Takeyama M, Doi Y, Matsui T, Fujioka H, Takaha M
Department of Urology, Osaka Central Hospital.
Hinyokika Kiyo. 1988 Jan;34(1):155-8.
A 25-year-old female was admitted for further investigation of the right renal mass, which was noted during evaluation for hepatitis. She had no personal or family history of stigmas of tuberous sclerosis. On physical examination, a movable hard smooth mass of fist size was palpable in the right abdomen. Drip infusion pyelography revealed an elevation of right kidney. Ultrasonography revealed that the abdominal mass had a high amplitude echo area. On CT the mass was heterogeneous with irregular margin and had regions of low attenuation value, suspicious of a tumor with high fat content. An angiogram of the right renal artery revealed a hypervascular tumor showing multiple saccular aneurysms, and absence of arteriovenous shunting. Based on the aforementioned findings, the mass was diagnosed as renal angiomyolipoma. Partial right nephrectomy was performed through an extraperitoneal approach. Pathological diagnosis was a renal angiomyolipoma. Convalescence was uneventful, and the remaining parenchyma of right kidney was working well on drip infusion pyelography three months after operation. The management of renal angiomyolipoma from the conservative point of view is also discussed.
一名25岁女性因在评估肝炎时发现右肾肿物而入院进一步检查。她没有结节性硬化症的个人或家族病史。体格检查时,在右腹部可触及一个拳头大小、可活动、质地硬且表面光滑的肿物。静脉肾盂造影显示右肾抬高。超声检查显示腹部肿物有高回声区。CT检查显示该肿物密度不均匀,边缘不规则,有低密度区,怀疑是脂肪含量高的肿瘤。右肾动脉血管造影显示一个血管丰富的肿瘤,有多个囊状动脉瘤,无动静脉分流。基于上述发现,该肿物被诊断为肾血管平滑肌脂肪瘤。通过腹膜外途径进行了右肾部分切除术。病理诊断为肾血管平滑肌脂肪瘤。术后恢复顺利,术后三个月静脉肾盂造影显示右肾剩余实质功能良好。同时也从保守角度讨论了肾血管平滑肌脂肪瘤的治疗。