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

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Enis Rauf Coskuner ◽  
Burak Ozkan ◽  
Veli Yalcin
Keyword(s):  
Partial Nephrectomy ◽  
Frozen Section ◽  
Vena Cava ◽  
Young Patients ◽  
Surgical Margin ◽  
Arterial Embolization ◽  
Benign Neoplasm ◽  
Renal Angiomyolipoma ◽  
Increased Risk

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.

scholarly journals Combination of Superselective Arterial Embolization and Radiofrequency Ablation for the Treatment of a Giant Renal Angiomyolipoma Complicated with Caval Thrombus

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Konstantinos N. Stamatiou ◽  
Hippocrates Moschouris ◽  
Kiriaki Marmaridou ◽  
Michail Kiltenis ◽  
Konstantinos Kladis-Kalentzis ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Transarterial Embolization ◽  
Vena Cava ◽  
Arterial Embolization ◽  
Maximum Diameter ◽  
Renal Angiomyolipoma ◽  
Efficient Treatment ◽  
Extrinsic Compression

This is a case of a 78-year-old male patient with multiple angiomyolipomas of a solitary right kidney. The largest of these tumors (maximum diameter: 13.4 cm) caused significant extrinsic compression of the inferior vena cava complicated by thrombosis of this vessel. Treatment of thrombosis with anticoagulants had been ineffective and the patient had experienced a bleeding episode from the largest right renal angiomyolipoma, which had been treated by transarterial embolization in another institution, 4 months prior to our intervention. Our approach included superselective transarterial embolization of the dominant, right kidney angiomyolipoma with hydrogel microspheres, which was combined, 20 days later, with ultrasonographically guided radiofrequency ablation. Both interventions were uneventful. Computed tomography 2 months after ablation showed a 53% reduction in tumor volume, reduced space-occupying effect on inferior vena cava, and resolution of caval thrombus. Nine months after intervention the patient has had no recurrence of thrombosis or hemorrhage and no tumor regrowth has been observed. The combination of superselective transarterial embolization and radiofrequency ablation seems to be a feasible, safe, and efficient treatment of large renal angiomyolipomas.

scholarly journals Partial Nephrectomy for a Massive Sporadic Renal Angiomyolipoma: Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Jacob Albersheim-Carter ◽  
Molly Klein ◽  
Paari Murugan ◽  
Christopher J. Weight
Keyword(s):  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Arterial Embolization ◽  
Hemodynamic Instability ◽  
Renal Angiomyolipoma ◽  
Management Options ◽  
Retroperitoneal Hemorrhage ◽  
Common Benign Tumor ◽  
Renal Artery Embolization ◽  
Segmental Renal Artery

Introduction.Angiomyolipomas are the most common benign tumor of the kidney, associated with Tuberous Sclerosis in 20% of cases and arising sporadically in 80% of cases. Renal angiomyolipomas are neoplasms of mesenchymal origin with varying proportions of vasculature, smooth muscle spindle cells, and adipocytes, making management of such neoplasms a challenging endeavor. Possible management options include partial or radical nephrectomy and segmental renal artery embolization.Case Presentation.A 61-year-old woman admitted for a large retroperitoneal hemorrhage was discovered to have a giant, sporadic, 3818.3 g, 30.0 × 26.5 × 18.0 cm left perinephric angiomyolipoma. Given her hemodynamic instability upon presentation, she underwent segmental arterial embolization, followed by an open left partial nephrectomy. Ten-month follow-up revealed no noticeable loss of renal function.Discussion.Literature review revealed occasional renal angiomyolipomas of comparable size, with all angiomyolipomas larger than this requiring treatment with radical nephrectomy.Conclusion.We show that nephron-sparing surgery may be considered in the treatment of even the largest of renal angiomyolipomas.

Conventional vascular risk factors: Their role in the association between migraine and cardiovascular diseases

Cephalalgia ◽  
2014 ◽  
Vol 35 (2) ◽  
pp. 146-164 ◽  
Author(s):  
Simona Sacco ◽  
Francesca Pistoia ◽  
Diana Degan ◽  
Antonio Carolei
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Young Patients ◽  
Vascular Risk Factors ◽  
The Body ◽  
Final Conclusion ◽  
Vascular Risk ◽  
Multiple Sources ◽  
Increased Risk

