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Zhu J, Wang G, Sun G, Xie B, Xiao W, Li Y. Primary hepatic epithelioid angiomyolipoma: a small case series. ANZ J Surg 2022; 92:1803-1808. [PMID: 35578781 DOI: 10.1111/ans.17777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/07/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hepatic epithelioid angiomyolipomas (HEAMLs) are rare and usually arise in case reports, and thus, we aimed to study the clinicopathological features, treatment and prognosis of these lesions. METHODS We identified patients from institutional database with HEAMLs and retrospectively collected clinical data. RESULTS Of 12 patients, 10 were females, and the median age was 49 years. A liver mass was found on chance upon routine health screening in nine patients. Imaging features included clear border (9/12), internal heterogeneity (8/12), arterial enhancement (12/12), fat (5/12), intra-tumour vessel (3/12), draining hepatic vein (2/12) and pseudocapsule (1/12). The preoperative diagnoses contained HEAML (n = 5), hepatocellular carcinoma (n = 6), and hepatic cystadenocarcinoma (n = 1). All cases had received surgery and obtained a negative margin. All specimens showed positive findings for HMB-45 and Melan A. No tumour recurrence or mortality was described with a mean follow-up time of 23.5 months. CONCLUSIONS HEAML is a low potential malignancy tumour that frequently appears in middle-aged females. It has nonspecific symptoms and may present special imaging features including intra-tumour vessel, early draining hepatic vein and lack of a pseudo capsule. The lesion is confirmed by pathological and immunohistochemical findings. Surgery and subsequent long-term follow-up are the most appropriate management approaches.
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Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guiyan Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Gen Sun
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Bin Xie
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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Calame P, Tyrode G, Weil Verhoeven D, Félix S, Klompenhouwer AJ, Di Martino V, Delabrousse E, Thévenot T. Clinical characteristics and outcomes of patients with hepatic angiomyolipoma: A literature review. World J Gastroenterol 2021; 27:2299-2311. [PMID: 34040323 PMCID: PMC8130035 DOI: 10.3748/wjg.v27.i19.2299] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/31/2020] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
First reported in 1976, hepatic angiomyolipoma (HAML) is a rare mesenchymal liver tumor occurring mostly in middle-aged women. Diagnosis of the liver mass is often incidental on abdominal imaging due to the frequent absence of specific symptoms. Nearly 10% of HAMLs are associated with tuberous sclerosis complex. HAML contains variable proportions of blood vessels, smooth muscle cells and adipose tissue, which renders radiological diagnosis hazardous. Cells express positivity for HMB-45 and actin, thus these tumors are integrated into the group of perivascular epithelioid cell tumors. Typically, a HAML appears on magnetic resonance imaging (or computed tomography scan) as a hypervascular solid tumor with fatty areas and with washout, and can easily be misdiagnosed as other liver tumors, particularly hepatocellular carcinoma. The therapeutic strategy is not clearly defined, but surgical resection is indicated for symptomatic patients, for tumors showing an aggressive pattern (i.e., changes in size on imaging or high proliferation activity and atypical epithelioid pattern on liver biopsy), for large (> 5 cm) biopsy-proven HAML, and if doubts remain on imaging or histology. Conservative management may be justified in other conditions, since most cases follow a benign clinical course. In summary, the correct diagnosis of HAML is challenging on imaging and relies mainly on pathological findings.
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Affiliation(s)
- Paul Calame
- Department of Radiology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Gaëlle Tyrode
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | | | - Sophie Félix
- Department of Pathology, Jean Minjoz University Hospital, Besançon 25000, France
| | - Anne Julia Klompenhouwer
- Department of Surgery, Erasmus University Medical Center, Rotterdam PO Box 2040, The Netherlands
| | - Vincent Di Martino
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Eric Delabrousse
- Department of Radiology, Jean Minjoz University Hospital, Besançon 25030, France
| | - Thierry Thévenot
- Department of Hepatology, Jean Minjoz University Hospital, Besançon 25030, France
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3
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Günster SA, Kim M, Lock JF, Krajinovic K. Hepatic angiomyolipoma: A case report and literature review. Int J Surg Case Rep 2020; 77:345-348. [PMID: 33212308 PMCID: PMC7683232 DOI: 10.1016/j.ijscr.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022] Open
Abstract
HAML is a rare mesenchymal liver tumour which belongs to the family of perivascular epithelioid cell tumours. HAML is typically composed of blood vessels, smooth muscle, and adipose cells. HAML is characteristically positive for HMB-45. In patients with symptoms, uncertain diagnosis, or tumour growth, surgical resection should be performed.
