Surgical excision of recurrent renal angiomyolipoma after previous embolization and nephron-sparing surgery - A case report

Introduction: Renal angiomyolipoma is the most common benign kidney tumor, representing 1-3 % of solid renal tumors. Despite its benign nature, it can be associated with lethal hemorrhage, and can also show signs of local extension mimicking malignant tumors. The cornerstone of treatment remains angioembolization and nephron sparing surgery.

Presentation of case: A 51-year-old Nepalese woman presented to the emergency department with acute abdominal pain and signs of hypovolemic shock. She was managed with resuscitation, followed by angioembolization of a left renal artery pseudoaneurysm. A few months later, she underwent laparoscopic nephron-sparing surgery. One year later, she had excision of a recurrent left angiomyolipoma. Both the initial and final histologic examinations confirmed the diagnosis of classic variant renal angiomyolipoma.

Discussion: Although transcatheter angioembolization is the treatment of choice for bleeding angiomyolipoma, there is a higher likelihood of re-embolization and the need for surgical excision. Therefore, surgeons should carefully consider treatment options and discuss the pros and cons of each with the patient and their family, taking into account the available infrastructure and expertise.

Conclusion: We report a rare and interesting case of acutely bleeding angiomyolipoma. The patient was successfully treated with angioembolization followed by laparoscopic nephron-sparing surgery. However, the tumor recurred a year later, necessitating conversion to open nephron-sparing surgery.