC value of the renal lesions and normal kidneys. ADC maps from different b values were generated by a statistical package. Results： The ADC values of normal kidneys with three different motion-probing gradients（b=500, 800, 1000 sec/mm^2） were 2.78 ± 0.14 × 10^-3mm^2s^-1, 2.45 ± 0.13 × 10^3mm^2s^-1, 2.13 ± 0.14 × 10^-3mm^2s^-1, respectively. The ADC values of renal cell carcinoma with three different motion-probing gradients（b=500, 800, 1000 sec/mm^2） were 1.63 ± 0.14 × 10^3mm^2s^-1, 1.31 ± 0.18 × 10^3mm^2s^-, 1.07 ± 0.15 × 10^-3mm^2s^-1, respectively. Among the renal cell carcinoma, the ADC value of clear cell type were 1.67 ± 0.09 × 10^3mm^2s^-1, 1.36 ± 0.13 × 10^3mm^2s^-1, 1.15 ± 0.14 × 10^3mm^2s^-1,respectively; the ADC values of granular cell type were 1.59±0.19 × 10^3mm^2s^-1, 1.25 ± 0.22 × 10^3mm^2s^-1, 0.97 ± 0.12 × 10^3mm^2s^-1, respectively. The ADC values of renal angiomyolipoma with three different motion-probing gradients（b=500, 800,1000 sec/mm^2） were 0.88 ± 0.08 × 10^3mm^2s^-1, 0.63 ± 0.07 × 10^3mm^2s^-1, 0.43 ± 0.04 × 10^3mm^2s^-1, respectively. The ADC values of renal cystic lesions with three different motionprobing gradients（b=500, 800, 1000 sec/mm^2） were 3.73 ± 0.18 × 10^3mm^2s^-1, 3.44 ± 0.13 × 10^3mm^2s^-1, 3.09± 0.21 × 10^3mm^2s^-1, respectively. Statistically significant differences exists between the ADC values of normal kidney, renal carcinomas, renal angiomyolipomas and renal cysts when the b value is the same. Among the different cell types of renal carcinomas, the ADC value of granular cell carcinoma is lower than that of clear cell carcinomas. Conclusion： It is of benefit in diagnosing and distinguishing between benign and malignant renal tumors to know the ADC values in diffusion weighted magnetic resonance imaging. Furthermore, these values help to know the internal structure of the tumor and the tumor typel, which is helpful to the treatment and in predicting the patient＇ s prognosis.

Fat Poor Renal Angiomyolipoma Showing Collapsed Shape: A Case Report

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.

Resection of a giant renal angiomyolipoma in a solitary kidney with preoperative arterial embolization

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.

Giant renal angiomyolipoma with tuberous sclerosis complex

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.