Renal Angiomyolipoma in Pregnancy: a Case Report and Systematic Review

Renal angiomyolipoma (AML) is a benign tumour in the kidney with the potential of an acute life-threatening haemorrhage. Preventive treatment is therefore recommended in cases of an AML larger than 4 cm. The clinical approach to the management of AML in pregnancy remains a challenge and no recommendations are given in the major urological guidelines. We conducted a systematic review of the published literature to further elucidate this topic. Furthermore, we present a clinical case report of the management of a large AML diagnosed in a pregnant woman. A total of 41 case reports fulfilled the inclusion criteria and data were extracted together with data from our case report. In 79% of the cases, AML was diagnosed during pregnancy. A total of 69% presented with AML rupture and 67% of all cases required surgical treatment during pregnancy by means of embolization, tumour resection, or total nephrectomy. In some cases, the treatment was combined with caesarean section in late pregnancy. In general, there was a tendency toward delivery by caesarean section. The clinical approach to the management of AML in pregnancy remains a challenge due to the lack of systematic research. Based on the present review, we recommend discussing each case of AML in pregnancy in a multidisciplinary conference and to involve the patient in the decision of the management strategy. A predefined plan for the management of acute haemorrhage from the AML ought to be documented in the patient’s medical journal.