Медицинская литература. Новинки

 

 

 

 

 

 

Ангиомиолипомы: современные представления и клинические наблюдения

Вы можете загрузить полный текст статьи в формате pdf

Ангиомиолипомы являются доброкачественными образованиями, в большинстве случаев возникающими в почках. Чаще всего являются случайными находками ввиду асимптомного течения и небольших размеров, а также имеют характерную КТ-картину, на основании которой можно без труда поставить диагноз. Однако в некоторых случаях выявляются образования, существенно отличающиеся от типичной картины при КТ-исследованиях как по структуре (отсутствие/слабая выраженность жирового компонента), так и по характеру роста (рецидивирование, матастазирование), что вызывает существенные дифференциально-диагностические трудности и подозрения на злокачественность. Подход к лечению зависит от размеров образования. Как правило, образования малых размеров асимптомны и не сопровождаются риском осложнений, что обусловливает наблюдательную тактику. При больших размерах образований они могут быть причиной возникновения опасных осложнений, ввиду чего требуется проведение хирургического лечения, которое может иметь разные формы в зависимости от характера поражения почечной паренхимы.

Ключевые слова:
ангиомиолипома, ангиомиолипома, ассоциированная с туберозным склерозом, эпителиоидно-клеточная ангиомиолипома, почечно-клеточная карцинома, ангиоэмболизация, резекция почки, нефрэктомия, angiomyolipoma, tuberous sclerosis associated аngiomyolipoma, epithelioid аngiomyolipoma, renal cell carcinoma, embolization, partial nephrectomy, nephrectomy

