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文献考察：腎血管筋脂肪腫Renal angiomyolipoma
１）Clin Nephrol. 1998 May;49(5):281-6.
Renal angiomyolipoma: optimal treatment based on size and symptoms.（腫瘍の大きさ4cm以下は破裂の可能性はきわめて低く，8cm以上は有症状になるまたは破裂する可能性が高く治療すべき，4-8cmは定期的な画像診断でfollow-upし，大きくなるまたは有症状となれば治療すべき）
Dickinson M, Ruckle H, Beaghler M, Hadley HR.
The natural history of renal angiomyolipoma is not well delineated. Current management options include observation, embolization, and partial or total nephrectomy. Recommendations for treatment are usually based on the patient's symptoms or the size of the lesion. In an effort to help define the optimal treatment of renal angiomyolipomas, we reviewed our experience over the last 10 years with these tumors. We performed a retrospective study of 37 patients (48 renal units) diagnosed with renal angiomyolipoma over a ten year period at our medical center (mean follow-up 40 months, range 1 month-12 years). Lesions were classified as small ( 8 cm) based on the single largest lesion in each kidney. The relationship between the size, symptoms and treatment was reviewed. Patients were also analyzed with regard to the diagnosis of tuberous sclerosis. Our findings indicate renal angiomyolipomas less than 4 cm (21/37 patients) tend to be asymptomatic and generally do not require intervention. Angiomyolipomas greater than 8 cm were responsible for significant morbidity and generally require treatment (5/6). Patients with tuberous sclerosis made up one half (3/6) of the large lesions. Medium-sized lesions had a less predictable natural history, with 54% (7/13) requiring intervention to treat hemorrhagic complications. Small asymptomatic lesions ( 8 cm) will most likely become symptomatic and should be treated electively prior to the development of symptoms and potential complications. PMID: 9617489
２）Radiology. 2002 Oct;225(1):78-82.
Renal angiomyolipoma: relationships between tumor size, aneurysm formation, and rupture.（腫瘍サイズ4cm以上と，血管腫の大きさ5mm以上が破裂しやすい）
Yamakado K, Tanaka N, Nakagawa T, Kobayashi S, Yanagawa M, Takeda K.
PURPOSE: To evaluate the relationships between tumor size, aneurysm formation, and spontaneous rupture in renal angiomyolipomas. MATERIALS AND METHODS: Twenty-three patients with renal angiomyolipoma were examined with angiography and computed tomography (CT). The single largest lesion in each kidney was evaluated. Tumor size was measured at CT, and aneurysm size was measured at renal angiography. Tumor and aneurysm sizes were compared between the group with ruptured angiomyolipoma and the group with unruptured angiomyolipoma. Multiple regression analysis was performed to identify factors affecting rupture. RESULTS: Twenty-nine kidneys with angiomyolipoma were identified. Eight angiomyolipomas were hemorrhagic; the remaining 21 were not hemorrhagic. Tumor size was larger than 4 cm and aneurysm size was 5 mm or larger in all hemorrhagic lesions. There were significant differences in mean tumor size (11.4 cm +/- 5.5 [SD] vs 5.0 cm +/- 3.1, P <.02 and mean aneurysm size mm vs p between the ruptured unruptured tumor groups. when of cm or larger were used as predictors rupture sensitivity specificity respectively with former criterion latter criterion. multiple regression analysis indicated that was most important factor linked to rupture. conclusion: formation appears be related large aneurysms confer a higher probability rupture.pmid:> |
