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Clinical Correlates of Renal Angiomyolipoma Subtypes in 209 Patients: Classic, Fat Poor, Tuberous Sclerosis Associated and Epithelioid

2008; Lippincott Williams & Wilkins; Volume: 180; Issue: 3 Linguagem: Inglês

10.1016/j.juro.2008.05.041

1527-3792

Brian R. Lane, Hakan Aydın, Teresa Danforth, Ming Zhou, Erick M. Remer, Andrew C. Novick, Steven C. Campbell,

Renal cell carcinoma treatment

No AccessJournal of UrologyAdult Urology1 Sep 2008Clinical Correlates of Renal Angiomyolipoma Subtypes in 209 Patients: Classic, Fat Poor, Tuberous Sclerosis Associated and Epithelioid Brian R. Lane, Hakan Aydin, Teresa L. Danforth, Ming Zhou, Erick M. Remer, Andrew C. Novick, and Steven C. Campbell Brian R. LaneBrian R. Lane Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Hakan AydinHakan Aydin Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio , Teresa L. DanforthTeresa L. Danforth Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , Ming ZhouMing Zhou Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio , Erick M. RemerErick M. Remer Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Imaging Institute, Cleveland Clinic, Cleveland, Ohio , Andrew C. NovickAndrew C. Novick Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio , and Steven C. CampbellSteven C. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio View All Author Informationhttps://doi.org/10.1016/j.juro.2008.05.041AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Angiomyolipomas classically present radiographically as fat containing lesions but some fail to demonstrate fat content. Histologically confirmed angiomyolipomas uniformly follow a benign course but rare epithelioid variants of angiomyolipoma can recur and metastasize. We investigated the clinical, radiographic and histological characteristics of each angiomyolipoma subtype. Materials and Methods: Pertinent data were recorded for 209 patients surgically treated for angiomyolipoma in 219 kidneys from 1981 to 2007. Classic and fat poor angiomyolipomas were classified radiographically based on the presence or absence of fat and classified histologically based on the presence of triphasic, monophasic or epithelioid histology. Results: Median radiographic size was 3.2, 4.9 and 10 cm in patients with a single angiomyolipoma (59% of patients), multiple angiomyolipomas and tuberous sclerosis (probable or definite), respectively. In these 3 groups 65%, 47% and 33% of lesions were not suspected radiographically (fat poor angiomyolipoma). Fat poor angiomyolipomas were more commonly single, smaller and in older patients. Triphasic histology was evident in 76% of angiomyolipomas with 16% demonstrating a predominance of 1 component and 8% containing epithelioid features. Despite potentially aggressive findings in 18% (eg presence within the perinephric fat, lymph node involvement) no angiomyolipoma recurred during a mean followup of 3.4 years (range 0 to 24). A total of 28 (13%) patients with angiomyolipoma had concomitant renal cell carcinoma. Conclusions: A surprisingly high number of resected angiomyolipomas was not suspected radiographically indicating the importance of precise radiographic characterization to minimize nephrectomy for fat poor angiomyolipoma, which should remain a research priority. In this sizeable single institution series no triphasic, monophasic or epithelioid angiomyolipoma recurred despite potentially aggressive findings in a substantial proportion of cases. References 1 : Contemporary diagnosis and management of renal angiomyolipoma. J Urol2002; 168: 1315. Link, Google Scholar 2 : Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology1997; 205: 497. Google Scholar 3 : Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. Radiology2004; 230: 677. Google Scholar 4 : Imaging characteristics of minimal fat renal angiomyolipoma with histologic correlations. Urology2005; 66: 1155. Google Scholar 5 : Fat poor renal angiomyolipoma: patient, computerized tomography and histological findings. J Urol2006; 176: 905. Link, Google Scholar 6 : Differential