Repeated selective arterial embolization without surgical resection in the management of a giant sporadic renal angiomyolipoma in a female patient of childbearing age – A Case Report

Foo Chek Hao, Pandiyan Pannirselvam, Park Joon Jae*, Ng Foo Cheong and Ng Keng Sin

Introduction: Angiomyolipomas (AML) are the commonest benign renal tumors. Most are small and found incidentally, but some can reach sizes of >20cm (giant AMLs). Due to their risk of spontaneous hemorrhage, these giant AMLs are most commonly treated by surgical resection with or without preoperative Selective Arterial Embolization (SAE). To our knowledge, there have been no giant AML cases that were treated solely by SAE in the published English literature. 

Methods: We present a case of sporadic giant renal AML in a 26-year-old female patient solely treated with SAE. The patient initially presented with a painless right-sided abdominal mass. A Computed Tomography (CT) of the abdomen and pelvis found multiple bilateral renal AMLs, the largest of which measured 25.3×19.6×9.4 cm arising from the right interpolar region. Subsequent screening tests show no features to suggest the presence of tuberous sclerosis.

Result: A total of four cycles of SAE was performed using Lipiodol (ethiodized oil), absolute alcohol and polyvinyl alcohol particles over a period of 48 months. The patient experienced post-embolization syndrome which resolved with supportive treatment. At 80 months follow up, the largest AML in the right kidney had decrease in size from 25.3 to 13.9 cm. The patient was counselled about the increased risk of spontaneous rupture during any future pregnancy and has so far declined surgical resection of her AMLs. 

Conclusion: Multiple cycles of embolization have been shown to achieve a good response. SAE is a safe treatment modality and may be a viable nonsurgical option in the management of giant AMLs.

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Published on: Oct 28, 2020 Pages: 76-79

Full Text PDF Full Text HTML DOI: 10.17352/aur.000024
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