Embolization of Ruptured Renal Angiomyolipoma in Puerpera

Abstract

Angiomyolipomas (AMLs) are rare benign tumors derived from mesenchymal tissue and composed of varying degrees of adipose tissue, muscle and blood vessels. Renal AMLs (RAMLs) are the result of a sporadic event, and, in most of cases, the diagnosis is usually incidental, but hemorrhage and shock may be present. During pregnancy, the size of AMLs may increase and they may rupture, probably due to the high expression of hormone receptors, and the increase in maternal circulation and abdominal pressure. The authors present a case of a woman with ruptured RAML submitted to urgent endovascular treatment four days after giving birth by cesarean section.

Resumo

Angiomiolipomas (AMLs) são tumores benignos raros derivados do tecido mesenquimal, compostos em graus variados de tecido adiposo, muscular e de vasos sanguíneos. Os AMLs renais (AMLRs) resultam de um evento esporádico e, na maioria dos casos, o diagnóstico costuma ser fortuito, mas quadros de hemorragia e choque podem estar presentes. Durante a gestação, os AMLs podem aumentar de tamanho e romper, provavelmente pela alta expressão de receptores hormonais, e pelo aumento da circulação materna e da pressão abdominal. Os autores apresentam um caso de uma paciente com AMLR roto submetida a tratamento endovascular de urgência no quarto dia pós-operatório de uma cesariana.

Keywords

angiomyolipoma - kidney - therapeutic embolization - pregnancy complications - postpartum period

Palavras-chave

angiomiolipoma - rim - embolização terapêutica - complicações na gravidez - período pós-parto

• References

• 1 Palácios RM, Góes ASO, Albuquerque PC, Aguiar MFM, Ribeiro FRCM, Góes Junior AMO. Tratamento endovascular de angiomiolipoma renal por embolização arterial seletiva. J Vasc Bras 2012; 11: 324-328 . Doi: 10.1590/S1677-54492012000400013
• 2 Ao L, Ogasahara E, Okuda Y, Hirata S. Spontaneous rupture of renal angiomyolipoma during pregnancy. BMJ Case Rep 2017; 2017: bcr2016217284 . Doi: 10.1136/bcr-2016-217284
• 3 Góes Junior AMO, Jeha SAH, Salgado JRC. Embolização arterial superseletiva para tratamento de angiomiolipoma em paciente com rim único. J Vasc Bras 2016; 15 (02) 142-146 . Doi: 10.1590/1677-5449.005515
• 4 Antar A, Boyle A, Patel T. Angiomyolipoma of the adrenal gland: a case presentation and a review of adrenal lipomatous tumors. Urol Case Rep 2017; 12: 59-61 . Doi: 10.1016/j.eucr.2016.11.004
• 5 Boudaouara O, Kallel R, Smaoui W. , et al. Renal epithelioid angiomyolipoma: 2 cases report. Afr J Urol 2017; 23: 197-200 . Doi: 10.1016/j.afju.2016.10.002
• 6 Govednik-Horny C, Atkins M. Angiomyolipoma with vascular invasion during pregnancy. Ann Vasc Surg 2011; 25 (08) 1138.e9-1138.e13 . Doi: 10.1016/j.avsg.2011.05.023
• 7 Preece P, Mees B, Norris B, Christie M, Wagner T, Dundee P. Surgical management of haemorrhaging renal angiomyolipoma in pregnancy. Int J Surg Case Rep 2015; 7C: 89-92 . Doi: 10.1016/j.ijscr.2015.01.004
• 8 Flum AS, Hamoui N, Said MA. , et al. Update on the diagnosis and management of renal angiomyolipoma. J Urol 2016; 195 (4 Pt 1): 834-846 . Doi: 10.1016/j.juro.2015.07.126
• 9 Orywal AK, Zeile M, Brüning R, Gross AJ, Netsch C. Rupture of renal angiomyolipoma during childbirth. Urology 2015; 85 (04) e19-e20 . Doi: 10.1016/j.urology.2014.12.008
• 10 Gimeno Argente V, Bosquet Sanz M, Bonillo García MA, Gómez Pérez L, Pontones Moreno JL, Jiménez Cruz JF. Cirugía conservadora del angiomiolipoma renal bilateral durante el embarazo. Actas Urol Esp 2006; 30 (06) 633-637 . Doi: 10.1016/S0210-4806(06)73506-9
• 11 Pereira S, Martinho D, Rodrigues R. , et al. Rotura espontânea de angiomiolipoma renal. Acta Urol 2009; 26: 118
• 12 Wang C, Li X, Peng L, Gou X, Fan J. An update on recent developments in rupture of renal angiomyolipoma. Medicine (Baltimore) 2018; 97 (16) e0497 . Doi: 10.1097/MD.0000000000010497
• 13 dos Santos MM, Proença SMS, Reis MI. , et al. Spontaneous rupture of renal angiomyolipoma during pregnancy. Rev Bras Ginecol Obstet 2014; 36 (08) 377-380 . Doi: 10.1590/SO100-720320140005019
• 14 Çetin C, Büyükkurt S, Demir C, Evrüke C. Renal angiomyolipoma during pregnancy: Case report and literature review. Turk J Obstet Gynecol 2015; 12 (02) 118-121 . Doi: 10.4274/tjod.32848
• 15 Bińkowska M, Debska M, Mazurek M, Słapa R, Debski R. Embolization of renal angiomyolipoma in pregnancy: case report. Ginekol Pol 2009; 80 (06) 449-452
• 16 Shah J, Jones J, Miller MA, Patel U, Anson KM. Selective embolization of bleeding renal angiomyolipoma in pregnancy. J R Soc Med 1999; 92 (08) 414-415
• 17 Liu J, Meng T, Yang X, Zhao G, Li B. Spontaneous rupture of renal angiomyolipoma in the third trimester. Taiwan J Obstet Gynecol 2015; 54 (06) 788-790 . Doi: 10.1016/j.tjog.2015.10.016
• 18 Lewis EL, Palmer JM. Renal angiomyolipoma and massive retroperitoneal hemorrhage during pregnancy. West J Med 1985; 143 (05) 675-676
• 19 Lim CH, Mulvin D. Embolisation of bleeding renal angiomyolipoma in pregnancy. Open J Urol 2011; 1: 25-27 . Doi: 10.4236/oju.2011.13007
• 20 Yanai H, Sasagawa I, Kubota Y. , et al. Spontaneous hemorrhage during pregnancy secondary to renal angiomyolipoma. Urol Int 1996; 56 (03) 188-191 . Doi: 10.1159/000282838
• 21 Ozkara H, Özkan B, Solok V. Management of renal abscess formation after embolization due to renal angiomyolipomas in two cases. Int Urol Nephrol 2006; 38 (3-4): 427-429 . Doi: 10.1007/s11255-005-0253-x