Introduction Hepatic angiomyolipoma (HAML) is a rare mesenchymal liver tumour which belongs to the family of perivascular epithelioid cell tumours (PEComas). It is typically composed of blood vessels, smooth muscle, and adipose cells, and shows strong immunoreactivity for HMB-45. Presentation of the case A 57-year-old woman was referred to our hospital with an unclear liver lesion. A fine needle biopsy revealed a suspicion of hepatic angiomyolipoma with extramedullary haematopoiesis. Preoperative imaging revealed a tumour 17 cm in diameter in the left liver lobe segments II and III. A lobectomy of the left lobe segments II and III was performed. The pathological diagnosis of hepatic angiomyolipoma was obtained. Discussion Variations in the predominance of the tissue components in HAML impedes diagnosis based on imaging alone. The most promising evidence of HAML is the histological identification of lipomatous, myomatous, and angiomatous tissue combined with immunohistochemical positivity for HMB-45. Although the tumour is considered benign, some cases have been described with malignant behaviour. Surgical resection should be considered in case of symptoms, inconclusive biopsy, or growth in follow-up. Other surgical indications may include aggressive patterns such as vascular invasion, p53 immunoreactivity, or rapidly proliferating tumour cells. Conclusion HAML is a rare liver tumour. In patients with symptoms, uncertain diagnosis, or tumour growth, surgical resection should be performed according to oncological criteria.
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Affiliation(s)
- Simone A Günster
- Surgical Department 1, Clinical Center Fürth, Jakob-Henle-Straße 1, D-90766, Fürth, Germany
| | - Mia Kim
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Johan F Lock
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital of Würzburg, Würzburg, Germany
| | - Katica Krajinovic
- Surgical Department 1, Clinical Center Fürth, Jakob-Henle-Straße 1, D-90766, Fürth, Germany.
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4
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Seow J, McGill M, Wang W, Smith P, Goodwin M. Imaging hepatic angiomyolipomas: key features and avoiding errors. Clin Radiol 2019; 75:88-99. [PMID: 31677881 DOI: 10.1016/j.crad.2019.09.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/23/2019] [Indexed: 02/08/2023]
Abstract
Hepatic angiomyolipomas (HAMLs) are rare mesenchymal neoplasms, which have highly variable imaging appearances, often leading to misdiagnosis. They belong to the family of perivascular epithelioid cell neoplasms (PEComas). HAMLs have a wide spectrum of imaging appearances due to variable amounts of smooth muscle cells, adipose tissue, and blood vessels in their makeup. Although typically sporadic, they are also associated with tuberous sclerosis. Sporadic lesions tend to be solitary whilst patients with tuberous sclerosis often have multiple HAMLs invariably accompanied by renal AMLs. Having been originally considered benign hamartomas, increasing reports of complications, including malignant behaviour, has also resulted in uncertainty in regard to their optimal management. Typically described imaging characteristics are of a hypervascular fat-containing lesion with prominent intratumoural vessels and an early draining vein; however HAMLs commonly demonstrate a paucity of fat or wash-out on contrast-enhanced imaging, and not all HAML lesions are hypervascular. HAMLs can therefore easily be misdiagnosed as other hepatic lesions, in particular hepatocellular carcinoma. This review describes the imaging characteristics of HAMLs, illustrating the wide variety of potential appearances across ultrasound, contrast-enhanced ultrasound, computed tomography, and magnetic resonance imaging, and highlights the challenges and potential errors that can be made. This review will aid radiologists in avoiding potentially major pitfalls when faced with this rare but important liver pathology.
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Affiliation(s)
- J Seow
- Radiology Department, Royal Perth Hospital, Perth, Australia
| | - M McGill
- Radiology Department, Austin Health, Heidelberg, Melbourne, Australia
| | - W Wang
- Radiology Department, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - P Smith
- Epworth Medical Imaging, Geelong, Australia
| | - M Goodwin
- Radiology Department, Austin Health, Heidelberg, Melbourne, Australia; University of Melbourne, Parkville, Melbourne, Australia.
