Contemporary Diagnosis and Management of Renal Angiomyolipoma

No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Oct 2002Contemporary Diagnosis and Management of Renal Angiomyolipoma Caleb P. Nelson and Martin G. Sanda Caleb P. NelsonCaleb P. Nelson and Martin G. SandaMartin G. Sanda View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64440-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We present a comprehensive resource that summarizes contemporary advances relevant to the clinical management of renal angiomyolipoma. Materials and Methods: A MEDLINE search was done using the key words angiomyolipoma, hemangioma or lipoma and kidney neoplasm, and therapeutic embolization. References from these articles were reviewed to identify additional relevant source material. We identified 13 series published since 1986 comprising 336 patients as well as 24 reports of therapeutic embolization for angiomyolipoma, comprising 76 patients. To our knowledge we report the largest compilation series to date. Results: Angiomyolipoma is generally benign, although an uncommon subtype (epithelioid angiomyolipoma) may behave more aggressively. Tuberous sclerosis associated angiomyolipoma tends to be larger, multiple and more likely to cause spontaneous hemorrhage than the sporadic entity. Tumors that hemorrhage tend to be larger. Computerized tomography or magnetic resonance is usually sufficient for diagnosis. Biopsy is rarely useful. Primary indications for intervention include symptoms such as pain or bleeding or suspicion of malignancy. Prophylactic intervention is justifiable for large tumors, in females of childbearing age or in patients in whom followup or access to emergency care may be inadequate. Recent advances that have affected management include improved understanding of tuberous sclerosis complex and angiomyolipoma genetics, the identification of molecular markers that facilitate histopathological diagnosis, and the refinement of embolization and partial nephrectomy techniques. Conclusions: Although some cases of angiomyolipoma may require complete nephrectomy, most can be managed by conservative nephron sparing approaches. Ongoing research into the molecular biology and clinical behavior of angiomyolipoma may improve our ability to manage these lesions. References 1 : Angiomyolipoma of the kidney. J Urol1951; 65: 525. Link, Google Scholar 2 : Atlas of Genitourinary Pathology. Washington, D. C: Army Institute of Pathology1946. Google Scholar 3 : Demonstration eines grossen Angio-Myo-Lipoms der Niere. Dtsch Med Wochenschr1900; 26: 290. Google Scholar 4 : Extrarenal angiomyolipoma. J Surg Oncol1984; 25: 89. Google Scholar 5 : Renal angiomyolipomas of the perinephric space. J Urol1992; 147: 447. Link, Google Scholar 6 : Extrarenal retroperitoneal angiomyolipoma: nonoperative management. J Urol2000; 163: 234. Link, Google Scholar 7 : Angiomyolipoma of the bladder wall. J Urol2000; 163: 901. Link, Google Scholar 8 : Involvement of spleen by renal angiomyolipoma. Metastases or multicentricity? J Urol1983; 130: 328. Link, Google Scholar 9 : Die Nierentumoren bei der Tuberosen Hirnsklerose. Zeigl Beitr Pathol Anat Allg Pathol1911; 50: 235. Google Scholar 10 : Renal angiomyolipoma: optimal treatment based on size and symptoms. Clin Nephrol1998; 49: 281. Google Scholar 11 : Renal angiomyolipoma: current concepts of diagnosis and management. AUA Update Series1992; vol. 11. Google Scholar 12 : Management of renal angiomyolipoma: a report of 53 cases. BJU Int1999; 83: 