Renal Angiomyolipomas with Inferior Vena cava invasion
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SURGERY
Renal Angiomyolipomas with Inferior Vena cava invasion Maher Abdessater 1
&
Anthony Kanbar 1 & Pietro Kheir 2
Accepted: 11 October 2020 # Springer Nature Switzerland AG 2020
Abstract Angiomyolipomas are benign tumors that can occur in the kidneys. Though venous invasion is a common complication of renal cell carcinoma, it rarely occurs with angiomyolipoma given its benign nature. We aim by this article to conduct an extensive literature review documenting rare cases of angiomyolipomas with venous extension, particularly with inferior vena cava invasion. The literature review was conducted following PRISMA checklist, using PubMed searching for English and nonEnglish articles up to January 2020, and Mesh terms: angiomyolipoma, inferior vena cava, vein. Only cases reporting patients with angiomyolipomas with venous extension were included. Data extraction of different patients’ parameters was conducted by two independent researchers in a uniform manner to a detailed datasheet. The search ended up with 90 cases, after excluding 116 cases for multiple reasons. Venous invasion of angiomyolipoma is a rare phenomenon. Clinical presentation is similar to any other renal tumor. Imaging is primordial for diagnosis and classification. Surgery is indicated as soon as venous involvement is demonstrated. In most cases, the prognosis is favorable with low morbidity and mortality. Keywords Renal angiomyolipoma . Venous thrombus . Inferior vena cava thrombus
Introduction Angiomyolipoma (AML) is a benign tumor that can occur in several sites of the body, including the kidney. First described in 1911 by Fischer et al. [1], renal AML is the most common benign solid renal lesion, occurring more frequently in women with a ratio of 1:22 [2]. Renal AML is sporadic in 80% of cases, presenting at a mean age of 52 with usually a unique lesion. In the remaining 20%, it occurs in the context of tuberous sclerosis complex (TSC) and less frequently with other phacomatoses, polycystic kidney disease, and pulmonary lymphangiomyomatosis [3]. The average tumor size at the
This article is part of the Topical Collection on Surgery Electronic supplementary material The online version of this article (https://doi.org/10.1007/s42399-020-00586-5) contains supplementary material, which is available to authorized users. * Maher Abdessater [email protected] 1
Department of Urology And Renal Transplantation, La Pitié Salpétrière University Hospital, Paris, France
2
Department of Cardiovascular Surgery, La Pitié Salpétrière University Hospital, Paris, France
time of diagnosis is 5.4 cm in patients with sporadic AML, 8.9 cm in patients with TSC [4]. Renal AMLs are discovered incidentally in 41% of cases or may exhibit symptoms. Symptoms result from tumor growth, usually presenting as the classical triad of kidney neoplasms such as flank pain (41%), hematuria (11%), and abdominal mass (11%), alongside a multitude of non-specific symptoms [5]. A presumptive radiological diagnosis is poorly made on ultrasound, although a better diagnosis
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