The management strategy of renal angiomyolipoma.

The purpose of this study is to analyze the management strategy of renal angiomyolipoma. From 1990 to 2002, a total of 62 patients with renal angiomyolipoma were treated at our medical center. Angiomyolipomas were found in 44 female patients (71.0%) and 18 male patients. Of these patients the age ranged from 18 to 87 y/o (mean: 46.9 y/o). Four of 8 patients with bilateral angiomyolipomas were associated with tuberous sclerosis (TS). Nine (14.5%) of 62 patients had got spontaneous rupture. However, 54.8 per cent of patients were asymptomatic. The mean tumor size was 4.83 cm. Tumors larger than 4 cm had a greater incidence of symptoms (60.7%) and a higher nephrectomy rate (43%). Clinical management was based on tumor size and clinical presentation. Treatment consisted of conservative observation in 30 patients (group 1, 48.4%), selective embolization therapy in 2 patients with hemorrhage (group 2, 3.2%), partial nephrectomy and other surgical procedures in 14 patients (group 3, 22.6%), and total nephrectomy in 16 patients (group 4, 25.8%). Nine of 62 patients were associated with spontaneous angiomyolipoma rupture under conservative treatment in 3, TAE in 1, partial nephrectomy in 1, total nephrectomy in 3 and laparotomy to check bleeding in 1. Neither mortality no major complication was noted. Generally the outcomes were smooth and acceptable. Beyond the total nephrectomy for patients with highly suspected malignancy, we suggest conservative treatment with observation strategy for small asymptomatic tumors, selective arterial embolization as the first choice for hemorrhage or rupture and partial nephrectomy for renal sparing strategy.