A Life-Threatening Case of Giant Bilateral Renal Angiomyolipoma: Insights and Treatment Approaches

Introduction: Renal angiomyolipoma (AML) is a rare tumor, with only 0.3% – 3% of cases occurring in the general population. While small AMLs can often be managed conservatively, giant bilateral cases pose significant health risks and demand immediate intervention. This case report explores the diagnosis and management of a 41-year-old male patient with giant bilateral AML, highlighting key treatment strategies and their implications.

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Key Findings:

• A 41-year-old male with tuberous sclerosis complex (TSC) and epilepsy presented with gross hematuria and hemorrhagic shock.
• A CT scan confirmed bilateral giant renal AMLs with a 4 cm right renal hematoma and multiple intra-tumoral aneurysms.
• Due to unavailability of angioembolization, the patient underwent an urgent right nephrectomy.
• The resected tumor weighed 6 kg, and histopathology confirmed AML.
• The patient was discharged after a stable recovery, with no recurrence of hematuria over two years of follow-up.

Understanding Renal Angiomyolipoma (AML): AML is the most common benign renal tumor, characterized by a mix of blood vessels, smooth muscle, and adipose tissue. While most cases remain asymptomatic, those associated with TSC tend to be larger and symptomatic, increasing the risk of life-threatening hemorrhage.

Diagnosis and Treatment Approaches:

• Diagnosis: AML can be identified using a CT scan, with fat presence (-25 HU or lower) confirming its nature.
• Management Strategies:
  • Small (<4 cm), asymptomatic AMLs: Routine clinical and radiological monitoring.
  • Giant symptomatic AMLs (>4 cm) or cases with hemorrhage: Require urgent multidisciplinary management, including surgical intervention.
  • Conservative approaches: Partial nephrectomy and embolization are preferred when feasible to preserve renal function.

Expert Perspectives on AML Management: The American Urological Association (AUA) recommends a case-by-case approach to AML treatment, balancing intervention with renal preservation. As embolization techniques advance, there is increasing hope for minimally invasive solutions that reduce surgical risks.

Access the Full Case Study: Read the full study at https://doi.org/10.29328/journal.acr.1001097 for a detailed breakdown of this rare and complex case.

Further Reading & Related Studies:

• Explore more case reports on renal neoplasms here.
• Learn about the latest advancements in nephrology and urology treatments.

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