28. Ulusal Üroloji Kongresi, Antalya, Türkiye, 10 - 13 Ekim 2019, ss.11-12
INTRODUCTION: Angiomyolipomas (AML) are hamartomatous lesions that are frequently detected in the kidney. It has a wide clinical spectrum ranging from a small incidentally detected renal mass to lymphovascular invasion or retroperitoneal hemorrhage. In this article, we present an incidental case with lymph node and inferior vena cava involvement.
CASE: A 55-year-old asymptomatic female patient presented to the urology outpatient clinic due to a renal mass suspected of having AML incidentally detected by ultrasound. The patient had no additional comorbidity other than rheumatoid arthritis. Patient's operation history included cesarean section and appendectomy. Patient's family history was unremarkable. According to the dynamic contrast-enhanced upper abdominal magnetic resonance imaging (MRI) taken in May 2016, a mass lesion of 2.5 cm in diameter in the right kidney was considered to have a properly defined AML. Subsequently, the patient was taken to clinical follow-up with annual imaging. The lesion size was reported as 43x25 mm in dynamic contrast-enhanced MRI in August 2017 and 40x20 mm in computed tomography (CT) in January 2018. During this period, no additional treatment was applied to the patient who had no complaints. In the routine control, dynamic contrast-enhanced MRI taken on 11.01.2019 identified a medullary AML lesion without any contrast enhancement in fat intensity of 60x50 mm in the widest part of the right renal middle- lower caliceal system.
In addition, the area of the fat intensity continuing from lesion to renal vein and inferior vena cava was reported as vein invasion.Then, on 23.01.2019, FDG-PET / CT showed a mass lesion that did not show FDG uptake in the right kidney and this lesion continued in the inferior vena cava in the 3.5 cm segment, in addition, multiple lymph nodes with minimal FDG involvement with a diameter of 1 cm in the mediastinum were detected (SUDmax: 4,2). The patient underwent 2 tru-cut biopsies on 31.01.2019 and 26.02.2019, and the pathology report was reported first as the renal parenchyma with normal cortex and medulla and the other as atypical lipomatous structure. During this period, the patient was followed up at the antother clinic. Urology council decided to follow up the patient, and the patient was referred to nephrology for everolimus treatment. On 16.07.2019, the patient had myocardial infarction and coronary stenting was performed in another clinic. The council was decided to obtain a cardiology opinion for the patient's everolimus treatment.
RESULT: Although angiomyolipomas are mostly benign in terms of histopathological and clinical course, if there is an increase in progressive growth in follow-up and no intervention is planned in these patients increases the likelihood of complications. Complications increase the necessity of additional surgery in these patients and the possibility of morbidity and mortality due to these surgeries.