Symptoms and Treatment of Angiomyolipoma (AML) in New York City
Dr. Alex Shteynshlyuger is a board-certified urologist in NYC. He specializes in the treatment of men and women with kidney cysts, masses, renal cancer and angiomyolipoma (AML).
What is Renal Angiomyolipoma (AML)?
Renal Angiomyolipoma or AML is a non-cancerous tumor or benign growth that usually occurs in kidneys. AML mostly occur in women of reproductive age but can also occur in men. Angiomyolipoma is composed of 3 components fat cells, abnormal blood vessels, and muscle cells. It is important to distinguish AML (aangiomyolipoma from a benign tumor of the adrenal gland called myelolipoma. While I treat patients with both of these conditions, the treatment of these two conditions differ.
Renal angiomyolipoma usually occurs sporadically without any predisposing risk factors. Typically angiomyolipomas have a genetic mutation in tuberous sclerosis complex genes (TSC1 or TSC2 genes). Some patients with angiomyolipomas have the tuberous sclerosis complex. These patients usually have multiple angiomyolipomas in both kidneys. It is important to note that most patients with angiomyolipoma have only one AML tumor in one of the kidneys.
Is there a need to worry about an angiomyolipoma?
While angiomyolipoma is not cancer but usually a benign (noncancerous growth) within the kidneys, it can sometimes be a life-threatening condition. Angiomyolipomas may start bleeding spontaneously. The risk of bleeding increases as the size of the mass increases. The timing of bleeding is unpredictable and can be life-threatening. It is important to have a thorough urological evaluation and follow-up plan with an experienced specialist.
What are the symptoms of angiomyolipoma (AML) of the kidney?
Most commonly angiomyolipoma is found incidentally on the renal ultrasound or CT scan. Occasionally angiomyolipomas can cause abdominal pain or back pain when they grow large in size or start bleeding.
What are the general recommendations for the treatment of angiomyolipoma?
Treatment of angiomyolipoma is individualized for every patient based on underlying medical history, family history, and risk factors.
If angiomyolipoma is causing symptoms such as pain or bleeding, treatment is recommended regardless of size.
In general, angiomyolipoma tumors less than 4 cm have a low risk of bleeding spontaneously and can be carefully observed with MRI, CT scan or ultrasound. Tumors that grow larger than 4 cm are at increased risk of bleeding spontaneously. The general recommendation is to treat AML that is larger than 4 cm in diameter.
What are the treatment options for angiomyolipoma?
For most patients the treatment options for angiomyolipoma include:
(1) partial nephrectomy or sometimes radical nephrectomy to remove angiomyolipoma. This can usually be performed through small keyhole incisions using laparoscopy or robotic surgery. Dr. Alex Shteynshlyuger uses DaVinci Robot for this procedure. Surgery is an effective treatment for angiomyolipomas.
(2) Angio-embolization of angiomyolipoma is another effective treatment option for these tumors. The benefit of angioembolization is its minimally invasive approach. Angioembolization is not as effective as surgery. However, surgery can be performed if angioembolization fails.
For patients with tuberous sclerosis complex (TSC) and multiple small angiomyolipomas, a good treatment option involves treatment with medications such as Affinitor (everolimus) which suppress the growth of angiomyolipomas and can shrink existing AML tumors.
Dr. Alex Shteynshlyuger is a fellowship trained, board-certified urologist specializing in the treatment of kidney masses including angiomyolipoma. He utilizes most modern and effective treatment options for managing patients with angiomyolipoma including angioembolization, robotic surgery including partial nephrectomy. He also performs open surgery and radical nephrectomy when necessary. He also treats patients with tuberous sclerosis complex associated angiomyolipomas.