Department of Urology, Peking University Third Hospital, Beijing 100191, China.
Department of Pathology, Peking University Third Hospital, Beijing 100191, China.
Medicina (Kaunas). 2024 Aug 10;60(8):1293. doi: 10.3390/medicina60081293.
Renal angiomyolipoma (AML) without local invasion is generally considered benign. However, it may extend to the renal sinus, even the renal vein, or the inferior vena cava (IVC). In patients with non-tuberous sclerosis complex, coexistence of renal cell carcinoma (RCC) and renal AML is uncommon. A 72-year-old woman was incidentally found to have a solitary right renal mass with an IVC thrombus extending into the right atrium during a routine health checkup. Robot-assisted laparoscopic radical nephrectomy and thrombectomy were successfully performed through adequate preoperative examination and preparation. Two tumor lesions were found and pathologically confirmed as renal AML and RCC, and the tumor thrombus was derived from the renal AML. During the one-year follow-up period, no signs of recurrence or metastatic disease were observed. Renal AML with a tumor thrombus in the IVC and right atrium accompanied by RCC may occur, although rarely. In clinical practice, if preoperative manifestations differ from those of common diseases, rare diseases must be considered to avoid missed diagnoses. In addition, adequate examination and multidisciplinary discussions before making a diagnosis are necessary. For a level 4 tumor thrombus with no infringement of the venous wall, adoption of robot-assisted minimally invasive surgery, without extracorporeal circulation technology, is feasible.
肾血管平滑肌脂肪瘤（AML）无局部侵犯一般被认为是良性的。然而，它可能延伸至肾窦，甚至肾静脉或下腔静脉（IVC）。在非结节性硬化症患者中，肾细胞癌（RCC）和肾 AML 共存并不常见。一位 72 岁女性在常规健康检查时偶然发现右侧孤立性肾肿块，IVC 血栓延伸至右心房。通过充分的术前检查和准备，成功实施了机器人辅助腹腔镜根治性肾切除术和血栓切除术。发现了两个肿瘤病变，并经病理证实为肾 AML 和 RCC，肿瘤血栓来源于肾 AML。在一年的随访期间，未观察到复发或转移疾病的迹象。尽管罕见，但可能会发生伴有 RCC 的 IVC 和右心房内肾 AML 肿瘤血栓。在临床实践中，如果术前表现与常见疾病不同，必须考虑罕见疾病以避免漏诊。此外，在做出诊断之前进行充分的检查和多学科讨论是必要的。对于无静脉壁侵犯的 4 级肿瘤血栓，采用机器人辅助微创手术，无需体外循环技术，是可行的。
