[Renal angiomyolipoma: diagnostic difficulties and surgical indications in 20 surgically treated patients]

Between 1982 and 1993, 6 male and 14 female patients underwent partial or total nephrectomy due to renal angiomyolipoma (AML). Presentation forms were: in 6 cases (30%) acute pain with severe haematuria or signs of visceral bleeding, 3 (15%) acute pain without other symptoms, 7 (35%) chronic pain associated to haematuria or fever, or isolated haematuria, and in 4 (20%) it was a chance finding. No significant differences were found among tumor sizes considering the severity of the presentation form, but all AMLs with serious signs and symptoms had more than 5 cm diameter. A pre-operative diagnosis of AML was made in 15 (75%) patients, while 5 (25%) underwent surgery for other presumed diagnosis. Nine were conservative procedures of renal parenchyma and 11 were total or radical nephrectomies. There were no significant differences between tumour sizes by treatment performed. The authors review the imaging diagnostic difficulties and the various criteria supporting surgery in AML, and conclude by recommending individualized diagnosis and treatment in patients with AML suspicion of including puncture biopsy or cytology when in doubt, trying to avoid surgery in well characterized tumours, under 4 or 5 cm, provided that they could be followed-up regularly.