Introduction Migraine, in particular migraine with aura, has been found to be associated with cardiovascular disease. However, the role of conventional vascular risk factors in the association is still debated. The aim of the present review is to address the association between migraine and conventional cardiovascular risk factors as well as to address their possible role in the association between migraine and cardiovascular disease. Methods Data for this review were obtained through searches in multiple sources up to May 2014 using the terms “migraine” OR “headache” in combination with all the vascular risk factors of interest. Results Data about the possible association between migraine and high blood pressure values are heterogeneous, hindering any final conclusion. Data addressing the possible association between migraine and diabetes mellitus indicate the lack of any association or in some cases a negative association between the two conditions. The body of evidence on the role of dyslipidemia in migraineurs is relatively homogeneous and, with few exceptions, reports an association between migraine and an unfavorable lipid profile; however, the difference in lipid levels between migraineurs and non-migraineurs is small and its clinical implication unclear. Regarding obesity, a trend has been observed of increased risk of migraine with increasing obesity, especially in young patients, albeit in the midst of conflicting data. Evidence about the association between cigarette smoking and migraine mostly indicates that migraineurs are more commonly smokers than non-migraineurs. On the other hand, the majority of the available studies report less alcohol use in migraineurs than in non-migraineurs. Finally, many of the available studies suggest a more frequent family history of cardiovascular disease in migraineurs as compared to non-migraineurs. Since most of the studies that supported the association between migraine and cardiovascular disease adjusted the analyses for the presence of several vascular risk factors, they cannot entirely explain this association. Conclusions Based on the available reported data, it seems unlikely that the higher risk of cardiovascular disease in migraineurs is mediated by any single vascular risk factor. For this reason the role of specific interactions among risk factors with the contribution of genetic, environmental, personality and psychological factors should be appropriately investigated.

scholarly journals Bilateral Deep Vein Thrombosis Associated with Inferior Vena Cava Agenesis in a Young Patient Manifesting as Low Back Pain

2017 ◽  
Vol 30 (4) ◽  
pp. 333 ◽  
Author(s):  
Felipe Langer ◽  
Daiane Dos Santos ◽  
Gustavo Suertegaray ◽  
Carlos Jesus Pereira Haygert
Keyword(s):  
Inferior Vena Cava ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Young Patients ◽  
Young Male ◽  
Vascular Anomaly ◽  
Lower Limbs ◽  
Increased Risk

Congenital absence of the inferior vena cava is a rare vascular anomaly, and most cases are asymptomatic. Nevertheless, patients with inferior vena cava malformations may have increased risk of deep venous thrombosis. Particularly, cases of bilateral deep venous thrombosis may arise owing to an insufficient collateral venous drainage from the lower limbs. We hereby describe a case of a previously healthy young male patient presenting with bilateral lower limb deep venous thrombosis as the initial clinical manifestation of congenital inferior vena cava agenesis. We conclude that in young patients presenting with deep venous thrombosis, especially when thrombosis occurs spontaneously, bilaterally, or recurrently, inferior vena cava anomalies should be thoroughly investigated and ruled out as appropriate.

scholarly journals Spontaneous Retroperitoneal Hemorrhage (Wunderlich Syndrome) due to Large Upper Pole Renal Angiomyolipoma: Does Robotic-Assisted Laparoscopic Partial Nephrectomy Have a Role in Primary Treatment?

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Achilles Ploumidis ◽  
Ioannis Katafigiotis ◽  
Maria Thanou ◽  
Nikos Bodozoglou ◽  
Labros Athanasiou ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Arterial Embolization ◽  
Primary Treatment ◽  
Young Female ◽  
Minimal Invasive ◽  
Laparoscopic Partial Nephrectomy ◽  
Renal Angiomyolipoma ◽  
Retroperitoneal Hemorrhage ◽  
Robotic Assisted ◽  
Elective Setting

Spontaneous rapture with consequent retroperitoneal hemorrhage (Wunderlich’s syndrome) is the complication mostly feared from large renal angiomyolipomas (RAMLs). In hemodynamic stable patients, minimal invasive therapies have superseded open surgery as the mainstay of treatment, with contemporary cases mostly treated by selective arterial embolization. Robotic-assisted laparoscopic partial nephrectomy (RALPN) is an established minimal access treatment that has been used in the past for benign and malignant lesions of the kidney in the elective setting, but rarely in urgent situations as primary treatment. We present a case of a ruptured RAML in a young female treated effectively by RALPN.

