Patient: 40 years old JGMJ, male, married, is seen by the emergency service of Rotger Clinic on December 29, 1998, for suffering left lumbar trauma at work.
The patient complained of mild pain in the left lumbar fossa with normal and stable vital signs.
Ultrasound confirms a large tumor of the left kidney of more than 30 cm in maximum diameter, characterized as angiomyolipoma occupying all this kidney and other similar parenchymal lesions that are distributed in the right kidney.
On physical examination we found facial tuberosities distributed in butterfly wings over the upper and lower lips and diagnosed as tuberculous or Bourneville disease.
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She was admitted to the Urology Center 4 days later and had a clinical history of fever of 38.5 °C as a manifestation of urinary tract infection that resolved with antibiotic therapy.
She came to consultation and in the clinical examination revealed a large mass of medial edges impisos, slightly painful to deep pressure located in the left lumbar region and left empty, reaching the left iliac fossa and crossing the line.
You are asked to have a C.T., IVP, and a complete blood test.
The CT scan of December 30, 1998 showed multiple skull level and small calcified nodular images of subepidermal location, compatible with typical manifestations of tuberous sclerosis.
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As well as at the level of the left cerebellar hemisphere also compatible with cortical calcifying hamartomas.
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Abdominally, the right kidney shows multiple nodular images predominantly cortical and partially fatty content compatible with angiomyolipomas.
The excretory system is normal.
On the left side, there is severe enlargement and morphological distortion of the left kidney with a large fat component in its upper pole that causes compression and anterosuperior displacement of the spleen and medial displacement of the rest of the renal sinus structures as well as in the abdomen.
Another sign of visceral involvement is the hepatic nodule.
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Intravenous pyelography showed that the left kidney was not functioning, so it was decided to perform left excision and lymphadenectomy on January 29 1999.
Extracellular kidney with an immediate weight of 6,300 g.
Through an anterior approach.
On 5 February 1999 a report of the extracted piece was received: 31 x 19 cm and 5,235 g of weight.
A 27 cm diameter contour tumor with a polymorphous macrosis was found, alternating pairs of faces and faces.
Residual compressed kidney measuring 14 x 5.5 cm in diameter is identified, which includes another well-defined nodular tumor, homogeneous gray 3.5 cm. Four lymph nodes are isolated and more than 2.8 cm smooth muscle cells are integrated microscopically.
The latter predominates fasciculate zones together with other polygonal zones, with frequent multinucleation and occasional non-anaplastic aberrant elements.
The tumor has borders extending to the adjacent renal parenchyma and fat.
The renal tissue is characterized by asymmetrical compression.
Tumor free lymph nodes
No morphological signs of malignancy were identified.
We conclude: renal angiomyolipoma in two tumors of 27 and 3.5 cm in greater diameter, absence of lymph node metastases.
On March 6, 2001 she had hypertension 170/110, seen by Cardiology with minimal mitral and aortic regurgitation.
On April 2, 2001 intravenous pyelography showed a large right kidney with angiomyolipomas.
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She is treated with internal medicine for hypertension: tenormin and astudal.
TAC was performed on 17 April 2002: multiple angiomyolipomas.
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He is currently controlled for hypertension, with good health.