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Tran Cao HS, Marcal LP, Mason MC, Yedururi S, Joechle K, Wei SH, Vauthey JN. Benign hepatic incidentalomas. Curr Probl Surg 2019; 56:100642. [DOI: 10.1067/j.cpsurg.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
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Kong WT, Tang M, Qiu YD, Shi J, Wu M. The differential enhancement pattern of contrast enhanced ultrasound and magnetic resonance imaging characteristics in hepatic angiomyolipoma: 7 case reports. Clin Hemorheol Microcirc 2019; 71:17-26. [PMID: 30010112 DOI: 10.3233/ch-170317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Wen-Tao Kong
- Department of Ultrasound, Drumtower Hospital Affiliated to Medicial College of Nanjing University, Nanjing, China
| | - Min Tang
- Department of Radiology, Drumtower Hospital Affiliated to Medicial College of Nanjing University, Nanjing, China
| | - Yu-Dong Qiu
- Department of Hepatobiliary Surgery, Drumtower Hospital Affiliated to Medicial College of Nanjing University, Nanjing, China
| | - Jiong Shi
- Department of Pathology, Drumtower Hospital Affiliated to Medicial College of Nanjing University, Nanjing, China
| | - Min Wu
- Department of Ultrasound, Drumtower Hospital Affiliated to Medicial College of Nanjing University, Nanjing, China
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Kirnap M, Ozgun G, Moray G, Haberal M. Perivascular epithelioid cell tumor outgrowth from the liver. Int J Surg Case Rep 2018; 53:295-298. [PMID: 30453241 PMCID: PMC6240724 DOI: 10.1016/j.ijscr.2018.10.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/09/2018] [Accepted: 10/19/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Perivascular epithelioid celltumor (PEComa) is a rare mesenchymal neoplasia and can be found in various body sites. On the other hand, hepatic PEComa is very rare, with only a few studies having reported hepatic malignant PEComa. There is no gold standard regarding the use of diagnostic imaging studies. The diagnosis of hepatic PEComa is made by a positive immunohistochemical staining for HMB45 and Melan A. Herein, we discussed the therapeutic and follow-up process of a symptomatic hepatic PEComa case. PRESENTATION OF CASE A 22-year-old woman presented with a palpable mass in abdomen. A computerized tomographic examination showed a giant hepatic mass of left lobe origin, which was excised surgically. The pathology result was reported as a PEComa. DISCUSSION The diagnostic approach, treatment modalities, and follow-up procedures are not standard. The main treatment modality for PEComa is surgical excision with adequate surgical margin. CONCLUSION A longer follow-up is required for patients with hepatic PEComa because the nature of the disease is not entirely clear.
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Affiliation(s)
- Mahir Kirnap
- Departments of Transplantation, Baskent University, Ankara, Turkey
| | - Gonca Ozgun
- Departments of Pathology, Baskent University, Ankara, Turkey
| | - Gokhan Moray
- Departments of Transplantation, Baskent University, Ankara, Turkey
| | - Mehmet Haberal
- Departments of Transplantation, Baskent University, Ankara, Turkey.
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8
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Voulgari PV, Tatsi V, Milionis HJ, Goussia A, Xydis V, Glantzounis GK. Liver perivascular epithelioid cell tumor in a patient with systemic lupus erythematosus. Int J Surg Case Rep 2018; 53:193-5. [PMID: 30412918 DOI: 10.1016/j.ijscr.2018.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Perivascular epithelioid cell tumor (PECOMA) is a rare mesenchymal neoplasm which expresses both myogenic and melanocytic markers showing a benign course,although malignant tumors have also been reported. To date there are approximately 33 cases of published hepatic pecomas. PRESENTATION OF CASE We describe a 47-year-old man with a 27-year past medical history of systemic lupus erythematosus (SLE) who underwent left liver lobectomy due to a liver pecoma. His postoperative course complicated with infection, thrombosis of hepatic artery and liver ischemia as well as drug fever. DISCUSSION Treatment protocol especially for hepatic PECOMA has not reached a consensus although surgical resection is the preferred therapy. CONCLUSION This is the first case of coexistence of liver pecoma and SLE.
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Sakuraoka Y, Suzuki T, Tanaka G, Shimizu T, Shiraki T, Kyongha P, Mori S, Iso Y, Kato M, Aoki T, Kubota K, Yamagishi H, Shioyama Y. Hepatic myomatous angiomyolipoma diagnosedpreoperatively from specific imaging features: A case report. Int J Surg Case Rep 2018; 51:404-8. [PMID: 30273908 DOI: 10.1016/j.ijscr.2018.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022] Open
Abstract
An extremely rare case report of hepatic myomatous angiomyolipoma. Including specific imaging features to diagnose with hepatic angiomyolipoma. There is a significant interesting imaging findings of hepatic myomatous angiomyolipoma. Previous reports only revealed the pathological findings and a few imaging findings, however we show two specific features of imaging with rare pathological findings.
Introduction Hepatic angiomyolipoma is a rare tumour and is difficult to obtain the accurate diagnosis preoperatively because the imaging features are similar to hepatocellular carcinoma. Presentation of Case We present a case study of an 80-year old woman with a liver tumour measuring 6.2 cm × 6.0 cm. We were able to diagnose the tumour preoperatively as a rare hepatic myomatous angiomyolipoma based on the presence of early venous return evident on angiography and small low-intensity areas corresponding to fat within the tumour revealed by out-of-phase EOB-MRI. The tumour was removed by minimally invasive surgery and our preoperative diagnosis was confirmed by positive immunoreactivity for both angiomyolipoma-specific human melanoma black 45 and smooth muscle cell positivity for melanin. Discussion We consider that the information obtained in this case will be useful for preoperative diagnosis of other hepatic angiomyolipomas, thus facilitating more appropriate and less invasive surgery and improving the overall outcome. Conclusion Hepatic myomatous angiomyolipoma is a rare tumour. We illustrated the two specific imaging features to diagnose it preoperatively.
