Korean J Gastroenterol.  2012 Oct;60(4):242-248. 10.4166/kjg.2012.60.4.242.

Hepatic Angiomyolipoma with Variable Histologic Features: 8 Cases Resembling Hepatocellular Carcinoma or Inflammatory Pseudotumor

Affiliations
  • 1Department of Pathology, Keimyung University School of Medicine, Daegu, Korea.
  • 2Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. kjc@amc.seoul.kr

Abstract

BACKGROUND/AIMS
Hepatic angiomyolipoma (AML) is a rare mesenchymal tumor of the liver and demonstrates a marked histologic diversity. HMB-45 is a promising immunomarker for this tumor and especially helpful to diagnosis of some AMLs with unusual morphology. The purpose of this study was to better define the variable histologic feature of hepatic AML.
METHODS
Eight hepatic AMLs were examined, and all of that were resection specimens. The diagnosis was confirmed by the presence of HMB-45 positive cells. Median age was 41.5 years old, and mean size of tumor was 8.94 cm.
RESULTS
Conventional mixed type was 5 cases which showed myomatous, angiomatous and lipomatous component, and 3 cases were myomatous predominant. Variable patterns including spider web cell morphology, solid sheet-like and trabecular pattern were identified on myomatous component and variable amount and patterns of inflammatory cell infiltration was identified.
CONCLUSIONS
With only histologic features, it is difficult to distinguish hepatic AML from other hepatic tumor including hepatocellular carcinoma or inflammatory pseudotumor. A correct diagnosis of hepatic AML is possible by a close histologic examination with immunohistochemical stainings such as HMB-45 which is important to patient's prognosis.

Keyword

Liver; Angiomyolipoma; HMB-45; Histology

MeSH Terms

Adult
Aged
Angiomyolipoma/metabolism/*pathology/surgery
Carcinoma, Hepatocellular/metabolism/*pathology/surgery
Female
Granuloma, Plasma Cell/metabolism/pathology
Humans
Liver Neoplasms/metabolism/*pathology/surgery
Male
Melanoma-Specific Antigens/*metabolism
Middle Aged
Tomography, X-Ray Computed

Figure

  • Fig. 1 Gross and radiologic findings of hepatic angiomyolipoma. (A-C) Well-defined ovoid soft masses were identified on the hepatic parenchyma with variable sizes and colors. (D) A well demarcated hypervascular mass was identified in the posterior segment of the right lobe (CT, enhanced).

  • Fig. 2 Variable histologic features of hepatic angiomyolipoma (H&E stain). (A) Predominantly lipomatous component was identified in one case (×40). (B) Spider web pattern was identified in predominantly myomatous component cases (×100). (C) Epithelioid cells of myomatous component showed solid and sheet-like pattern (×40). (D) One case had predominantly trabecular pattern of myomatous component (×40).

  • Fig. 3 (A) Vesicular nuclei with predominant nucleoli (arrows) were identified on the myomatous cells (H&E, ×400). (B) Some myomatous cells had intranuclear pseudoinclusions (arrow heads) (H&E, ×400). (C) Melanin pigments (arrows) were present in the cytoplasm of some myomatous cells (H&E, ×400). (D) Tumor cells were positive for HMB-45 immunohistochemical staining (×400).


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