expression of melanocytic markers in myoid, lipomatous, and vascular components of renal angiomyolipomas. Arch Pathol Lab Med2007; 131: 122. Google Scholar 7 : Malignant transformation of renal angiomyolipoma. J Urol1999; 161: 1900. Link, Google Scholar 8 : Atypical angiomyolipoma of the kidney: a distinct morphologic variant that is easily confused with a variety of malignant neoplasms. Cancer1998; 83: 1581. Google Scholar 9 : Malignant transformation of renal angiomyolipoma: a case report. Am J Surg Pathol2002; 26: 523. Google Scholar 10 : Controversies related to epithelioid variant of renal angiomyolipoma: a review of the literature. Urology2006; 67: 846. Google Scholar 11 : Tuberous sclerosis complex consensus conference: revised clinical diagnostic criteria. J Child Neurol1998; 13: 624. Google Scholar 12 : The management of renal angiomyolipoma. J Urol1986; 135: 1121. Link, Google Scholar 13 : Conservative management of giant symptomatic angiomyolipoma in patients with tuberous sclerosis complex. BJU Int2007; 100: 794. Google Scholar 14 : Renal angiomyolipoma: optimal treatment based on size and symptoms. Clin Nephrol1998; 49: 281. Google Scholar 15 : Incidence of benign pathologic findings at partial nephrectomy for solitary renal mass presumed to be renal cell carcinoma on preoperative imaging. Urology2006; 68: 737. Google Scholar 16 : Incidence of benign lesions for clinically localized renal masses smaller than 7 cm in radiological diameter: influence of sex. J Urol2006; 176: 2391. Link, Google Scholar 17 : A preoperative prognostic nomogram for solid enhancing renal tumors 7 cm or less amenable to partial nephrectomy. J Urol2007; 178: 429. Link, Google Scholar 18 : Diagnosis of angiomyolipoma using computed tomography-region of interest < or =−10 HU or 4 adjacent pixels < or =−10 HU are recommended as the diagnostic thresholds. Clin Radiol2006; 61: 410. Google Scholar 19 : CT histogram analysis: differentiation of angiomyolipoma without visible fat from renal cell carcinoma at CT imaging. Radiology2008; 246: 472. Google Scholar 20 : Renal mass biopsy: a renaissance?. J Urol2007; 179: 20. Google Scholar 21 : Characterization of t(6;11)(p21;q12) in a renal-cell carcinoma of an adult patient. Genes Chromosomes Cancer2007; 46: 419. Google Scholar 22 : Hereditary kidney cancer. Urol Clin North Am2003; 30: 831. Google Scholar 23 : Concurrent angiomyolipoma and renal cell neoplasia: a study of 36 cases. Mod Pathol2001; 14: 157. Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByLaguna M (2018) Re: Natural History of Renal Angiomyolipoma (AML): Most Patients with Large AMLs >4cm can be Offered Active Surveillance as an Initial Management StrategyJournal of Urology, VOL. 196, NO. 5, (1397-1398), Online publication date: 1-Nov-2016.Laguna M (2018) Re: Everolimus for Angiomyolipoma Associated with Tuberous Sclerosis Complex or Sporadic Lymphangioleiomyomatosis (EXIST-2): A Multicentre, Randomised, Double-Blind, Placebo-Controlled TrialJournal of Urology, VOL. 191, NO. 3, (626-627), Online publication date: 1-Mar-2014. Volume 180Issue 3September 2008Page: 836-843 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordstuberous sclerosisangiomyolipomakidney neoplasmspathologyAcknowledgmentsAdrian Hernandez assisted with statistical considerations.MetricsAuthor Information Brian R. Lane Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Hakan Aydin Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Teresa L. Danforth Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Ming Zhou Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Erick M. Remer Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Imaging Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Andrew C. Novick Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Nothing to disclose. More articles by this author Steven C. Campbell Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio Financial interest and/or other relationship with Aventis Pharmaceuticals, Pfizer and Novartis Pharmaceuticals. More articles by this author Expand All Advertisement PDF DownloadLoading ...