Not long ago, Ms. Ma, 33 years old, went to the Urology Department of Shanghai Tongren Hospital because of swelling and pain in her right waist, and found that the tumor of her right kidney with a diameter of 20 cm was much larger than that of a tennis ball. The diagnosis was a giant hamartoma of the kidneys, and it is no wonder that the waist has been swollen and painful.
Because the tumor is too large, direct surgical resection may be more risky and the amount of bleeding is also large. In order to give the patient the best treatment plan, the urology department and the interventional department are strongly combined, first using the interventional method to embolize the tumor body to reduce its blood supply, and then perform surgical resection. With the perfect cooperation of the two departments, the operation went very smoothly, the intraoperative bleeding volume < 100ml, and the patient recovered very well, and was quickly discharged from the hospital.
So, what exactly is this renal hamartoma?
Renal hamartoma is the most common benign tumor of the kidney, because the tumor tissue contains three components of blood vessels, smooth muscle and fat, also known as angioleis myotoma, referred to as renal hamartoma.
Because renal hamartomas contain special fat components, they are specific in ultrasound, CT, or magnetic resonance imaging, which is one of the few benign tumors that can be confirmed by imaging. With the widespread application of modern examination techniques, more and more asymptomatic renal hamartomas are being discovered.
This is a congenital disease that occurs in both men and women, and is more common in women. The disease can be a single kidney or a double kidney. Renal hamartoma will grow slowly, enlarge, generally no symptoms, most patients in the physical examination accidentally found, some patients because of the tumor body blood vessel rupture and bleeding, severe low back pain and hematuria and other symptoms and emergency medical treatment; severe cases can appear hemorrhagic shock in a short period of time and life-threatening.
Small renal hamartomas present as small nodules or round-like lesions with an envelope or pseudocapsulation that is clearly demarcated from the normal kidney. After the tumor gradually enlarges, it will infiltrate and grow like a tree root, which can infiltrate and destroy the kidney tissue; the larger the tumor grows, the deeper it is immersed in the kidney, the more it destroys the normal kidney. If there is a multiple hamartoma of both kidneys, a large number of normal kidney tissues will be destroyed, which can eventually lead to renal insufficiency and even kidney failure.
Imaging tests are confirmed by ultrasound, CT, or magnetic resonance imaging.
Ultrasound often shows renal mixed echo masses of varying sizes, interspersed with highly echoed adipose tissue features; abnormal arteriovenous malformations, arteriovenous fistulas, or aneurysms may be seen; intrarenal or perrenal hypoecholic masses are seen in patients with bleeding.
The uneven density of kidney masses can be seen on CT images with low-density fat components. Magnetic resonance can confirm the diagnosis by identifying the fat component in the lesion.
When renal hamartoma is found, it is recommended to treat it as soon as possible to nip the renal hamartoma in the budding state to prevent infiltration and destruction of the kidneys when enlarged. And because renal hamartomas have a large number of arteriovenous malformations or aneurysms, there is a risk of major bleeding and should also be treated as soon as possible.
Traditional treatment is open surgery or laparoscopic surgery, with partial kidney removed or entire kidney removed. The emerging minimally invasive interventional therapy can maximize the preservation of normal kidney tissue and prevent renal bleeding, and it is more appropriate to choose interventional embolization for renal hamartomas that are large in size and are not clearly demarcated from normal kidneys.
Interventional surgery is under the guidance of medical imaging equipment, through the femoral artery puncture, the introduction of a thin catheter to the renal artery, after contrast to confirm the blood supply artery of the tumor, and then according to the structural shape of the tumor body, select different embolic agents, including gelatin sponge, anhydrous alcohol, microspheres, spring coils, etc., through the catheter these embolic agents are injected into the blood supply artery of the tumor, the blood supply artery is blocked, the tumor loses nutrients, and naturally atrophises and dies. Throughout the procedure, the patient is awake, does not require general anesthesia, and does not have obvious pain.
Interventional embolization can achieve the purpose of treatment, but also preserve normal kidney tissue, but also can be carried out in conjunction with surgery, just like the case mentioned at the beginning of the article, so that the patient has little trauma, fast recovery, and can be recovered and discharged from the hospital in 3 to 5 days after surgery.
Therefore, more and more people understand intervention and choose to intervene. In 2018, US President Trump's wife Melania, because of sudden severe low back pain and kidney bleeding, was diagnosed with renal hamartoma, and also chose interventional embolization treatment, kidney bleeding was cured, and the body recovered quickly.
In clinical work, whether it is individual surgery or auxiliary treatment with fraternal departments, interventional medicine can be seen in many cases. What else would you like to know about intervention? Welcome to communicate together!
Let more people know about interventional therapy
The Department of Interventional Medicine of Shanghai Tongren Hospital is a key medical specialty in Shanghai, and the characteristics of diagnosis and treatment include comprehensive interventional treatment of various benign and malignant tumors, such as liver cancer, lung cancer, pancreatic cancer, etc.; interventional treatment of malignant gastrointestinal obstruction; interventional treatment of acute bleeding diseases; minimally invasive treatment of uterine fibroids and adenomyosis.
【Clinic Hours】
Director Shang Mingyi Specialist Clinic: Every Monday morning
Interventional Specialist Clinic: Every Tuesday morning
To make an appointment, please pay attention to the public number:
(The accompanying picture originates from the Network, if there is infringement, please notify and delete)
Contributed by: Interventional Department Liu Bingyan
Review: Publicity Section