Angioembolization prior to nephrectomy in Wunderlich syndrome: a case report of collision angiomyolipoma and clear cell renal cell carcinoma

Abstract

A 29-year-old man with previously undiagnosed tuberous sclerosis complex arrived at the emergency department due to anemia-related gross hematuria. A computed tomography scan revealed a bilateral renal mass consistent with angiomyolipoma and a right retroperitoneal hematoma. Angioembolization of the right renal artery was performed prior to nephrectomy. The histopathologic results were collision angiomyolipoma and clear cell renal cell carcinoma.
 Relevance: The multisystemic presentation of tuberous sclerosis complex combined with the histologic findings of collision angiomyolipoma and clear cell renal cell carcinoma is a rare entity in the medical literature.
 Clinical implications: Angioembolization results in fewer postoperative complications of ileus, pain, or infection, and its utility in the present case was important for facilitating the approach during nephrectomy and reducing the risk for intraoperative bleeding.
 Conclusions: The present case report provides a description of Wunderlich syndrome in a patient with tuberous sclerosis complex and the histopathologic diagnosis of a collision tumor, consisting of angiomyolipoma and clear cell renal cell carcinoma. Angioembolization of the right renal artery was performed before nephrectomy, reducing the risk for intraoperative bleeding.