ABSTRACT
Renal angiomyolipomas are uncommon tumours during pregnancy, but it’s important to consider them in the differential diagnosis, for the increased risk of complications such as bleeding, specially during pregnancy. Their characteristics are different depending on if the tumour is associated or not with facomatosis. To show both possibilities, we describe two cases of pregnant women with angiomyolipomas: the first one presented with bleeding of the tumour (Wünderlich’s syndrome), but surveillance without treatment was possible until 37th week of gestation, and embolization of the tumour was performed afterwards. The second patient had multiple well known angiomyolipomas, associated to tuberous sclerosis; even though she had required two previous embolizations, she had an uneventful pregnancy, without any episodes of bleeding. Both pregnancies ended successfully by means of a cesarean section. Since there are few papers available in the literature, there is not an agreement about therapeutic management when pregnant women present with bleeding angiomyolipomas (Wünderlich’s syndrome). Treatment options include partial or total nephrectomy (with cesarean section simultaneously in patients at 28 weeks of gestation or later), transcateter selective arterial embolization (which can also be preventive), and sometimes, conservative management. If this last option is possible, there’s still discussion about the risk of vaginal delivery compared with that of cesarean section, in terms of bleeding of the tumour.
Key words: Angiomyolipoma, tuberous sclerosis, pregnancy.
RÉSUMÉ
Les angiomiolipomes sont des tumeurs rares dans d’importantes femmes enceintes, mais à tenir compte pour le risque de complications, comme la saignée utérine pendant la grossesse. Ses caractéristiques diffèrent comme elles soient développés ou non dans le contexte de facomatosi. Pour illustrer les deux possibilités on communique deux cas cliniques de femmes enceintes avec angiomiolipom: une de d’elles a commencé avec des saignées (syndrome de Wünderlich), il a été surveillé et il a été seulement traité jusqu’à la semaine 37 de la grossesse, postérieurement la tumeur se. L’autre patient avait de multiples angiomiolipom; bien qu’avoir requis deux embolisacion précédents à la grossesse, il n’a pas souffert d’épisodes de saignée pendant celui-ci. Les deux grossesses ont à succès ment fini au moyen de césarienne.
Mots clef : angiomiolipom, sclérose tubéreuse, grossesse.
RESUMO
Angiomiolipom são tumores infrequentes ter em conta pelo risco de complicações durante a gravidez nas mulheres grávidas mas importantes, a como o sangrado uterino. Suas caraterísticas diferem segundo desenvolvem-se não no contexto de facomatose. Para ilustrar ambas possibilidades comunicam-se dois clínicos casos de grávidas com angiomiolipom: um de elas começou com sangrares, vigiou-se (sindrome de Wünderlich) e somente tratou-se até a semana 37 da gravidez, posteriormente o tumor embolizaçao. O paciente múltipla tinha angiomiolipom; ter requerido dois embolizacao anteriores à gravidez embora não sofreu episódios de sangrar durante este. Ambas gravidezes finalizaram com ajuda de cesariano com sucesso.
Palavras-chave: angiomiolipom, esclerose tuberosa, gravidez.
