腎血管筋脂肪腫の臨床的検討

Abstract

腎血管筋脂肪腫(AML)症例20例23腎を臨床的に検討した.症状として疼痛や腫瘤を多く認めたが, 5例は無症状であった.腫瘍の局在は右側が11例と多かった.腫瘍径と症状の有無には明らかな相関関係は認めなかった.臨床的に画像上腎細胞癌(RCC)の鑑別が困難であった5腎に対して, 腎摘除術が施行された.腎部分切除術を施行した症例の術前診断は全例がAMLであり, 腫瘍径の平均は12.3cmであった.又, 術後の合併症は認めなかった

Between April 1980 and December 1999, 23 kidneys in 20 patients were diagnosed as having renal angiomyolipoma at our institution. The patients were 6 males and 14 females aged 24 to 79 years, with a mean age of 55.4 years. Two patients had associated tuberous sclerosis and 3 had bilateral disease. Of all patients the main clinical symptoms were pain (45%) and palpable mass (40%); 5 patients (25%) had asymptomatic lesions. The size of the tumor ranged from 1.3 to 24 cm (mean 7.7 cm). Treatment consisted of nephrectomy in 9 patients, partial nephrectomy in 6 and selective embolization in one. Pre-operative diagnosis was renal cell carcinoma in 5 of the 9 patients who underwent nephrectomy. Six patients with 7 diseased kidneys were followed radiologically. One patient underwent percutaneous biopsy to confirm the diagnosis. We suggest that nephron-sparing surgery for patients with renal angiomyolipoma should be the first step if tumor size is 4 cm < or = or increasing rapidly. Selective embolization is also a useful method. However, we need long-term follow-up to evaluate the effectiveness of embolization.