215. Google Scholar 13 : Management of renal angiomyolipoma: analysis of 15 cases. Eur Urol1998; 33: 572. Google Scholar 14 : Renal angiomyolipoma—experience of 20 years in Taiwan. Eur Urol1997; 32: 175. Google Scholar 15 : Radiological parameters of bleeding renal angiomyolipoma. Scand J Urol Nephrol1996; 30: 265. Google Scholar 16 : Outcome analysis of 42 cases of renal angiomyolipoma. J Urol1994; 152: 1988. Link, Google Scholar 17 : Management of renal angiomyolipoma: a report of 14 cases and review of the literature. Is nonsurgical treatment adequate for this tumor? Eur Urol1994; 25: 183. Google Scholar 18 : The evolution of renal angiomyolipomas in patients with tuberous sclerosis. J Urol1994; 152: 35. Link, Google Scholar 19 : The natural history of renal angiomyolipoma. J Urol1993; 150: 1782. Link, Google Scholar 20 : Renal angiomyolipoma: report of 24 cases. Br J Urol1990; 66: 585. Google Scholar 21 : Angiomyolipoma: clinical metamorphosis and concepts for management. J Urol1988; 139: 20. Link, Google Scholar 22 : Diagnosis and treatment of renal angiomyolipoma. Urol Int1987; 42: 201. Google Scholar 23 : Renal angiomyolipoma: 6 case reports and literature review. J Urol1986; 135: 349. Link, Google Scholar 24 : Giant bilateral renal angiomyolipomas associated with tuberous sclerosis. Urology2001; 57: 554. Google Scholar 25 : Selective arterial embolization in the management of symptomatic renal angiomyolipomas. Eur J Radiol1999; 32: 153. Google Scholar 26 : Renal angiomyolipoma with haemorrhage treated by urgent embolization. Scand J Urol Nephrol1998; 32: 54. Google Scholar 27 : Renal angiomyolipoma: embolotherapy with a mixture of alcohol and iodized oil. J Vasc Intervent Radiol1998; 9: 255. Google Scholar 28 : Renal angiomyolipomas: long-term follow-up of embolization for acute hemorrhage. Can Ass Radiol J1997; 48: 191. Google Scholar 29 : Renal angiomyolipoma: selective arterial embolization—effectiveness and changes in angiomyogenic components in long-term follow-up. Radiology1997; 204: 65. Google Scholar 30 : Elective embolization for prevention of hemorrhage from renal angiomyolipomas. J Vasc Intervent Radiol1994; 5: 587. Google Scholar 31 : Bilateral angiomyolipomas: the benefits and limitations of embolization for renal salvage—a case report. Mol Med1991; 88: 292. Google Scholar 32 : Angiographic management of retroperitoneal hemorrhage from renal angiomyolipoma in polycystic kidney disease. J Urol1991; 145: 1248. Link, Google Scholar 33 : Renal angiomyolipoma: experience in 23 patients. Chinese Med J1991; 48: 217. Google Scholar 34 : Angiomyolipoma: postembolization liquefaction and percutaneous drainage. Urol Radiol1990; 12: 145. Google Scholar 35 : Percutaneous transcatheter embolization of symptomatic renal angiomyolipomas: a report of four cases. Neth J Surg1990; 42: 72. Google Scholar 36 : Therapeutic embolization for renal angiomyolipoma: case report and review of the literature. Radiat Med1987; 5: 191. Google Scholar 37 : Angiomyolipomas in tuberous sclerosis: subselective embolotherapy with alcohol, with long-term follow-up study. Radiology1986; 160: 437. Google Scholar 38 : Hemorrhagic renal angiomyolipoma: superselective renal arterial embolization for preservation of renal function. Cardiovasc Intervent Radiol1985; 8: 39. Google Scholar 39 : "Macro" aneurysm in renal angiomyolipoma: two cases, with therapeutic embolization in one patient. Urol Radiol1984; 6: 201. Google Scholar 40 : Management of symptomatic renal angiomyolipomas by embolisation. Urol