Surgeons’ preferences and practice patterns regarding intra-operative frozen section during partial nephrectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 436-436
Author(s):  
Abhinav Sidana ◽  
James Donovan ◽  
Krishnanath Gaitonde
Keyword(s):  
Partial Nephrectomy ◽  
Practice Patterns ◽  
Frozen Section ◽  
Multivariate Logistic Regression Analysis ◽  
Surgical Margin ◽  
Urologic Oncology ◽  
Additional Specimen ◽  
Open Partial Nephrectomy ◽  
Positive Margins ◽  
Tumor Bed

436 Background: Intra−operative frozen section (FS) evaluation for tumor margin during partial nephrectomy (PN) is a matter of controversy in urologic oncology. We evaluate the preferences and practice patterns of urologists regarding intra−operative FS during PN. Methods: A 17 item questionnaire was designed to collect information on surgeons’ preferences and practice patterns regarding FS during PN. The survey was sent to the members of the Society of Urologic Oncology and the Endourological Society. Univariate and multivariate logistic regression analysis was done to identify the predictors determining the preferences. Results: 197 responses were received. 69% and 58% of respondents chose to obtain FS (always or sometimes) during Open Partial Nephrectomy (OPN) and Laparoscopic Partial Nephrectomy (LPN) respectively. There was a strong correlation between surgeons’ preferences during OPN and LPN. Younger surgeons are less likely to obtain FS during OPN (p<0.05). For surgeons who did not routinely obtain FS, “confidence about complete resection” was the most common reason (79%), followed by “no change in management with positive margins” (35%). Majority (75%) believed the margins to be negative if surgical margin was free of tumor microscopically by one cell layer. Older surgeons considered negative margins to be free of tumor microscopically by >= 5mm. Surgeons who performed more than 25 PNs annually were less likely to fulgurate the tumor bed after resection (p=0.025) while more likely to send an additional specimen from tumor bed for FS analysis (p=0.007). 54% and 42% of respondents would repeat FS for positive microscopic margins during OPN and LPN respectively. 95% of the respondents would not recommend additional treatment for positive margins on final pathology. Conclusions: Despite recent literature pointing to low clinical utility of intraoperative FS analysis, more than half of the surgeons still opt for intraoperative FS. Surgeon’s age and volume influence preferences and practice pattern in regards to FS analysis to some extent. Fellowship training, surgical approach and region of practice do not appear to dictate a surgeon’s preferences in regards to intra-operative FS during PN.

scholarly journals Sporadic multiple renal angiomyolipoma with lymph node involvement: a case report and literature review

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052110017
Author(s):  
Xiaobo Ding ◽  
Meizi Cui ◽  
Tiejun Wang ◽  
Helei Wang ◽  
Xinyu Wang ◽  
...  
Keyword(s):  
Lymph Node ◽  
Tuberous Sclerosis ◽  
Partial Nephrectomy ◽  
Tuberous Sclerosis Complex ◽  
Radical Nephrectomy ◽  
Vena Cava ◽  
Clinical Manifestations ◽  
Lymph Node Involvement ◽  
Renal Angiomyolipoma ◽  
Node Involvement

Angiomyolipoma (AML) is a benign tumor that mainly occurs in the kidneys. Simultaneous involvement of the kidney and local regional lymph nodes is very rare and might be misdiagnosed as a metastasizing malignant cancer. In the present study, a 50-year-old woman was referred to our hospital after a routine health screening ultrasound. Sporadic multiple renal AML with lymph node involvement was suspected based on the clinical manifestations and radiologic features. Partial nephrectomy was performed and a para-inferior vena cava lymph node was removed. The pathologic results confirmed multiple AML with lymph node invasion. We also reviewed the English-language literature regarding renal AML with lymph node involvement. We found that middle-aged women were likely to develop this disease and that loin pain was the main presenting feature. Most patients had no history of tuberous sclerosis complex. Radical nephrectomy was the predominant treatment. No local recurrence or distant metastasis occurred in any patients after radical nephrectomy or partial nephrectomy. In conclusion, renal AML with lymph node involvement is rare but can occur in both patients with tuberous sclerosis complex and those with multiple sporadic AML. Partial nephrectomy should be the first-line treatment, after which further treatment is not necessary.

scholarly journals Selective Arterial Embolization for Renal Angiomyolipoma Treating: The Role of Pain

2011 ◽  
Vol 41 (1) ◽  
pp. 134 ◽  
Author(s):  
T. Cai ◽  
U. Rozzanigo ◽  
D. Tiscione ◽  
P. Dalla Palma ◽  
G. Malossini
Keyword(s):  
Arterial Embolization ◽  
Renal Angiomyolipoma ◽  
Selective Arterial Embolization
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