J Liver Cancer.  2021 Mar;21(1):76-80. 10.17998/jlc.21.1.76.

Huge Hepatic Angiomyolipoma Mimicking Low Grade Hepatocellular Carcinoma

Affiliations
  • 1Department of Surgery, Yonsei University College of Medicine, Seoul, Korea

Abstract

A 41-year-old man was diagnosed with a huge symptomatic liver mass and was referred to our hospital for liver biopsy and further evaluation. He presented with right upper quadrant tenderness. Enhanced abdominal computed tomography and magnetic resonance imaging revealed a 12.5-cm relatively well-defined heterogeneous enhancing mass in the right inferior liver with a large exophytic component containing a fat component and progressive delayed enhancement. The patient underwent right inferior sectionectomy. The pathological diagnosis was confirmed as angiomyolipoma, 12.3×9.2×5.0 cm in size, with tumor necrosis in 20% of the tissue. Hepatic angiomyolipoma is known as a benign tumor, but in our case, because of the large tumor size and coagulative necrosis, this tumor had malignant potential; surgical resection was deemed to be appropriate, and close follow-up monitoring was essential postoperatively.

Keyword

Hepatic angiomyolipoma; Hepatocellular carcinoma

Figure

  • Figure 1 Abdominal computed tomography revealed a 12.5-cm sized relatively well-defined heterogeneous enhancing mass in the right inferior liver with a large exophytic component containing a fat component (A, B).

  • Figure 2 On magnetic resonance imaging, the hepatic mass showed progressive delayed enhancement; the last two arterial phase images revealed the presence of early draining veins around the tumor (arrows), which is a typical imaging finding of angiomyolipoma (A–H). AP, arterial phase; PP, portal phase; PDFF, proton density fat fraction.

  • Figure 3 (A) Gross image of specimen with dilated veins (arrowheads) on liver surface. (B) Resected specimen with heterogeneous fatty and hemorrhagic components (arrowheads).

  • Figure 4 Histopathological findings of angiomyolipoma; (A) thick-walled vessels (white arrow, portal vein) and thin-walled vessels (black arrow) are fused at the boundary between normal liver tissue (N) and the tumor (T) (×40, hematoxylin and eosin [H&E] stain). (B–D) The pleomorphism of histological features of hepatic angiomyolipoma is showed (×100, H&E stain) (B, adipose tissues; C, foam cells; and D, smooth muscle cells).


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