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Endo K, Kuroda H, Kakisaka K, Oikawa T, Sawara K, Ishida K, Sugai T, Takikawa Y. Hepatic Angiomyolipoma Staining in the Post-vascular Phase of Contrast-enhanced Ultrasound Due to the Presence of Macrophages. Intern Med 2018; 57:1247-1251. [PMID: 29279500 PMCID: PMC5980804 DOI: 10.2169/internalmedicine.9697-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
A 47-year-old Japanese man was referred to hospital after the detection of a liver tumor. Dynamic computed tomography and gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging were consistent with a diagnosis of hepatocellular carcinoma (HCC). No perfusion defect was observed in the post-vascular phase of contrast-enhanced ultrasound (CEUS). Histopathological staining of the tumor cells was positive for antibodies against HMB-45 and cluster of differentiation (CD) 68, confirming the diagnosis of hepatic angiomyolipoma (HAML). These findings indicated the presence of macrophages in HAML. We herein report a case of HAML explain how macrophages that are present within the tumor affect the staining characteristics in the post-vascular phase of CEUS.
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Affiliation(s)
- Kei Endo
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Hidekatsu Kuroda
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Keisuke Kakisaka
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Takayoshi Oikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Kei Sawara
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
| | - Kazuyuki Ishida
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Japan
| | - Tamotsu Sugai
- Department of Molecular Diagnostic Pathology, Iwate Medical University, Japan
| | - Yasuhiro Takikawa
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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Klompenhouwer AJ, Verver D, Janki S, Bramer WM, Doukas M, Dwarkasing RS, de Man RA, IJzermans JNM. Management of hepatic angiomyolipoma: A systematic review. Liver Int 2017; 37:1272-1280. [PMID: 28177188 DOI: 10.1111/liv.13381] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/30/2017] [Indexed: 12/13/2022]
Abstract
Hepatic Angiomyolipoma (HAML) is a rare mesenchymal liver tumour assumed to be predominantly benign, although incidental cases with malignant behaviour such as invasive growth, recurrence after resection and metastases have been reported. The aim of this systematic review was to assess the biological behaviour, estimate the risk of HAML related mortality and recommend on a justifiable management strategy. We performed a systematic literature search in Embase, Medline, Web-of-Science, Scopus, Pubmed Publisher, Cochrane and Google Scholar. We included all articles published from inception until March 2016 which reported on follow-up of various treatment strategies. We included 18 articles reporting on 292 patients. Male:female ratio was estimated at 1:3 with gender not reported in 31 cases. Of 292 patients 247 were treated with surgery, including one liver transplant, seven with chemotherapy or Sirolimus, three with embolization, and 35 conservatively. Recurrence after resection was described in 6/247 (2.4%) with pathologically proven HAML resulting in metastases and death in 2/247 (mortality rate 0.8%). Progression was described in 6/35 patients treated conservatively (21.4%). Two of 12 patients with malignant behaviour of HAML had an epithelioid-type HAML, of the remaining 10 histological subtype was undefined. With a risk estimate of 0.8% in surgically treated patients HAML related mortality is very low. Biopsy is indicated when imaging is inconclusive. In case of certain HAML diagnosis on imaging conservative management with annual imaging is justified. Resection should be considered in case of symptoms, inconclusive biopsy or growth in follow-up.
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Affiliation(s)
| | - Danielle Verver
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Shiromani Janki
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | | | - Michail Doukas
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
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Chen W, Liu Y, Zhuang Y, Peng J, Huang F, Zhang S. Hepatic perivascular epithelioid cell neoplasm: A clinical and pathological experience in diagnosis and treatment. Mol Clin Oncol 2017; 6:487-493. [PMID: 28413654 PMCID: PMC5374935 DOI: 10.3892/mco.2017.1168] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 12/19/2016] [Indexed: 12/26/2022] Open
Abstract
Hepatic perivascular epithelioid cell neoplasm (PEComa) is a rare type of neoplasm derived from mesenchymal tumors that is often misdiagnosed as hepatocellular carcinoma (HCC), hepatic hemangioma or other liver malignancies. The clinical and histological characteristics of PEComa have yet to be fully documented. To optimize the diagnosis and treatment of the disease, a retrospective analysis was performed to investigate the clinicopathological characteristics of 7 patients diagnosed with hepatic PEComa in the Sun Yat-Sen Memorial Hospital between January 2004 and December 2015. Briefly, all the patients lacked specific symptoms, and a serological examination provided no further useful information. Additionally, non-specific imaging manifestations were observed. Microscopically, detection of epithelioid or spindle-shaped cells with adipocytes was suggestive of the disease, and an analysis of biomarkers, including the monoclonal antibody HMB-45, the melanocytic differentiation marker, Melan-A, and smooth muscle α-actin (SMA), helped to confirm the diagnosis. Regarding the treatment, 6 patients (85.7%) received surgical resection procedures, and 1 patient (14.3%) was admitted for tumor arterial embolization and percutaneous microwave coagulation therapy. After a follow-up period of 12–20 months, no recurrence was observed. Taken together, hepatic PEComa should be suspended in patients with a liver tumor with asymptomatic manifestation and normal serological test results. In imaging studies, hepatic PEComa was able to mimic HCC, hepatic hemangioma and metastatic tumor, although the mass did not invade the adjacent organs and vessel. The definitive diagnosis was made on the basis of the typical morphological features and notable markers of the tumor tissue. It is recommended that patients with PEComa in a benign pattern deserve serial imaging follow-up, but surgery is indicated in patients suffering from large tumors (>5 cm), or progressive enlargement or malignant tendency.