Radiol1984; 6: 196. Google Scholar 41 : Management of bleeding renal angiomyolipomas by transcatheter embolization following CT diagnosis. Urol Radiol1984; 6: 205. Google Scholar 42 : Angiomyolipoma: emerging concepts in management. Urology1982; 20: 566. Google Scholar 43 : Renal tumor infarction with absolute ethanol. AJR Am J Roentgenol1982; 139: 1139. Google Scholar 44 : Renal angiomyolipoma: diagnosis and management. Urology1980; 15: 1. Google Scholar 45 : Massive renal angiomyolipoma: preoperative infarction by balloon catheter. J Urol1979; 121: 360. Link, Google Scholar 46 : Management of hemorrhage secondary to renal angiomyolipoma with selective arterial embolization. J Urol1977; 117: 122. Link, Google Scholar 47 : Angiomyolipoma of the kidney: report of 27 cases and review of the literature. J Urol1969; 102: 396. Link, Google Scholar 48 : Benign renal tumors detected among healthy adults by abdominal ultrasonography. Eur Urol1995; 27: 124. Google Scholar 49 : Renal manifestations of tuberous sclerosis complex. Clin Pediatr1996; 35: 483. Google Scholar 50 : Contribution a l'etude de l'idiotic, sclerose tubereuse des circonvolutions cerebrales; idiotic et epilepsie hemiplegique. Arch Neurol1880; 1: 69. Google Scholar 51 : Idiotie et epilepsie symptomatiques de sclerose tubereuse ou hypertrophique. Arch Neurol (Paris)1900; 10: 29. Google Scholar 52 : Zur diagnostik der tuberosen sklerose. Z Erforsch Behandl Jugendl Schwachsinns1908; 2: 1. Google Scholar 53 : On the incidence of fits and mental retardation in tuberous sclerosis. J Med Genet1991; 28: 395. Google Scholar 54 : Phenotypes of the tuberous sclerosis complex with a revision of diagnostic criteria. Ann NY Acad Sci1991; 615: 1. Google Scholar 55 : The kidney in the tuberous sclerosis complex. Adv Nephrol Necker Hospital1994; 23: 43. Google Scholar 56 : A population study of renal disease in patients with tuberous sclerosis. Br J Urol1994; 74: 151. Google Scholar 57 : A cross sectional study of renal involvement in tuberous sclerosis. J Med Genet1996; 33: 480. Google Scholar 58 : Renal lesions in tuberous sclerosis. J Urol1987; 138: 477. Link, Google Scholar 59 : The renal lesions of tuberous sclerosis. Semin Diagn Pathol1985; 3: 97. Google Scholar 60 : Renal lesion growth in children with tuberous sclerosis complex. J Urol1998; 160: 141. Link, Google Scholar 61 : The management of renal angiomyolipoma. J Urol1986; 135: 1121. Link, Google Scholar 62 : Frequent progesterone receptor immunoreactivity in tuberous sclerosis-associated renal angiomyolipomas. Mod Pathol1998; 11: 665. Google Scholar 63 : Rapidly-growing renal angiomyolipoma associated with pregnancy. Actas Urol Esp1994; 18: 755. Google Scholar 64 : Identification of the tuberous sclerosis gene TSC1 on chromosome 9q34. Science1997; 277: 805. Google Scholar 65 The European Chromosome 16 Tuberous Sclerosis Consortium Identification and characterization of the tuberous sclerosis gene on chromosome 16. Cell1993; 75: 1305. Google Scholar 66 : Identification of tuberin, the tuberous sclerosis-2 gene product. J Biol Chem1995; 270: 16409. Google Scholar 67 : Loss of heterozygosity in tuberous sclerosis hamartomas. J Med Genet1996; 33: 962. Google Scholar 68 : Loss of tuberin in both subependymal giant cell astrocytomas and angiomyolipomas supports a two-hit model for the pathogenesis of tuberous sclerosis tumors. Am J Pathol1997; 151: 1639. Google Scholar 69 : Extrathoracic angiomyolipomas in lymphangioleiomyomatosis. Eur Respir J1996; 9: 402. Google