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      Preoperative radiological characterization of hepatic angiomyolipoma using magnetic resonance imaging and contrast-enhanced ultrasonography: a case report

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          Abstract

          Introduction

          A hepatic angiomyolipoma is a rare benign tumor of the liver composed of a mixture of smooth muscle cells, blood vessels and a variable amount of adipose tissue. Differentiating them from malignant liver tumors can often be very difficult.

          Case presentation

          We report the case of a 43-year-old Caucasian man presenting with a large liver mass in the right lobe. The results of magnetic resonance imaging and contrast-enhanced ultrasonography were consistent with a well-demarcated adipose tissue- containing tumor, showing prolonged hyperperfusion in comparison with the surrounding liver tissue. Surgery was performed and the diagnosis of hepatic angiomyolipoma was made with histopathology.

          Conclusion

          Preoperative radiological characterization using magnetic resonance imaging and contrast-enhanced ultrasonography may improve diagnostic accuracy of hepatic angiomyolipoma. Identification of smooth muscle cells, blood vessels and adipose tissue with a positive immunohistochemical reaction for HMB-45 is the final evidence for an angiomyolipoma.

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          Management of Hepatic Angiomyolipoma

          Ching-Yao Yang, Ming-Chih D Ho, Yung-Ming Jeng … (2007)
          Preoperative diagnosis of hepatic angiomyolipoma is difficult, and the treatment for it remains controversial. The aim of this study is to review our experience in the treatment of hepatic angiomyolipoma and to propose a treatment strategy for this disease. We retrospectively collected the clinical, imaging, and pathological features of patients with hepatic angiomyolipoma. Immunohistochemical studies with antibodies for HMB-45, actin, S-100, cytokeratin, vimentin, and c-kit were performed. Treatment experience and long-term follow-up results are summarized. During a period of 9 years, 10 patients with hepatic angiomyolipoma were treated at our hospital. There was marked female predominance (nine patients). Nine patients received surgical resection without complications. One patient received nonoperative management with biopsy and follow-up. One patient died 11 months after surgery because of recurrent disease. We propose all symptomatic patients should receive surgical resection for hepatic angiomyolipoma. Conservative management with close follow-up is suggested in patients with asymptomatic tumors and meet the following criteria: (1) tumor size smaller than 5 cm, (2) angiomyolipoma proved through fine needle aspiration biopsy, (3) patients with good compliance, and (4) not a hepatitis virus carrier.
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            Characteristics and treatment strategy of hepatic angiomyolipoma: a series of 94 patients collected from four institutions.

            Zhi- Chang, Jin Ming Zhang, Jiao Ying … (2011)
            To report on a Chinese multicenter series of hepatic angiomyolipoma (HAML) patients and to study the characteristics and the treatment strategy of the disease. Data of 94 patients diagnosed with HAML from four institutions of China between December 1997 and January 2008 were reviewed retrospectively. Immunohistochemical assays were performed on the surgical specimens and follow up studies were done in all the patients. 52 of 94 patients (55.3%) showed no significant clinical symptoms. There were no specific findings on laboratory examinations. The correct preoperative diagnostic rate of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) was 0% (0/94), 15.7% (11/70) and 22.7% (10/44), respectively. Regarding the treatment, 93 patients had a hepatectomy and 1 patient was treated by radiofrequency ablation. The postoperative pathology showed HAML in all the patients: 69 patients were studied with HMB-45 staining by immunohistochemistry and the positive rate was 100% . The postoperative follow-up rate was 91.5% (86/94), no sign of recurrence or metastasis was observed during the follow-up period. This is the largest HAML series reported in the literature. There are no specific signs and symptoms in HAML patients; the preoperative imaging diagnosis (including CT, MRI) is insensitive. The common pathological features include the basic histological components and expression of HMB-45. Conservative treatment is not suggested; surgical resection should be considered as a treatment choice for HAML.
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              Hepatic angiomyolipoma.

              Wei Xin, Amber Petrolla (2008)
              Hepatic angiomyolipoma is a rare, benign, hepatic mesenchymal neoplasm found in both males and females, and most commonly in adult females. Angiomyolipoma occurs most commonly in the kidneys. The liver represents the second most frequent site of involvement. Hepatic angiomyolipomas are composed of varying amounts of smooth muscle cells, adipose tissue, and vessels. The smooth muscle cell component is the most specific to the diagnosis. The smooth muscle cells can have varying morphologies and are positive for homatropine methylbromide-45 but are negative for hepatocyte paraffin 1 and S100 protein. The definitive diagnostic study remains the histologic examination of the surgically resected lesion coupled with immunohistochemical stains. The differential diagnosis includes hepatocellular carcinoma, hepatic adenoma, leiomyoma, hepatoblastoma, melanoma, and gastrointestinal stromal tumor. The immunohistochemical staining pattern differentiates this lesion from other malignant and benign liver lesions. If the diagnosis of hepatic angiomyolipoma has been made, it can be followed conservatively or surgically resected.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Med Case Reports
                Title: Journal of Medical Case Reports
                Publisher: BioMed Central
                ISSN (Electronic): 1752-1947
                Publication date Collection: 2011
                Publication date (Electronic): 26 September 2011
                Volume: 5
                Page: 481
                Affiliations
                [1 ]Medical Clinic, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
                [2 ]Department of Pathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
                [3 ]Department of Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
                Article
                Publisher ID: 1752-1947-5-481
                DOI: 10.1186/1752-1947-5-481
                PMC ID: 3189154
                PubMed ID: 21943146
                SO-VID: 155e2f46-dd01-4fcc-855b-9d8a15107342
                Copyright © Copyright ©2011 Krebs et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 20 May 2011
                Date accepted : 26 September 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
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                ScienceOpen disciplines: Medicine

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