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Affiliation(s)
- Wenying Chen
- Department of Gastroenterology and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, Guangdong 510120, P.R. China
| | - Yeqing Liu
- Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Yanyan Zhuang
- Department of Gastroenterology and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, Guangdong 510120, P.R. China
| | - Juanfei Peng
- Department of Gastroenterology and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, Guangdong 510120, P.R. China
| | - Fengting Huang
- Department of Gastroenterology and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, Guangdong 510120, P.R. China
| | - Shineng Zhang
- Department of Gastroenterology and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangzhou, Guangdong 510120, P.R. China
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Lee SJ, Kim SY, Kim KW, Kim JH, Kim HJ, Lee M, Yu ES. Hepatic Angiomyolipoma Versus Hepatocellular Carcinoma in the Noncirrhotic Liver on Gadoxetic Acid–Enhanced MRI: A Diagnostic Challenge. AJR Am J Roentgenol 2016; 207:562-70. [DOI: 10.2214/ajr.15.15602] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Kuramoto K, Beppu T, Namimoto T, Hayashi H, Imai K, Nitta H, Hashimoto D, Chikamoto A, Ishiko T, Iyama K, Ikeda O, Yamashita Y, Baba H. Hepatic angiomyolipoma with special attention to radiologic imaging. Surg Case Rep 2015; 1:38. [PMID: 26366342 DOI: 10.1186/s40792-015-0038-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 04/09/2015] [Indexed: 01/27/2023] Open
Abstract
Background Angiomyolipoma is a unique mesenchymal neoplasm composed of blood vessels as well as smooth muscle and adipose cells. The liver is a less common site of origin, and hepatic angiomyolipoma is often an incidental finding on diagnostic imaging or is identified on evaluation of nonspecific symptoms. Case presentation We experienced four patients who were diagnosed histologically with hepatic angiomyolipoma. The preoperative diagnoses were angiomyolipoma in two patients, hepatocellular carcinoma in one, and cavernous hemangioma in one. Three patients were treated with hepatectomy (one laparoscopic and two open approaches), and the diagnosis was completed by histological investigation of the resected specimen. The remaining one was diagnosed from tumor needle biopsy. Diffusion-weighted magnetic resonance imaging (MRI) with respiratory triggering using b values of 0 and 800 s/mm2 was employed. An apparent diffusion coefficient map was generated from b values of 0 and 800 s/mm2 for calculation of the apparent diffusion coefficient. The apparent diffusion coefficient values were calculated as 3.66, 1.21, 1.80, and 0.91 in patients 1 to 4, respectively. In MRI imaging, fat component was clearly demonstrated with chemical shift imaging in three patients. Early venous return was detected in three patients with computed tomography angiography. Conclusion Fat component and early venous return are important for a correct diagnosis of hepatic angiomyolipoma. Unfortunately, apparent diffusion coefficient values in hepatic angiomyolipoma were overlapping with those in other benign and malignant tumors.
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Abstract
More and more asymptomatic benign liver tumours are discovered incidentally and can be divided into regenerative lesions and true neoplastic lesions. The most common regenerative lesions include hemangioma, focal nodular hyperplasia and inflammatory pseudotumours of the liver. Neoplastic lesions include hepatocellular adenomas and angiomyolipomas. Regenerative lesions rarely increase in volume, do not yield a higher risk of complications and usually do not require treatment. By contrast, hepatocellular adenomas and angiomyolipomas can increase in volume and are associated with a risk of complications. Large hepatocellular adenomas (>5 cm in diameter) are undoubtedly associated with a risk of bleeding and malignant transformation, particularly the inflammatory (also known as telangiectatic) and β-catenin mutated subtypes. Accurate diagnosis needs to be obtained to select patients eligible for surgical resection. MRI has markedly improved diagnosis and can identify the major hepatocellular adenomas subtypes. The use of biopsy results to inform the indication for resection remains questionable. However, when diagnosis remains uncertain after imaging, percutaneous biopsy could help improve diagnostic accuracy.
