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However, current clinical tools for accurately predicting hemorrhage risk remain limited. This study aimed to establish and validate a clinical nomogram for\u00a0predicting hemorrhagic rupture in AML based on preoperative characteristics, and to investigate the underlying molecular correlates involving\u00a0\n                      <jats:italic>CD34<\/jats:italic>\n                      ,\u00a0\n                      <jats:italic>PPARG<\/jats:italic>\n                      , and\u00a0\n                      <jats:italic>PTEN<\/jats:italic>\n                      \u00a0expression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1462_abs_003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A total of 379 patients with AML and 40 normal kidney tissue samples (2010\u20132021) were retrospectively analyzed. Patients were temporally divided into a training cohort (n=285) and an independent temporal validation cohort (n=94). Independent clinical predictors of hemorrhagic rupture were identified through univariate and multivariate logistic regression and incorporated into a nomogram. Model performance was evaluated using receiver operating characteristic (ROC) analysis and calibration plots in the validation cohort. Additionally, immunohistochemistry, qPCR, and ELISA were conducted to assess\n                      <jats:italic>CD34<\/jats:italic>\n                      ,\n                      <jats:italic>PPARG<\/jats:italic>\n                      , and\n                      <jats:italic>PTEN<\/jats:italic>\n                      expression to explore biological mechanisms associated with rupture.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1462_abs_004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Tuberous sclerosis complex (TSC), tumor size\u00a0\u22654\u202fcm, rich vascular supply, and exophytic growth pattern were identified as independent predictors of hemorrhagic rupture (all p&lt;0.05). The nomogram demonstrated excellent discrimination (AUC=0.967) and satisfactory calibration in the independent validation cohort. At the molecular level, immunohistochemical analysis revealed elevated\n                      <jats:italic>CD34<\/jats:italic>\n                      and\n                      <jats:italic>PPARG<\/jats:italic>\n                      expression and reduced\n                      <jats:italic>PTEN<\/jats:italic>\n                      expression in AML compared with normal tissues (p&lt;0.05). Consistently, qPCR and ELISA assays confirmed significant upregulation of\n                      <jats:italic>CD34<\/jats:italic>\n                      and\n                      <jats:italic>PPARG<\/jats:italic>\n                      and downregulation of\n                      <jats:italic>PTEN<\/jats:italic>\n                      in hemorrhagic AML relative to non-hemorrhagic AML (p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"j_med-2026-1462_abs_005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      The developed nomogram serves as a reliable pre-operative tool for individualized risk stratification of AML rupture. Furthermore, the aberrant expression of\n                      <jats:italic>CD34<\/jats:italic>\n                      ,\n                      <jats:italic>PPARG<\/jats:italic>\n                      , and\n                      <jats:italic>PTEN<\/jats:italic>\n                      provides mechanistic insights into the vascular remodeling and fragility underlying AML hemorrhage, suggesting potential targets for future therapeutic research.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1515\/med-2026-1462","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T11:44:40Z","timestamp":1780659880000},"source":"Crossref","is-referenced-by-count":0,"title":["Development of a clinical nomogram for predicting hemorrhagic rupture in renal angiomyolipoma and analysis of molecular correlates (\n                    <i>CD34<\/i>\n                    ,\n                    <i>PPARG<\/i>\n                    , and\n                    <i>PTEN<\/i>\n                    )"],"prefix":"10.1515","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3723-9626","authenticated-orcid":false,"given":"Xiaobing","family":"Li","sequence":"first","affiliation":[{"name":"Science and Technology Industry Development Center , Chongqing Medical and Pharmaceutical College , Chongqing , China"},{"name":"College of Public Health , Chongqing Medical University , Chongqing , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wan","sequence":"additional","affiliation":[{"name":"Special Medical Department, Daping Hospital , Army Medical University , Chongqing , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Li","sequence":"additional","affiliation":[{"name":"Science and Technology Industry Development Center , Chongqing Medical and Pharmaceutical College , Chongqing , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Urology , The First Affiliated Hospital of Chongqing Medical University , Chongqing , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xianhui","family":"Hu","sequence":"additional","affiliation":[{"name":"Urology Department , Chengdu Integrated TCM & Western Medicine Hospital , Chengdu , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"2026060511465546158_j_med-2026-1462_ref_001","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez-Pello, S, Hora, M, Kuusk, T, Tahbaz, R, Dabestani, S, Abu-Ghanem, Y, et al.. 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