Editing Benign Kidney Tumours (section)

=== Management ===
* '''Consider size of the tumour, presence of symptoms, and patient factors'''
** Most studies have focused on a 4-cm cut point but size represents a continuum of risk
* '''<span style="color:#ff0000">Asymptomatic, smaller tumors (typically <4 cm)</span>'''
** '''<span style="color:#ff0000">Observation (preferred) with repeat initial imaging at 6 to 12 months to define the growth rate and clinical significance.</span>'''
*** Repeat imaging can be lengthened once stability has been established, with follow-up performed only annually or biannually for smaller tumors
*** Solitary, sporadic AMLs have a mean growth rate of 5%/year; multifocal AMLs and those in patients with TSC have mean growth rate of 20%/year
* '''<span style="color:#ff0000">Symptomatic or larger tumors (>4cm)</span>'''
** '''<span style="color:#ff0000">Consider intervention taking into account the patient’s age, comorbidities, and other related factors</span>'''
*** '''<span style="color:#ff0000">A proactive approach should also be considered In (2):</span>'''
***# '''<span style="color:#ff0000">Females of childbearing age</span>'''
***# '''<span style="color:#ff0000">Patients with limited access to surveillance or to emergency care</span>'''
* '''<span style="color:#ff0000">Options for intervention (4):'''
*# '''<span style="color:#ff0000">Partial nephrectomy'''
*# '''<span style="color:#ff0000">Selective embolization'''
*#* '''Disadvantages'''
*#**'''Many require repeat procedures'''
*#**'''Risk of complications from procedure'''
*#*** Overall complication rate with embolization in some series is 10%, similar to rates of partial nephrectomy
*#**** Potential complications of embolization include hemorrhage, abscess formation, or sterile liquefaction of the tumor requiring percutaneous drainage or surgical intervention.
*#**'''Extended follow-up after selective embolization is needed, which would not be required after partial nephrectomy'''
*# '''<span style="color:#ff0000">Thermal ablation'''
*#* Limited data on efficacy
*#** Follow-up remains short, the evaluation of success remains poorly defined, and the duration for continued radiographic surveillance is unknown, thus committing the patient to multiple, long-term imaging
*# '''<span style="color:#ff0000">Sirolimus'''
*#* Has been investigated and can be used to reduce size of AML for possible surgery later