Document Detail


Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated.
MedLine Citation:
PMID:  19493268     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To examine the presentation, management and outcomes of patients with renal angiomyolipoma (AML) over a period of 10 years, at St George's Hospital, London, UK. PATIENTS AND METHODS: We assessed retrospectively 102 patients (median follow-up 4 years) at our centre; 70 had tuberous sclerosis complex (TSC; median tumour size 3.5 cm) and the other 32 were sporadic (median tumour size 1.2 cm). Data were gathered from several sources, including radiology and clinical genetics databases. The 77 patients with stable disease were followed up with surveillance imaging, and 25 received interventions, some more than one. Indications for intervention included spontaneous life-threatening haemorrhage, large AML (10-20 cm), pain and visceral compressive symptoms. RESULTS: Selective arterial embolization (SAE) was performed in 19 patients; 10 received operative management and four had a radiofrequency ablation (RFA). SAE was effective in controlling haemorrhage from AMLs in the acute setting (six) but some patients required further intervention (four) and there was a significant complication rate. The reduction in tumour volume was only modest (28%). No complications occurred after surgery (median follow-up 5.5 years) or RFA (median follow-up 9 months). One patient was entered into a trial and treated with sirolimus (rapamycin). CONCLUSIONS: The management of AML is both complex and challenging, especially in those with TSC, where tumours are usually larger and multiple. Although SAE was effective at controlling haemorrhage in the acute setting it was deemed to be of limited value in the longer term management of these tumours. Thus novel techniques such as focused ablation and pharmacological therapies including the use of anti-angiogenic molecules and mTOR inhibitors, which might prove to be safer and equally effective, should be further explored.
Authors:
Prasanna Sooriakumaran; Philippa Gibbs; Geoffrey Coughlin; Virginia Attard; Frances Elmslie; Christopher Kingswood; Jeremy Taylor; Cathy Corbishley; Uday Patel; Christopher Anderson
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Publication Detail:
Type:  Journal Article     Date:  2009-06-02
Journal Detail:
Title:  BJU international     Volume:  105     ISSN:  1464-410X     ISO Abbreviation:  BJU Int.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-05     Completed Date:  2010-03-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886721     Medline TA:  BJU Int     Country:  England    
Other Details:
Languages:  eng     Pagination:  101-6     Citation Subset:  IM    
Affiliation:
Department of Urology, St George's Hospital, London, UK. sooriakumaran@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Angiomyolipoma / complications,  therapy*
Catheter Ablation / methods*
Embolization, Therapeutic / methods*
Forecasting
Humans
Kidney Neoplasms / complications,  therapy*
Nephrectomy / methods*
Retrospective Studies
Treatment Outcome
Tuberous Sclerosis / complications,  therapy*
Young Adult

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