Management of renal angiomyolipoma: a report of 53 cases

Objective To evaluate the clinical, therapeutic and prognostic aspects of r enal angiomyolipoma (AML) in patients either monitored by clinical and radi ological follow-up or treated by surgical therapy. Patients and methods Fifty-three patients with renal AML were divided in tw o groups; 33 patients in group I were monitored by annual clinical and ultr asonographic follow-up and 20 in group 2 were treated with surgical therapy . Two patients had tuberous sclerosis (TS) with synchronous bilateral and m ultiple lesions. Apart from the patients with TS, there were 38 lesions in group I and 25 in group 2. The mean (range) follow-up of group 1 was 60.2 ( 12-164) months. Results In group 1, the diagnosis was most often incidental, after ultrason ography performed for symptoms unrelated to RML. In group 2, the suspicion of a malignant renal lesion, and spontaneous tumour rupture with bleeding a nd perirenal haematoma, were the main indications for surgical treatment, T he mean lesion diameter was significantly greater in group 2 (5.4 cm) and i n symptomatic patients (8.1 cm). In group 1, 92% of renal AMLs showed no ra diographic changes, serious complications or new renal or extrarenal lesion s during the follow-up. Only three lesions grew, after 22, 85 and 164 month s, respectively, Of the 20 patients in group 2, 14 underwent conservative s urgery, Conclusion Small (< 4 cm) isolated AMLs, detected inci dentally, showed a l ow risk of developing during long-term follow-up. Such patients may be foll owed conservatively by ultrasonography every 2 years. Spontaneous perinephr ic haemorrhage is related to the size of the lesion. When surgery is indica ted (by symptoms or diagnostic doubt), a conservative procedure can be perf ormed in most of cases.