Hepatic angiomyolipoma (AML) is a rare mesenchymal tumour with an undetermined malignant potential. Clinical symptoms are non-specific. The radiological hallmarks are high vascularization of lesion and presence of macroscopic fat. The proportion of fatty tissue varies significantly and discrepancies between pre-operative imaging and histological findings are observed in more than 50% of cases. Visualization of the draining vein may aid in differentiation between AML and hepatocellular carcinoma with abundant fatty component. Biopsy is indicated in ambiguous cases. Presence of clinical symptoms warrants surgical treatment. We present a clinical case of giant hepatic AML, discuss its typical features and treatment options.
Highlights
Metastatic involvement of the diaphragm is more common than primary malignancy.
Isolated diaphragmatic metastasis is very rare.
Contrast-enhanced multidetector computed tomography provides essential information for preoperative planning.
A pathology study and surgical revision are the most informative diagnostic methods.
involvement in the tumor process or as the removal of the primary sources of the tumor) was performed in 47 patients (32.2%), most of all with VP (72.3%). 29 patients (19.9%) were need to carotid resection and ravascularisation, in the group of VP 10.3% only. The prognostic factors for surgical complications are: morphological type of tumor, the prevalence of the tumor process on the carotid bifurcation of the carotid chemodectomy (Shamblin classification), combined surgical treatment (addition of surgical treatment to preoperative selective embolization of afferent branches of the carotid arteries), reconstruction of the carotid arteries. The analysis of intra-and postoperative hemorrhagic problems was carried out; in the early postoperative period, the incidence of stroke, local neurological complications (dysphagia, dyspnea, dysphonia) were assessed. Results: Postoperative mortality was 2.1% (two patients died from complications in the respiratory tract, one patient from decompensation of concomitant heart disease). After surgery 2 patients (1.4%) had a stroke. The edema of laryngopharyngeal tissues was observed in 41 cases (28%) in patients with CBT of Shamblin II and III, and VP. There were no significant differences in the morphological groups in the number of local neurological complications. Most often, local neurological dysfunction was observed in patients with Shamblin III CBT. When comparing subgroups, there was no significant effect of embolization of afferent branches on intraoperative blood loss. In the subgroup of preoperative X-ray occlusion (n ¼ 23), the average blood loss was 164AE67 ml, in the subgroup without X-ray exclusion (n ¼ 26)-178AE84 ml (p> 0.03). Postoperative hemorrhagic complications were observed in 3 patients (2.1%), no significant association with the prognostic factors under study was found. Conclusion: the morphological type of the tumor and the prevalence of the tumor lesion on the bifurcation of the carotid artery (CBT of Shamblin II and III) are associated with the greatest risk of developing postoperative complications. Preoperative embolization of the feeding branches does not affect the risks of hemorrhagic complications.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.