Investig Clin Urol.  2018 Nov;59(6):357-362. 10.4111/icu.2018.59.6.357.

Does epithelioid angiomyolipoma have poorer prognosis, compared with classic angiomyolipoma?

• Lee W
• Choi SY
• Lee C
• Yoo S
• You D
• Jeong IG
• Song C
• Kim KS
• Hong B
• Hong JH
• Ahn H
• Kim CS

• KMID: 2424289
• DOI: http://doi.org/10.4111/icu.2018.59.6.357

Abstract

PURPOSE
Classic angiomyolipoma (AML) is common benign kidney tumor. However, some studies have claimed that epithelioid angiomyolipoma (EAML) has malignant potential. We compared the patient characteristics and prognosis of EAML and classic AML to demonstrate predicting factors and poorer prognosis of EAML.
MATERIALS AND METHODS
The medical records of 231 patients who were diagnosed with EAML (n=27, 11.7%) or classic AML (n=204, 88.3%), were reviewed. All patients underwent computed tomography (CT) scans before operation or needle biopsy. We assessed the age, sex, tumor size, body mass index, comorbidities, and Hounsfield unit (HU) according to each CT phase. We defined the unfavorable group as patients with recurrence, metastasis and death due to tumor progression. Logistic regression analysis was used to predict EAML.
RESULTS
EAML patients were younger (41.2 years vs. 49.1 years, p=0.001), predominantly male (55.6% vs. 28.4%, p=0.005), and had a larger tumor (7.5 cm vs. 4.2 cm, p < 0.001). The median pre-contrast HU was not significantly different between EAML and classic AML (29.9±23.7 vs. 14.7±41.0, p=0.071). In multivariable analysis, younger age (odds ratio [OR], 0.96; p=0.032), male sex (OR, 3.33; p=0.013), and tumor larger than 4 cm (OR, 3.8; p=0.009) were significant predictive factors. Five patients (18.5%) had unfavorable outcomes, two patients had lymph node metastasis, and three patients had lung metastasis.
CONCLUSIONS
Patient and tumor characteristics can be helpful in determining the type of AML preoperatively. Younger age, male sex, and larger tumor mass may increase the possibility of diagnosing EAML. EAML has malignant potential and requires careful follow-up.

Keyword

Angiomyolipoma; Malignancy; Prognosis

MeSH Terms

Angiomyolipoma*
Biopsy, Needle
Body Size
Comorbidity
Follow-Up Studies
Humans
Kidney
Logistic Models
Lung
Lymph Nodes
Male
Medical Records
Neoplasm Metastasis
Prognosis*
Recurrence

Figure

• 

  Fig. 1 Histology of classic angiomyolipoma (AML) and epithelioid angiomyolipoma (EAML). (A) Classic AML composed of different proportions of smooth muscle cells, adipose tissue, and blood vessels (H&E, ×100). (B) EAML composed of a large number of hyperplastic epithelioid cells (H&E, ×100). (C) with positive staining for HBM-45 (Human Melanoma Black-45, ×100).

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