Литература:
1.Kavoussi L.R., Andrew C. Campbell-Walsh Urology. 10th Edition Review. New York: Elsevier, 2012. 616 p.
2.McAninch J., Lue T. F General Urology. London: McGraw Hill Lance, 2008. 489 p.
3.Eble J.N. Angiomyolipoma of the kidney. Semin. Diagn. Pathol. 1998; 15: 21-40.
4.Прокоп М., Галански М. Спиральная и многослойная компьютерная томография. М.: МЕДпресс-информ, 2006. 710 c.
5.Raft J., Lalot J., Meistelman C. et al. Influence of pregnancy on renal angiomyolipoma. Gynecol. Obstet. Fertil. 2005; 33 (11): 898-906.
6.Bakshi S.S, Vishal K., Kalia V. et al. Aggressive renal angiomyolipoma extending into the renal vein and inferior vena cava - an uncommon entity. Br. J. Radiol. 2011; 84 (1004): e166-e168.
7.Kyo C., Won-Tae K., Won-Sik H. et al. Trends of Presentation and Clinical Outcome of Treated Renal Angiomyolipoma. Yonsei Med. J. 2010; 51 (5): 728-734.
8.Wright T., Sooriakumaran P. Renal angiomyolipoma presenting with massive retroperitoneal haemorrhage due to deranged clotting factors: a case report. Cases J. 2008; 1: 213.
9.Pea M., Bonetti F., Martignoni G. et al. Apparent renal cell carcinomas in tuberous sclerosis are heterogenaneous: the identification of malignant epithelioid angiomyolipoma. Am. J. Surg. Pathol. 1998; 22: 180-187.
10.Bharwani N., Christmas T.J., Jameson C. Epithelioid angiomyolipoma: treatment and prognosis. Br. J. Radiol. 2009; 82 (984): e249-e252.
11.Lai H.Y., Chen C.K., Lee Y.H. et al. Multicentric aggressive angiomyolipomas: A rare form of PEComas. Am. J. Roentgenol. 2006; 186: 837-840.
12.Lane B.R., Aydin H., Danforth T.L. et al. Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid. J. Urol. 2008; 180: 836-843.
13.Alexandros K., Filippos L., Stylianos K. Ultrasound and CT imaging assessment of renal angiomyolipoma. BMJ Case Reports 2010; doi:10.1136/bcr.01.2010.2624
14.Bakshi S.S., Vishal K., Kalia V. et al. Aggressive renal angiomyolipoma extending into the renal vein and inferior vena cava - an uncommon entity. Br. J. Radiol. 2011; 84 (1004): e166-e168.
15.Merran S., Vieillefond A., Peyromaure M. et al. Renal angiomyolipoma with calcification: CT-pathology correlation. Br. J. Radiol. 2004; 77: 782-783.
16.Garin J.M., Marco I., Salva A. et al. CT and MRI in fat-containing papillary renal cell carcinoma. Br. J. Radiol. 2007; 80: e193-e195.
17.Zagoria R. Genitourinary Radiology: Radiology Requisites Series. New York: Mosby, 2004. 349 p.
18.Israel G.M., Bosniak M.A., Slywotzky C.M. et al. CT differentiation of large exophytic renal angiomyolipomas and perirenal liposarcomas. Am. J. Roentgenol. 2002; 179 (3): 769-773.
19.Jun Li M., Yan-Li W. Malignant epithelioid angiomyolipoma of the kidney with pulmonary metastases and p53 gene mutation. Wld J. Surg. Oncol. 2012; 10: 213.
20.Fergany A.F., Hafez K.S., Novick A.C. Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J. Urol. 2000; 163: 442-445.
21.Kim J.W., Lee T.W., Kim M.J. et al. Spontaneous rupture of renal angiomyolipoma in a female tuberous sclerosis patient with pulmonary lymphangioleiomyomatosis. Korean J. Urol. 2007; 48: 344-347.
22.Timothy W., Prasanna S. Renal angiomyolipoma presenting with massive retroperitoneal haemorrhage due to deranged clotting factors: a case report. Cases J. 2008; 1: 213.
23.Hadley D.A., Bryant L.J., Ruckle H.C. Conservative treatment of renal angiomyolipomas in patient with tuberous sclerosis. Clin. Nephrol. 2006; 65: 22-27.
24.Teresa L., Danforth T.L., Lane B.R. Conservative management of giant symptomatic angiomyolipomas in patients with the tuberous sclerosis complex. Br. J. Urol. Int. 2007; 100 (4): 794-797.
25.Lang E.K. Percutaneous and Interventional Urology and Radiology. New York: Thieme, 1990. 784 p.
26.Brecher M.E., Gill W.B., Straus F.H. 2nd Angiomyolipoma with regional lymph node involvement and long-term follow-up study. Hum. Pathol. 1986; 17: 962-963.
27.Yamakado K., Tanaka N., Nakagawa T. et al. Renal Angiomyolipoma: Relationships between Tumor size, Aneurysm Formation, and Rupture. Radiology. 2002; 225: 78-82.
28.Aruna R.P., Ranjan C., Ashwani G. et. al. Giant aneurysm formation in sporadic renal angiomyolipoma. J. Radiol. Case Rep. 2010; 4 (6): 21-27.
29.Bharwani N., Christmas T.J., Jameson C. et. al. Epithelioid angiomyolipoma: imaging appearances. Br. J. Radiol. 2009; 82: 249-252.
30.Nese N., Martignoni G., Fletcher C.D. et al. Pure epithelioid PEComas of the kidney: A clinicopathologic study of 41 cases: detailed assessment of morphology and risk stratification. Am. J. Surg. Pathol. 2011; 35 (2): 161-176.
31.Martignoni G., Pea M., Rigaud G. et al. Renal angiomyolipoma with epithelioid sarcomatous transformation and metastases. Am. J. Surg. Pathol. 2000; 24: 889-894.
32.Yamamoto T, Ito K., Suzuki K. et. al. Rapidly progressive malignant epithelioid angiomyolipoma of the kidney. J. Urol. 2002; 168: 190-191.
33.Smith Jr. J.A., Howards S.S., Preminger G.M. Hinman''s Atlas of Urologic Surgery: Expert Consult. New York: Elsevier, 2012. 1184 p.
34.Dickinson M., Ruckle H., Beaghler M. et al. Renal angiomyolipoma: optimal treatment based on size and symptoms. Clin. Nephrol. 1998; 49: 281-286.
35.Boorjian S.A., Frank I., Inman B. et al. The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology. 2007; 70: 1064-1068.
36.Stephen F., Alan S. Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization. Can. Urol. Assoc. J. 2011; 5 (6): E138-E141.
37.Boorjian S.A., Frank I., Inman B. et al. The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology. 2007; 70 (6): 1064-1068.
38.Ewalt D.H., Diamond N., Rees C. et al. Long-term outcome of transcatheter embolization of renal angiomyolipomas due to tuberous sclerosis comlex. J. Urol. 2005; 174: 1764-1766.
39.Williams J.M., Racadio J.M. Embolization of renal angiomyolipoma in patient with tuberous sclerosis complex. Am. J. Kidney Dis. 2006; 47: 95-102.
40.Bissler J.J., Racadio J., Donnelly L.F. et al. Reduction of postembolization syndrome after ablation of renal angiomyolipoma. Am. J. Kidney Dis. 2002; 39: 966-971.
41.Boorjian S.A., Frank I., Inman B. et. al. The role of partial nephrectomy for the management of sporadic renal angiomyolipoma. Urology. 2007; 70: 1064-1068.

Angiomyolipoma: Mordern Concepts and a Rewiev of Two Clinical Cases

Angiomyolipomas are benign lesions which in the majority of cases occur in kidneys. Due to the small size and asymptomatic behavior these findings are mostly incidental. They have a typical CT-appearance, which helps to make a diagnosis easily. However, in some cases, lesions detected which looks different from classical CT appearance. This include differences in structure (abscence/poor fatty component) and difrences in grown pattern (recurrence, metastasis). All this arose substantial difficulties in differential diagnosis and suspicious of malignancy. Method of treatment depends on lesion size. Small size lesions asymptomatic and not accompanied by the risks of complications that causes observation management. Large lesions can cause dangerous complications, requiring a surgical treatment, which may vary depending on a kidney parenchyma involvement.

Keywords:
ангиомиолипома, ангиомиолипома, ассоциированная с туберозным склерозом, эпителиоидно-клеточная ангиомиолипома, почечно-клеточная карцинома, ангиоэмболизация, резекция почки, нефрэктомия, angiomyolipoma, tuberous sclerosis associated аngiomyolipoma, epithelioid аngiomyolipoma, renal cell carcinoma, embolization, partial nephrectomy, nephrectomy