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Affiliation(s)
- Jacques Belghiti
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
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16
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Abstract
A 38-year-old male was admitted to our hospital due to upper abdominal pain. Computed tomography revealed a hepatic angiomyolipoma (AML; 10.5 × 9.5 × 7.0 cm in size), which had ruptured into the space between the liver and the diaphragm. Following transcatheter arterial embolization, surgical resection was performed. The tumor consisted of epithelioid cells (50–60%), mature fat (40–50%), and thickened-wall blood vessels. Considering the amount of epithelioid cells and their positivity for E-cadherin and β-catenin, the tumor was diagnosed as hepatic epithelioid AML. Cases of ruptured hepatic AML are rare. To the best of our knowledge, this is the sixth case reported in the English literature.
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Affiliation(s)
- Shogo Tajima
- Department of Pathology, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Akira Suzuki
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Kiyoshi Suzumura
- Department of Surgery, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
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17
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Zhu Z, Yang L, Zhao XM, Luo DQ, Zhang HT, Zhou CW. Myomatous hepatic angiomyolipoma: imaging findings in 14 cases with radiological-pathological correlation and review of the literature. Br J Radiol 2014; 87:20130712. [PMID: 24670055 DOI: 10.1259/bjr.20130712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To display and analyse the imaging features of myomatous hepatic angiomyolipomas (MHAMLs). METHODS The imaging features (CT = 9; MRI = 10; ultrasound = 10; contrast-enhanced ultrasound = 4) of 14 patients with pathologically proven MHAMLs were reviewed retrospectively. RESULTS MHAMLs were surgically resected in the 14 patients (10 females and 4 males; age, 27-64 years; mean, 45 years), all of whom had negative hepatitis markers and were positive for the immunohistochemical stain homatropine methylbromide-45. The tumours were solitary and well defined, and ranged in size from 1.9 to 9.1 cm (mean, 5.7 cm). On dynamic contrast-enhanced CT, MRI and ultrasound scans, all tumours showed fast strong enhancement in the arterial phase and moderate washout in the portal venous and delayed phases, and the greater portions of the tumours were slightly lower than the surrounding hepatic parenchyma. In some cases, a small area of prolonged or increasing enhancement in the tumour was recognized in the delayed phase. Early draining vessels to the portal vein or hepatic vein could be seen in some cases. However, no capsular signs could be confidently identified in the delayed phase. Haemorrhagic cavities were recognized in two cases, and nodular low-intensity areas in the tumours on T2 weighted imaging that showed slow and faint enhancement on dynamic scans were seen in two cases. However, no necrosis was identified. CONCLUSION Dynamic enhanced imaging studies revealed some specific features of MHAMLs that distinguish them from other hypervascular hepatic tumours, especially when combined with clinical features. Familiarity with imaging and clinical features of MHAMLs could avoid unnecessary surgical resection of these generally benign tumours. ADVANCES IN KNOWLEDGE This article systematically describes the imaging features of MHAMLs.
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Affiliation(s)
- Z Zhu
- Department of Diagnostic Radiology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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18
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Yang L, Xu Z, Dong R, Fan J, Du Y, Zhang Y, Wang X, Cheng X, Guo J. Is surgery necessary for patients with hepatic angiomyolipoma? Retrospective analysis from eight Chinese cases. J Gastroenterol Hepatol 2013; 28:1648-53. [PMID: 23731017 DOI: 10.1111/jgh.12289] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM Hepatic angiomyolipoma (AML) is a rare, hepatic mesenchymal neoplasm. Its preoperative diagnosis is very difficult, and the treatment is still controversial. The aim is to summarize experience in diagnosis and management of hepatic AML from a cancer center. METHODS We retrospectively reviewed the clinical presentation, histopathological, features and treatment of the tumors encountered at our institute from January 2000 to December 2012. RESULTS The patients included six females and two males, with female preponderance. Six patients are asymptomatic. Laboratory tests lack specificity. Combining imaging modality, only one patient obtained the accurate diagnosis of hepatic AML and was confirmed by fine-needle aspiration biopsy combined with homatropine methylbromide-45 staining. All other patients received hepatic resection. There was no tumor recurrence or increase of tumor size within the follow-up period. CONCLUSION We suggest fine-needle aspiration combined with homatropine methylbromide-45 staining should be performed in all patients who are asymptomatic and without serological abnormalities. Surgical resection might be considered only if the malignant potential of the lesion cannot be ruled out or the tumor size is increasing during observation.