Scholar 70 : How common are renal angiomyolipomas in patients with pulmonary lymphangiomyomatosis?. Am J Respir Crit Care Med1995; 152: 2138. Google Scholar 71 : Renal angiomyolipoma in association with pulmonary lympangioleiomyomatosis: forme fruste of tuberous sclerosis. Urology1993; 41: 440. Google Scholar 72 : Evidence that lymphangiomyomatosis is caused by TSC2 mutations: chromosome 16p13 loss of heterozygosity in angiomyolipomas and lymph nodes from women with lymphangiomyomatosis. Am J Human Genet1998; 62: 810. Google Scholar 73 : Loss of heterozygosity in the tuberous sclerosis (TSC2) region of chromosome band 16p13 occurs in sporadic as well as TSC-associated renal angiomyolipomas. Genes Chromosomes Cancer1995; 13: 295. Google Scholar 74 : Clonal analysis of renal sporadic angiomyolipomas. Human Pathol1998; 29: 1063. Google Scholar 75 : Clonality of tuberous sclerosis hamartomas shown by non-random x-chromosome inactivation. Hum Genet1996; 97: 240. Google Scholar 76 : Spontaneous subcapsular or perirenal haemorrhage caused by renal tumours. A urological emergency. Scand J Urol Nephrol1999; 33: 17. Google Scholar 77 : Spontaneous rupture of the kidney with perirenal hematoma. J Urol1975; 114: 181. Link, Google Scholar 78 : Angiomyolipoma of kidney. Semin Diagn Pathol1998; 15: 21. Google Scholar 79 : Diagnosis and management of renal angiomyolipoma. J Urol1985; 25: 461. Google Scholar 80 : Aetiology, diagnosis, and management of spontaneous perirenal haematomas. Eur Urol1996; 29: 302. Google Scholar 81 : Renal angiomyolipoma associated with lymph node involvement and renal cell carcinoma in patients with tuberous sclerosis. J Urol1989; 141: 930. Link, Google Scholar 82 : Chronic renal failure and its treatment in tuberous sclerosis. Nephrol Dial Transplant1996; 11: 481. Google Scholar 83 : Imaging of angiomyolipomas. Semin Ultrasound CT MR1997; 18: 100. Google Scholar 84 : Angiomyolipoma and renal cell carcinoma: US differentiation. Radiology1996; 198: 789. Google Scholar 85 : Hyperechoic renal tumors: anechoic rim and intratumoral cysts in US differentiation of renal cell carcinoma from angiomyolipoma. Radiology1993; 188: 179. Google Scholar 86 : Renal angiomyolipoma. Ultrasonographic, CT, angiographic and histologic correlation. Acta Radiol1991; 32: 239. Google Scholar 87 : Angiomyolipoma: ultrasonic-pathologic correlation. Radiology1981; 139: 451. Google Scholar 88 : Angiomyolipoma (hamartoma) of the kidney, an angiographic review. Acta Radiol Diagn1973; 14: 561. Google Scholar 89 : Roentgenographic findings in the renal lesion of tuberous sclerosis. AJR Am J Roentgenol1966; 98: 739. Google Scholar 90 : Small, asymptomatic angiomyolipomas of the kidney. Radiology1985; 154: 7. Google Scholar 91 : Small (< or = 3 cm) hyperechoic renal masses: comparison of helical and convention CT for diagnosing angiomyolipoma. AJR Am J Roentgenol1996; 167: 877. Google Scholar 92 : CT pixel mapping in the diagnosis of small angiomyolipomas of the kidneys. J Comput Assist Tomogr1993; 17: 98. Google Scholar 93 : CT diagnosis of renal angiomyolipoma: the importance of detecting small amounts of fat. AJR Am J Roentgenol1988; 151: 497. Google Scholar 94 : Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology1997; 205: 497. Google Scholar 95 : Unusual fat-containing tumors of the kidney. Radiographics1997; 17: 129. Google Scholar 96 : Detection of fat in a renal cell carcinoma mimicking angiomyolipoma. Radiology1993; 188: 427. Google Scholar 97 : CT demonstration of fat density