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The Role of Partial Nephrectomy without Arterial Embolization in Giant Renal Angiomyolipoma.

Coskuner ER, Ozkan B, Yalcin V - Case Rep Med (2012)

Bottom Line: Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4-8 cm size.The patient underwent resection of the mass with a safety region of 1 cm.Postoperative 2nd day the drain was taken and hospital stay was 4 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Acibadem University School of Medicine, Acibadem Bakirkoy Hospital, Halit Ziya Usakligil Cad. No: 1, Bakirkoy, 34140 Istanbul, Turkey.

ABSTRACT
Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4-8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.

No MeSH data available.


Related in: MedlinePlus

MRI showing a right retroperitoneal mass.
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fig1: MRI showing a right retroperitoneal mass.

Mentions: A 26-year-old woman without the tuberous sclerosis complex (TSC) presented with abdominal fullness, right upper quadrant pain and constipation. On physical examination, a right upper quadrant mass was palpated bimanually. Computerized tomography of abdomen demonstrated a 24 cm size angiomyolipoma that was arising from the lower pole of the right kidney (Figure 1). The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. After peritoneal incision the mesocolon was reflected medially along the line of Toldt. Clear uninvolved plane was found between the mass and the vena cava and dissected. The renal artery and vein were occluded with a bulldog clamp. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free of surgical margin. The collecting system and renal defect were closed (Figure 2).


The Role of Partial Nephrectomy without Arterial Embolization in Giant Renal Angiomyolipoma.

Coskuner ER, Ozkan B, Yalcin V - Case Rep Med (2012)

MRI showing a right retroperitoneal mass.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3318900&req=5

fig1: MRI showing a right retroperitoneal mass.
Mentions: A 26-year-old woman without the tuberous sclerosis complex (TSC) presented with abdominal fullness, right upper quadrant pain and constipation. On physical examination, a right upper quadrant mass was palpated bimanually. Computerized tomography of abdomen demonstrated a 24 cm size angiomyolipoma that was arising from the lower pole of the right kidney (Figure 1). The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. After peritoneal incision the mesocolon was reflected medially along the line of Toldt. Clear uninvolved plane was found between the mass and the vena cava and dissected. The renal artery and vein were occluded with a bulldog clamp. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free of surgical margin. The collecting system and renal defect were closed (Figure 2).

Bottom Line: Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4-8 cm size.The patient underwent resection of the mass with a safety region of 1 cm.Postoperative 2nd day the drain was taken and hospital stay was 4 days.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Acibadem University School of Medicine, Acibadem Bakirkoy Hospital, Halit Ziya Usakligil Cad. No: 1, Bakirkoy, 34140 Istanbul, Turkey.

ABSTRACT
Angiomyolipoma is a benign neoplasm composed of varying admixtures of blood vessels, smooth muscle cells, and adipose tissue. Because of an increased risk of spontaneous haemorrhage, surgical approach is needed greater than 4-8 cm size. We here report our partial nephrectomy experience in the 24 cm size giant angiomyolipoma. 26-year-old woman referred to our clinic with a 24 cm size angiomyolipoma in her lower pole of right kidney. The inferior vena cava was deviated to the left by the mass. All the blood tests were normal and we offered her the choices of partial nephrectomy or nephrectomy. Right subcostal approach was used. The patient underwent resection of the mass with a safety region of 1 cm. Frozen section evaluation was consistent with angiomyolipoma and free for surgical margin. Warm ischemia time was 35 min. and intraoperative bleeding volume was 200 cc. Postoperative 2nd day the drain was taken and hospital stay was 4 days. In literature we observed very rare angiomyolipoma cases with such a large dimension treated by partial nephrectomy without arterial embolization. If technically suitable partial nephrectomy is the main chioce in this kind of benign lesions in young patients.

No MeSH data available.


Related in: MedlinePlus