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Affiliation(s)
- Litao Yang
- Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou, China
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19
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Abstract
We present a case of a 53-year-old woman with abdominal discomfort for 6 months. The liver was enlarged. Contrast CT scan of the abdomen revealed a 10 cm hypervascular tumour at the right lobe of the liver. Right hepatectomy with complete excision of the tumour was achieved. Histological and immunohistochemical findings were consistent with perivascular epithelioid cell tumour. She is regularly followed up with contrast CT assessment. There is no tumour recurrence 12 months after the operation.
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Affiliation(s)
- Tan To Cheung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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20
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Anysz-Grodzicka A, Pacho R, Grodzicki M, Koperski L, Górnicka B, Cieszanowski A, Zieniewicz K, Krawczyk M. Angiomyolipoma of the liver: analysis of typical features and pitfalls based on own experience and literature. Clin Imaging 2012; 37:320-6. [PMID: 23465986 DOI: 10.1016/j.clinimag.2012.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/14/2012] [Indexed: 11/19/2022]
Abstract
We present imaging findings (ultrasound, computed tomography, and magnetic resonance imaging) of eight patients with hepatic angiomyolipoma (HAML). The lesions were solitary in seven patients, and one patient had multiple tumors (n=11). Angiomyolipoma, even though a rare liver tumor, should be included in the differential diagnosis in cases of highly vascularized lesion containing a significant amount of fat. Suggestion of the diagnosis of HAML might be helpful for the pathologist in the selection of the typical histochemical staining of the tumor, allowing accurate diagnosis, which, in turn, determines the implementation of appropriate therapeutic intervention.
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21
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Hechtman JF, Raoufi M, Fiel MI. Hepatic mass in a 73-year-old man. Gastroenterology 2012; 142:434, 679. [PMID: 22285537 DOI: 10.1053/j.gastro.2011.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 09/08/2011] [Indexed: 12/02/2022]
Affiliation(s)
- Jaclyn F Hechtman
- Department of Pathology, Mount Sinai School of Medicine, New York, New York, USA
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22
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Sumiyoshi T, Moriguchi M, Kanemoto H, Asakura K, Sasaki K, Sugiura T, Mizuno T, Uesaka K. Liver-specific contrast agent-enhanced magnetic resonance and ¹⁸F-fluorodeoxyglucose positron emission tomography findings of hepatocellular adenoma: report of a case. Surg Today 2011; 42:200-4. [PMID: 22160355 DOI: 10.1007/s00595-011-0067-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 02/27/2011] [Indexed: 02/07/2023]
Abstract
We report a case of hepatocellular adenoma, focusing on the findings of liver-specific contrast agent-enhanced magnetic resonance imaging (MRI) and ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET). The patient was a 37-year-old woman, referred to us after contrast-enhanced computed tomography showed a homogeneous, poorly enhanced liver tumor, 2.8 cm in diameter. Magnetic resonance imaging showed a liver mass with significant fatty change. The tumor increased in size to 3.3 cm over 9 months of follow-up. Gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid-enhanced MRI revealed spotty enhancement in the hypointense tumor in the hepatobiliary phase. Subsequent FDG-PET showed increased uptake of FDG (maximum standardized uptake value 5.0), which suggested the possibility of malignancy. The patient underwent partial hepatectomy, and histological examination of the resected specimen revealed a tumor composed of hepatocyte-like cells with minimal cellular atypia and significant diffuse fatty change. Based on these findings, we diagnosed hepatocellular adenoma.
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Affiliation(s)
- Tatsuaki Sumiyoshi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan.
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23
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Honda M, Lee KJ, Hashimoto S, Hayashida S, Suda H, Ohya Y, Yamamoto H, Takeichi T, Asonuma K, Inomata Y. Development of hepatic angiomyolipoma accompanied with focal nodular hyperplasia long after treatment of pelvic rhabdomyosarcoma. J Pediatr Surg 2011; 46:1267-70. [PMID: 21683235 DOI: 10.1016/j.jpedsurg.2011.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 12/11/2022]
Abstract
Survivors of childhood cancer have a higher risk of developing a secondary neoplasm in their lifetime. The increased risk of a second malignant neoplasm is related to treatment of the primary tumor and genetic predisposition. We describe a 19-year-old man with 2 hepatic masses, one of which was diagnosed as a hepatic angiomyolipoma and the other as focal nodular hyperplasia 14 years after the treatment of stage IV pelvic rhabdomyosarcoma. The combination of these tumors has not previously been reported in the literature.
