腎臟血管平滑肌脂肪瘤併局部及下腔靜脈侵犯

陳忠佐、王彥傑

國泰綜合醫院 外科部 泌尿科

Rare Presentation of Renal Angiomyolipoma: Aggressive Behavior with Perinephric Extension and Inferior Vena Cava Invasion

Chung-Tso Chen, Yen-Chieh Wang

 Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract:

Renal angiomyolipoma (AML) is the most common type of benign mesenchymal tumor of the kidney, which composed of blood vessels, smooth muscles and adipose tissues. Although the AML has typically no malignant potential without local invasion, however, the tumor may present aggressive behavior. Perinephric extension and intravascular invasion into the renal vein and inferior vena cava (IVC) of renal AML are rare but still need to be considered, as presented in our case.

We present a case of 43-year-old male with persistent abdominal pain for several days. Physical examination revealed mild right epigastric tenderness. Laboratory testing showed leukocytosis and elevated CRP. Abdominal contrast enhanced computed tomography (CT) was arranged, which revealed right renal heterogeneous mass mixed of soft tissue and fat densities with IVC extending, perirenal fat infiltration and subcapsular hematoma. Under the impression of AML ruptured with IVC invasion, he underwent a right radical nephrectomy and IVC thrombectomy. The patient recovered smoothly and no tumor recurrence was found during the 6 months follow-up period. This report presents this case and reviews the relevant literature.