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Adverse Occurrence type:
Histological diagnosis of angiomyolipoma is a benign lesion. As only biopsy has been performed from a conservative point of view it may be stated that it is not defintively representative for the tumour. Only if the whole space occupying lesions (SOL) has been examined this can be stated. In this particular case critical consideration will have to be given to the risks associated to a watch and see policy versus removal in an otherwise well working kidney graft and a most likely benign SOL.
Time to detection:
Immediately during implantation biopsy revealed an angiomyolipoma and this space occupying lesion (SOL; <0.5 cm) is followed up for >5 years.
Alerting signals, symptoms, evidence of occurrence:
Intraoperatively routine wedge biopsy (measured 0.8x0.3x0.3 cm). It was composed entirely of tumour, with no normal renal tissue included. Immunohistochemistry showed positivity for alpha smooth muscle actin. Histological features were typical of an angiomyolipoma. Ultrasound scan of the transplant kidney revealed a single echogenic focus, 4 mm diameter, consistent with post biopsy haematoma or residual tumour.
Suggest new keywords:
Kidney transplant/Kidney recipient/Kidney transplantation
Lappin DW, Hutchison AJ, Pearson RC, O'Donoghue DJ, Roberts IS. Angiomyolipoma in a transplanted kidney. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 1999;14(6):1574-5.
MC- Angiomyolipoma is a rare bening tumour. I can't find where to indicate the option. Need a revision. In adverse ocurrence type, shall we tick N/A or Risk of harm - others? (Mar); we go on N/A as it does not apply - we keep the record in the library because biopsy & most likely benign tumour (angiomylipoma) may justify the surveillance if the patient agrees on. (Carl-ludwig). ----- Each Notify record must have an adverse occurrence (and MPHO) classification --> the record has been classified under Malignancy/Kidney and urinary tract/Angiomyolipoma as this option was already included in the comprehensive adverse occurrence taxonomy (EP)
Expert comments for publication:
As the SOL was biopsied (<0.5 cm) with a benign result the authors decided to put the kidney recipient on surveillance. The left over risk is that the biopsy may not be representative for the whole SOL. Therefore it can only be assumed to be benign, but it is justified to balance the risks associated to removal of a SOL to the risk associated to watch and see policy of a SOL in a most likely benign tumour. The patient needs to be educated about the issue and informed consent according to Varese Charta (under publication) should be obtained.