Contemporary Minimally Invasive Treatment Options for Renal Angiomyolipomas
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MINIMALLY INVASIVE SURGERY (V BIRD, SECTION EDITOR)
Contemporary Minimally Invasive Treatment Options for Renal Angiomyolipomas Sri Sivalingam & Stephen Y. Nakada Published online: 3 February 2013 # Springer Science+Business Media New York 2013
Abstract Renal angiomyolipomas (AMLs) are benign renal masses that are often asymptomatic and detected incidentally. However, treatment might be necessary in symptomatic presentations or when the mass exceeds 4 cm in size. While the goal of management for renal AMLs is to relieve symptoms and prevent hemorrhage, a priority is renal function preservation, especially given the propensity of these lesions to recur. The traditional treatment for renal AMLs is renal angioembolization or surgical excision of the lesion. With advancements in minimally invasive surgery, several other modalities have now emerged for nephron sparing approaches. These include angioembolization, laparoscopic and percutaneous ablative therapies such as radiofrequency ablation, cryoablation and microwave ablation, and pure or robot-assisted laparoscopic partial nephrectomy. Given the relatively low frequency of renal AMLs requiring treatment, much of the available literature on these minimally invasive approaches is largely extrapolative, based on series on small renal masses, i.e. renal cell carcinoma (RCC). This report is based on a thorough review of the published literature to date on the minimally invasive treatment and outcomes of renal AMLs. Keywords Angiomyolipoma . Radiofrequency ablation . Microwave . Cryoablation . Angioembolization . Partial nephrectomy
Introduction Renal angiomyolipomas (AMLs) are benign masses of the kidney that were originally described in 1900 by Grawitz as large renal tumors composed of fat, muscle and blood vessels. They are of mesenchymal origin and contain mature adipose tissue, dysmorphic blood vessels and smooth muscle. The majority of renal AMLs are of sporadic origin, while S. Sivalingam : S. Y. Nakada (*) University of Wisconsin-Madison, Madison, WI, USA e-mail: [email protected]
approximately 10 % are associated with the tuberous sclerosis syndrome (TSS). A smaller proportion of AMLs also occur in the lymphangioleiomyomatosis syndrome complex. AMLs associated with TSS are multifocal and bilateral [1] and tend to exhibit a faster growth rate; therefore, TSS-associated AMLs manifest with symptoms more frequently, and recur more often after treatment. As reviewed by Nelson et al., AMLs in patients with TSS tends to present earlier, with larger tumors of greater multiplicity and with hemorrhage more frequent than the sporadic type [2]. Longitudinal studies suggest that while both sporadic and TSS-associated AMLs can enlarge significantly over time, the latter tumors are much more likely to exhibit such growth. The majority of renal AMLs are found incidentally during the workup of unrelated symptoms, and the increased use of cross sectional imaging has led to a rise in the diagnosis of these lesions [3]. A recent review suggests that about 59 % of patients wit
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