in renal cell carcinoma. Radiology1992; 33: 365. Google Scholar 98 : Fat containing renal mass in childhood: a case report of teratoid Wilm's tumor. J Urol1994; 151: 1662. Link, Google Scholar 99 : Intratumoral fat in a renal oncocytoma mimicking angiomyolipoma. AJR Am J Roentgeonl1990; 154: 307. Google Scholar 100 : Renal liposarcoma: case report. J Urol1976; 115: 747. Link, Google Scholar 101 : Fat in renal adenocarcinoma: never say never. Radiology1993; 188: 316. Google Scholar 102 : Adult renal hamartomas. Radiographics1997; 17: 155. Google Scholar 103 : Angiomyolipoma of the kidney: comparison between magnetic resonance imaging, computed tomography, and ultarsonography for diagnosis. Acta Radiol1988; 29: 523. Google Scholar 104 : Renal neoplasms amenable to partial nephrectomy: MR imaging. Radiology1999; 212: 28. Google Scholar 105 : Renal angiomyolipoma with sarcomatous transformation and pulmonary metastases. Am J Surg Pathol1991; 15: 1083. Google Scholar 106 : Malignant transformation of angiomyolipoma. J Urol1992; 147: 1356. Link, Google Scholar 107 : Renal angiomyolipoma: a clinicopathologic, immunohistochemical, and follow-up study of 46 cases. Am J Surg Pathol1999; 23: 1011. Google Scholar 108 : Epithelioid cell variant of renal angiomyolipoma. Histopathology1996; 28: 277. Google Scholar 109 : Epithelioid angiomyolipoma of the kidney: a report of five cases with a prominent and diagnostically confusing epithelioid smooth muscle component. Am J Surg Pathol1997; 21: 1123. Google Scholar 110 : Malignant transformation of renal angiomyolipoma. J Urol1999; 161: 1900. Link, Google Scholar 111 : Retroperitoneal epithelioid angiomyolipoma leading to fatal outcome. Pathol Int2000; 50: 649. Google Scholar 112 : Malignant epithelioid angiomyolipoma (sarcoma ex angiomyolipoma) of the kidney: a case report and review of the literature. Am J Surg Pathol2001; 25: 121. Google Scholar 113 : Renal angiomyolipoma with epithelioid sarcomatous transformation and metastases: demonstration of the same genetic defects in the primary and metastatic lesions. Am J Surg Pathol2000; 24: 889. Google Scholar 114 : Tuberous sclerosis-associated renal cell carcinoma, clinical, pathological, and genetic features. Am J Surg Pathol1996; 2: 539. Google Scholar 115 : Apparent renal cell carcinomas in tuberous sclerosis are heterogeneous: the identification of malignant epithelioid angiomyolipoma. Am J Surg Pathol1998; 22: 180. Google Scholar 116 : Melanocyte-marker HMB-45 is regularly expressed in angiomyolipoma of the kidney. Pathology1991; 23: 185. Google Scholar 117 : HMB-45 staining in angiomyolipoma cardiac rhabdomyoma, other mesenchymal processes, and tuberous sclerosis-associated brain lesions. Int J Surg Pathol1994; 1: 191. Google Scholar 118 : Carcinomalike monotypic epithelioid angiomyolipoma in patients without evidence of tuberous sclerosis: a clinicopathologic and genetic study. Am J Surg Pathol1998; 22: 663. Google Scholar 119 : Needle tract seeding following aspiration of renal cell carcinoma. J Urol1977; 118: 865. Link, Google Scholar 120 : Fine-needle aspiration cytology of renal angiomyolipoma: report of a case with immunocytochemical and electron microscopic findings. Diagn Cytopathol1998; 18: 297. Google Scholar 121 : Fine needle aspiration cytology in the diagnosis of solid renal and adrenal masses. Scand J Urol Nephrol1985; 19: 211. Google Scholar 122 : Fine needle aspiration cytology of renal and retroperitoneal angiomyolipoma. Report of two cases with cytologic findings