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24
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Butte JM, Do RK, Shia J, Gönen M, D'Angelica MI, Getrajdman GI, Allen PJ, Fong Y, Dematteo RP, Klimstra DS, Jarnagin WR. Liver angiomyolipomas: a clinical, radiologic, and pathologic analysis of 22 patients from a single center. Surgery 2011; 150:557-67. [PMID: 21621235 DOI: 10.1016/j.surg.2011.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Accepted: 03/22/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver angiomyolipomas (AML) are mesenchymal neoplasms with an uncertain clinical behavior. The spectrum of presentation, imaging and histologic features, and outcomes were analyzed in all patients treated at Memorial Sloan-Kettering Cancer Center. METHODS Demographics, disease, pathologic, treatment, and outcome-related variables for consecutive patients were reviewed retrospectively. All imaging studies obtained at presentation were reexamined, categorized, and compared using Fisher and Wilcoxon tests. RESULTS Between 1989 and 2010, 238 patients with AML were seen and 22 (9.3%) had liver involvement (exclusive = 17; combined with kidney = 5). The median age was 53 years; 18 were females, and 15 had symptoms. AML was not suspected at initial presentation in any patient. Fat-containing neoplasms on imaging were larger (P = .03), with more heterogeneous enhancement compared with fat-poor neoplasms (P = .001), but none of the imaging/histologic features correlated with outcome. Thirteen patients underwent resection (R0 = 9), 4 were observed, 2 received chemotherapy, 2 embolization, and 1 embolization plus intra-arterial chemotherapy. Two patients treated with R0-resection recurred and 2 treated with chemotherapy progressed, but no patient died of AML-related causes. At a median follow-up of 36 months, 7 patients were free of disease, 13 were alive with disease, 1 died of an unrelated cause, and another was lost to follow-up. CONCLUSION AMLs are rare neoplasms with an indolent course in most patients. Subtypes based on fat content are recognized, but clinical behavior does not seem to be different. Recurrence after resection is not associated with disease-related mortality. Resection may be unnecessary in selected asymptomatic patients if the diagnosis can be established definitively.
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Affiliation(s)
- Jean M Butte
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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25
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Abstract
AIM: To investigate the clinicopathologic characteristics of hepatic epithelioid angiomyolipoma (EAML).
METHODS: Two cases of hepatic EAML treated at General Hospital of Wuhan Iron and Steel Corporation from 2007 to 2009 were analyzed in this study. The clinicopathologic and immunohistochemical characteristics of the disease were described and the related literature was reviewed.
RESULTS: Both patients are female. Both cases of hepatic EAML had clear boundaries. The tumors were characterized by diffused epithelioid neoplastic cells. The epithelioid cells were round with eosinophilic or clear cytoplasm, and few neoplastic cells showed cellular atypia. Immunohistochemically, the neoplastic cells were diffusely positive for HMB45, Melan-A and SMA.
CONCLUSION: Hepatic EAML is a rare mesenchymal neoplasm. The diagnosis and differentiatial diagnosis of EAML rely mainly on histopathology and immunohistochemistry.
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26
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Ramia JM, De la Plaza R, Quiñones J, Sanchez-Tembleque MD, Caminoa A, Veguillas P, García Parreño J. Three trocars laparoscopic resection of angiomyolipoma of the liver. Int J Hepatol 2011; 2011:150691. [PMID: 22135749 PMCID: PMC3226358 DOI: 10.4061/2011/150691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/03/2011] [Accepted: 01/18/2011] [Indexed: 01/22/2023] Open
Abstract
Angiomyolipoma of the liver (AML) is an infrequent neoplasm composed of three tissues (adipose, muscle and vessels). In spite of advances in radiology, preoperative correct diagnosis is difficult. Clasically, a conservative management strategy was adopted in patients with asymptomatic tumors less than 5 cm with undoubtful diagnosis. But after publishing some few cases of malignant angiomyolipoma a more radical has been advocated. Laparoscopic resection of liver tumors is becoming a excellent approach for operating on benign liver tumors. Usually is performed using five trocars but in some cases a less invasive technique with three trocars could be used. We present a laparoscopic resection of liver angiomyolipoma in a 65 year-old male using only three trocars and also discuss the optimal management of AML and technical tips of three-trocar technique.
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Affiliation(s)
- J. M. Ramia
- Hepatopancreatobiliary Unit, Department of Surgery, Guadalajara University Hospital, 19002 Guadalajara, Spain,*J. M. Ramia:
| | - R. De la Plaza
- Hepatopancreatobiliary Unit, Department of Surgery, Guadalajara University Hospital, 19002 Guadalajara, Spain
| | - J. Quiñones
- Hepatopancreatobiliary Unit, Department of Surgery, Guadalajara University Hospital, 19002 Guadalajara, Spain
| | - M. D. Sanchez-Tembleque
- Department of Gastroenterology and Hepatology, Guadalajara University Hospital, 19002 Guadalajara, Spain
| | - A. Caminoa
- Department of Pathology, Guadalajara University Hospital, 19002 Guadalajara, Spain
| | - P. Veguillas
- Hepatopancreatobiliary Unit, Department of Surgery, Guadalajara University Hospital, 19002 Guadalajara, Spain
| | - J. García Parreño
- Hepatopancreatobiliary Unit, Department of Surgery, Guadalajara University Hospital, 19002 Guadalajara, Spain
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