Radiofrequency ablation for treatment of sporadic angiomyolipoma

Abstract

Introduction: Symptomatic angiomyolipoma (AML) and asymptomatic AML larger than 4 cm in size are usually treated with nephron-sparing surgery or arterial embolization. We used another technique, that is, radiofrequency ablation (RFA), for treatment of a sporadic AML in a patient with a solitary kidney, in whom maximal sparing of normal renal tissue was required.

Technical considerations: Contrast-enhanced computed tomography (CT) showed an enhancing well-defined mainly lipomatous tumor, with a maximum diameter of 4.5 cm in the upper pole of the left kidney. Diagnosis of AML was confirmed with fine-needle aspiration biopsy. RFA was performed with a RF 3000 system, consisting of a generator that supplied up to 200W of power, connected to a 15-gauge LeVeen multipolar array electrode that was placed under CT-guidance centrally in the AML. Initial power was set at low power and increased with increments of 10W, according to the algorithm provided by the manufacturer, resulting in a final tumor end temperature above 65 degrees C. No complications occurred and the patient was discharged home the day after. During follow-up (12 months) function of the solitary kidney of the patient was preserved and patient did not have any AML-related symptoms develop. Contrast-enhanced CT scan showed complete (100%) tumor ablation with absence of enhancement in the tumor and decreased tumor size from 4.5 cm to 2.9 cm at 12 months.

Conclusions: CT-guided RFA is a minimally invasive ablation procedure that allowed successful treatment of a sporadic AML in a patient with a solitary kidney. No complications occurred and no AML recurrence was observed during the 12-month follow-up.