and clinicopathologic pitfalls in diagnosis. Acta Cytol1995; 39: 945. Google Scholar 123 : Cytologic study of renal angiomyolipoma by fine-needle aspiration biopsy: report of four cases. Diagn Cytopathol1994; 10: 37. Google Scholar 124 : Preoperative diagnosis of renal angiomyolipoma: fine needle aspiration cytology and immunocytochemical characterization. Pathology1994; 26: 170. Google Scholar 125 : Is there still a place for angiography in the management of renal mass lesions. Eur Radiol1999; 9: 329. Google Scholar 126 : Surgical management of angiomyolipoma: nephron-sparing surgery for symptomatic tumour. Scand J Urol Nephrol2000; 34: 32. Google Scholar 127 : Nephron-sparing surgery for renal angiomyolipoma. Urology1998; 52: 577. Google Scholar 128 : Cryotherapy for renal cell carcinoma and angiomyolipoma. J Urol1996; 155: 252. Link, Google Scholar 129 : MR imaging of the kidneys after laparoscopic cryoablation. AJR Am J Roentgenol2000; 174: 635. Google Scholar 130 : Renal angiomyolipoma associated with inferior vena caval and right atrial thrombus. J Urol1999; 162: 1371. Link, Google Scholar 131 : An autopsy case of pulmonary embolism due to renal angiomyolipoma in an elderly woman.. Nippon Ronen Igakkai Zasshi1999; 36: 420. Google Scholar 132 : Progressive angiomyolipoma with inferior vena cava tumor thrombus. Urology1997; 50: 975. Google Scholar 133 : Renal angiomyolipoma with venous extension associated with complete duplication.. Prog Urol1997; 7: 637. Google Scholar 134 : Incidentally detected renal angiomyolipoma with tumour thrombus into the inferior vena cava. Scand J Urol Nephrol1997; 31: 189. Google Scholar 135 : "Aggressive" renal angiomyolipoma. Acta Radiol1996; 37: 927. Google Scholar 136 : Benign angiomyolipoma involving the renal vein and vena cava as a tumor thrombus: case report. J Urol1995; 153: 1205. Link, Google Scholar 137 : Bilateral renal angiomyolipoma associated with bilateral renal vein and inferior vena caval thrombi. J Urol1992; 148: 1885. Link, Google Scholar 138 : Angiomyolipoma of the kidney extending into the inferior vena cava: sonographic and CT findings. AJR Am J Roentgenol1988; 151: 1159. Google Scholar 139 : Malignant angiomyolipoma of the kidney associated with hypercalcemia. Br J Urol1988; 62: 89. Google Scholar 140 : Computed tomography of renal angiomyolipoma presenting as a right atrial mass. J Comput Assist Tomogr1986; 10: 1054. Google Scholar 141 : Computerized tomographic demonstration of inferior vena caval tumor thrombus from renal angiomyolipoma. J Urol1985; 133: 836. Link, Google Scholar 142 : Renal angiomyolipoma with sonographic demonstration of extension into the inferior vena cava. Radiology1982; 143: 755. Google Scholar 143 : Meta analysis of the relationship between tuberous sclerosis coplex and renal cell carcinoma. Eur J Radiol1998; 27: 131. Google Scholar 144 : Renal angiomyolipoma: report of three cases with regional lymph node involvement and/or with renal cell carcinoma. Tumori1995; 81: 469. Google Scholar 145 : Recurrent renal angiomyolipoma associated with renal carcinoma in a patient with tuberous sclerosis. Br J Urol1993; 72: 983. Google Scholar 146 : Composite renal cell carcinoma and angiomyolipoma: a study of the histogenetic relationship of the two lesions. Pathol Int1999; 49: 1. Google Scholar 147 : Clear cell tumor and angiomyolipoma. Am J Surg Pathol1991; 15: 199. Google Scholar 148 : Association of renal angiomyolipoma and renal cell carcinoma: preoperative diagnosis. Eur J Radiol1982; 2: 