Discussion On Diagnosis And Management Of Renal Angiomyolipoma:Report Of 197 Cases

Objective:To improve the clinical diagnosis and treatment levels on renal angiomyolipoma (RAML) in clinical work.Materials and Methods:The clinical data of 197 patients with RAML admitted to the Department of Urology of Shandong Provincial Hospital from July 1996 to December 2015 were analyzed retrospectively. The clinical manifestations, imaging diagnosis, treatment and gross and microscopic pathology were compared and discussed. According to the tumor size and the clinical symptoms were determined renal tumor enucleation, partial nephrectomy, nephrectomy and tumor ablation and other relevant measures.Results:In the 197 patients,172 patients underwent B-ultrasound,171 patients computerized tomography(CT),23 patients underwent magnetic resonance imaging(MRI). Under these imaging examination, the final diagnosis rate call achieve 94%. Pathologic diagnosis to tissue speciments from 180 patients with operation were RAML,7 patients underwent embolization or ablation,6 of them were diagnosed as EAML. The result of immunohistochemistry:HMB45 (+) 100%, SMA (+) 100%, Melan-A (+) 100%, CK (-) 100%. Most of the AML without operation is less than 4 cm in diameter.Conclusion:Renal angiomyolipoma is a benign tumor of the kidney, non-specific clinical manifestations, more female patients than men, generally can be diagnosed through diagnostic imaging, CT or MRI detection of typical cases fat content can be diagnosed. Part of the atypical RAML can be invasive performance, or due to the lack of fat components, easy diagnosis of kidney cancer, the need to diagnose by pathological examination, the possibility of such cases to be considered in the clinical need to consider the RAML. RAML is a benign tumor, and the longer course, progress is slow, the need to choose a conservative or interventional, surgical treatment based on tumor size and the presence of clinical symptoms. The prognosis is good, no long-term follow-up frequently. For patients with TSC, due to multiple tumor, and progress is relatively faster, treatment should be relatively positive, to strengthen the follow-up. EAML is a malignant epithelioid AML variation, academia’s awareness of late, yet unified diagnostic criteria. Clinicians still shallow understanding of its larger clinical diagnosis difficulty, high misdiagnosis rate, conventional imaging diagnosis is difficult, even pathological diagnosis should also depend on immunohistochemistry results. Surgical treatment is the first choice, but the prognosis is poor, the mortality rate is high, and long-term close follow-up is needed. Due to its insensitive to chemotherapy, for patients surgery can not be performed, currently available mTOR inhibitors and other new targeted drug therapy, but at present still lack of long-term effectiveness and safety data.