Overall incidence of Angiolipoma is reported in 1:1000 and it is extremely rare in pregnancy which poses a grave threat to the mother and baby. This is due to the influence of oestrogen on the growth of the angiolipoma which may rupture due to the vascularity and the catastrophic outcome for both the mother and baby.
This was a patient who was managed at the Royal Brisbane and Womens’ Hospital, Queensland, Australia in 2017.
30 year old Primipara with a BMI of 19.8 from Thailand presented with an asymptomatic Right Renal Angiolipoma which was 4 mm in size prior to pregnancy. Her foetal scans were normal except the last growth scan which revealed a Small for Gestational Age and oilgohydramniosis. Her renal functions were normal. The size of the angiolipoma increased in size over the pregnancy to 6.5mm. The labour was induced at 40 weeks and 2 days and closely monitored for any evidence of intraperitoneal bleed. Baby was delivered within 9 hours by forceps for CTG abnormalities and weighed 2460g. Though the Apgars were normal and the cord gases were mildly abnormal. Mother did not have another other complications and had an uneventful postnatal recovery.
The postnatal scan for the size of renal angiolipoma was organised 3 months postnatal period with the GP and she was advised to avoid oestrogen containing contraceptives and she accepted the Levonorgestrol intra uterine system.
This case demonstrates that these tumours increase in size during pregnancy which need to be closely monitored for the risk of rupture. Current evidence revealed the size of tumour greater than 3cm have increase chances for spontaneous rupture resulting in catastrophic intraperitoneal haemorrhage either during pregnancy or postnatal period. Treatment options are resection of tumour if more than 4 cm in size or embolisation. The tumours of less than 2 cm like our patient needs 3-4 year follow up scans as they are slowly growing.