92. Google Scholar 149 : Angiomyolipoma and renal cell carcinoma occurring in the same kidney: CT evaluation. J Comput Assist Tomogr1987; 11: 340. Google Scholar 150 : Malignant renal tumors in tuberous sclerosis. Urology1991; 37: 340. Google Scholar 151 : Multicentric renal angiomyolipoma associated with pulmonary lymphangioleiomyomatosis: case report, with histologic, immunohistochemical, and DNA content analyses. Urology1996; 48: 476. Google Scholar 152 : Renal angiomyolipoma with nodal involvement. A 20 year follow up. Br J Urol1995; 76: 517. Google Scholar 153 : Renal angiomyolipoma with extrarenal involvement—in vascular, lymph-node and perirenal tissue. Reports of four cases. Scand J Urol Nephrol1995; 29: 327. Google Scholar 154 : Renal angiomyolipoma. DNA content and immunohistochemical study of classic and multicentric variants. Arch Pathol Lab Med1994; 118: 735. Google Scholar 155 : Angiomyolipoma of kidney with lymph node involvement: DNA flow cytometric analysis. Arch Pathol Lab Med1990; 114: 65. Google Scholar 156 : II: Angiomyolipoma with regional lymph node involvement and long-term follow up study. Hum Pathol1986; 17: 962. Google Scholar 157 : Multicentric angiomyolipoma: renal and lymph node involvement. Urology1986; 28: 111. Google Scholar 158 : The significance of lymph nodal involvement in renal angiomyolipoma. J Urol1982; 128: 1292. Link, Google Scholar 159 : Benign renal angiomyolipoma with regional lymph node involvement. J Urol1976; 116: 715. Link, Google Scholar 160 : Renal angiomyolipoma: two varities. Urology1975; 6: 768. Google Scholar 161 : Angiomyolipoma presenting as fever of unknown origin. Am J Med1974; 57: 843. Google Scholar 162 : Renal angiomyolipoma. J Urol1965; 94: 203. Link, Google Scholar 163 : Angiolipoleiomyoma of the kidney, report of case with observation on histogenesis. 8: Google Scholar : renal angiomyolipoma into associated with involvement in a patient with tuberous sclerosis. J 179. Link, Google Scholar : and after nephrectomy for an angiomyolipoma. J Link, Google Scholar : Benign renal angiomyolipoma with regional lymph node involvement. Acta Pathol 37: Google Scholar : renal angiomyolipoma with fatal outcome. J Urol1985; 133: Link, Google Scholar : and spontaneous rupture of renal angiomyolipoma in a with tuberous sclerosis. 88: Google Scholar : Spontaneous hemorrhage secondary to renal angiomyolipoma. Urol Google Scholar : Massive retroperitoneal hemorrhage from spontaneous rupture of a renal angiomyolipoma pregnancy. A case report. J Med1994; 39: 477. Google Scholar : Renal angiomyolipoma and retroperitoneal hemorrhage pregnancy. J 143: Google Scholar : Tuberous sclerosis in pregnancy. 62: Google Scholar : Retroperitoneal hemorrhage secondary to renal angiomyolipoma. Urol Radiol1982; 255. Google Scholar : Renal with spontaneous rupture pregnancy. 52: 481. Google Scholar : Spontaneous rupture of kidney in pregnancy. J 365. Link, Google Scholar : Massive retroperitoneal hemorrhage from spontaneous rupture of of the kidney pregnancy. Am J 88: Google Scholar : in a patient with tuberous sclerosis. 88: Google Scholar the of of Ann by and Update on the Diagnosis and Management of Renal of 4 of Renal Angiomyolipoma with can be as an Management of and of Angiomyolipoma: A of and Angiomyolipoma Renal of and Selective of A of and of A and of Renal Angiomyolipoma in Fat Tuberous Sclerosis and of and of Renal of and Renal Spontaneous Retroperitoneal of 4 by Caleb P. Nelson articles by this Martin G. Sanda articles by this All