Clinical course of angiomyolipom in our cases

Abstract

Introduction: The aim of the study is to determine the factors that affect the clinical course of angiomyolipomas (AML)Materials and Methods: Between January 1992 and November 2003, 24 patients were diagnosed clinically and radiologically to have angiomyolipoma. They were followed prospectively for a mean of 4.6 years (range: 2-11 years). Patients were divided into 3 groups; Group 1: Patients with a solitary lesion, Group2: Patients with multiple lesions associated with tuberous sclerosis and Group 3: Patients with multiple lesions having no tuberous sclerosis. According to the size of the lesion (lesions <4 cm and lesions >4cm) patients were also subdivided into 2 groups. The lesions were followed regularly every 6 month with ultrasonography. These 3 groups were compared in terms of symptoms, size and the percentage of the growth of the lesion.Results: The median age of the patients was 43 (31-59). 13 patients in group 1, 1 patient in group 2 and 4 patients in group 3 had lesions <4 cm and 1 patient in group 1, 2 patients in group 2 and 3 patients in group 3 had lesions >4 cm. In 3 patients from group 2 and 2 patients from group 3 the lesions were bilateral. 7 cases out of 24 (29.1%) were diagnosed incidentally. Patients were found to have 8 different symptoms which were observed 37 times among all patients. The most common symptom, abdominal and flank pain, was observed in 54.1 % (13 patients) of patients. In patients with lesions <4 cm the prevalence of these symptoms were 16.2% (6), 2.7% (1), 5.4% (2) and in patients with lesions >4 cm were 8.1% (3), 37.8% ( 14), 29.7% (11) in group1, 2 and 3 respectively. Considering the growth of the lesions; in group 1with lesions <4 cm only 1 patient out of 13 showed 0.6 cm (18.1%) growth during follow-up. Similarly 1 patient of group1 with lesion >4 cm showed no increase in size of the lesion. In group 2 all patients showed an increase in size of the lesions, which was 1 cm (33.3%) in the group with the lesion <4 cm (1 patient) and 4.6 +/- 3.4 cm (41.8%) in the group with the lesion >4 cm (2 patients). Among group 3 patients with the lesions <4 cm, 3 of 4 showed a mean increase in the diameter of previous lesion of 0.9 +/- 4.2 cm (28.1%), while in 1 patient the lesion remained unchanged. Similarly in group 3 patients with the lesions >4 cm, 2 out of 3 showed a mean increase of 1.8 +/- 5.3 cm (33.3%), while 1 remained unchanged.Conclusion: In AML patients the most important factors which determine the lesion to grow and be symptomatic are the size, the number (multiplicity) of the lesions and the presence of tuberous sclerosis.