Angiomyolipoma (AML) is a mesenchymal renal tumor composedof variable proportions of adipose tissue as well asvascular and smooth muscle elements. It can cause important,potentially life-threatening complications. The aim ofthis case report is to show a conservative treatment modalityof this disease. A 50-year-old man underwent ultrasonographyand then computed tomography showing the presenceof bilateral renal masses of 27.5 × 19.5 × 21 cm on theleft kidney and 28.5 × 19.6 × 27.5 cm on the right, respectively.Serum creatinine was normal; an ultrasonographyguidedbiopsy of the left kidney did not allow a diagnosiswith absolute certainty, but was suggestive of AML. The patientalso underwent total body magnetic resonance imaging,which was negative for pathological findings. He underwenta strict regime of surveillance with magnetic resonanceimaging every 4–5 months, and at the last follow-up he wasasymptomatic and serum creatinine was still normal. Themanagement of giant AML is a complex and multifactorialdecision. Patients can knowingly choose an active surveillanceprogram, even in case of giant AMLs.
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