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Indian Journal of Surgery, Vol. 67, No. 6, November-December, 2005, pp. 342 Letter To Editor Renal angimyolipoma is nephrectony an obsolete procedure Kadian YS, Singla S, Sharma U Department of General Surgery, Pt. B. D. Sharma PGIMS, Rohtak-12400, Haryana, India Correspondence Address:Yogender Singh Kadian, 9/6 J Medical Enclave, PGIMS, Rohtak-124001, Haryana, India. E-mail: drums02@rediffmail.com Code Number: is05104 Sir, Angiomyolipoma is a rare benign neoplasm composed of varying amounts of adipose, smooth muscle and thick walled blood vessels.[1] It may be sporadic or associated with tuberous sclerosis. Until the advent of Computerized Tomography and MRI scan the standard treatment of angiomyolipoma was radical nephrectomy to rule out renal cell carcinoma and to prevent fatality from sudden massive bleeding.[2] In recent times conservative management of angiomyolipoma has been suggested considering its benign nature. Recommended protocol of treatment today includes observation for small and asymptomatic tumors and embolisation or nephron-sparing surgery for large and symptomatic tumors. Total nephrectomy may be required for large size tumors or if bleeding is not controlled with embolisation. We managed a case of sporadic renal angiomyolipoma in a 30-year-old female by nephrectomy. She presented with gross hematuria of 3 months duration. Ultrasonography of abdomen revealed a mass of size 7.3 x 8.8 cms with faint calcifications and necrosis in upper pole of left kidney. Contrast enhanced CT scan confirmed the same size tumor in relation to upper and middle pole of left kidney showing necrotic areas and irregular patchy enhancement. Left nephrectomy was performed in view of large sized symptomatic tumor and lack of embolisation facilities. Histopathological examination was consistent with angiomyolipoma. Her post-operative period was uneventful and she is well after one year of follow up. Steiner et al[3] advised no intervention for tumors < 4 cms who are asymptomatic. Mildly symptomatic may still be followed up conservatively by annual ultrasonography with the caution for future complications. In contrast, patients with tumors > 4 cms who have severe symptoms i.e. bleeding or uncontrolled pain should undergo nephron-sparing surgery or renal arterial embolisation. After analyzing the patient outcome in Steiner's series, it has been seen that total nephrectomy had to be done in 38.4 % of the cases with tumour size > 4 cms, meaning thereby total nephrectomy still remains as one of the treatment options in a significant number of cases. We want to stress the role of nephrectomy in a large size severely symptomatic angiomyolipomas as a life saving procedure. Nephrectomy may be required when expertise for nephron sparing surgery or therapeutic embolisation are not in hand. Sometimes, embolisation may not successfully control the bleeding, necessitating nephrectomy. Nephrectomy may also be required when not much of normal nephrons are left in a large sized tumor as in the present case. Hence, nephrectomy is still being performed in a large number of cases. References
Copyright 2005 - Indian Journal of Surgery |
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