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Angiomyolipoma (AML), a perivascular epithelioid cell tumour, is a benign tumour, typically involving the kidney. In this location, the cytological and histological characteristics of this lesion allow for a straightforward diagnosis in most cases. When AML occurs in extrarenal sites such as the liver, AML can mimic a malignant tumour clinically and radiologically. 1 A definitive diagnosis of hepatic angiomyolipoma (HAML) usually relies on histopathological evaluation of biopsy or resection material. A diagnosis of HAML is less often made, or at least suspected, on cytology specimens obtained using techniques such as fine needle aspiration (FNA). 1 In this setting, the interpretation can be challenging. We report a case of HAML with extramedullary hematopoiesis (EMH) presenting as a large hepatic mass, diagnosed by cytology through endoscopic ultrasound guided fine-needle aspiration. | C A S E REP ORTAn 81-year-old man with a history of chronic kidney disease stage III and diabetes was found to have an incidental 6 cm well-circumscribed mass in the left lobe of the liver mass on computed tomography (CT).The mass showed central low density suggestive of a scar, and focal nodular hyperplasia was suggested as an initial diagnosis. FNA of the lesion showed a mixture of spindled and epithelioid cells in a background of mixed histiocytes, plasma cells, and eosinophils (Figure 1).The epithelioid cells displayed abundant cytoplasm, round nuclei with prominent a nucleolus, and rare binucleated forms. In addition, the cellblock demonstrated mature adipose tissue and rare megakaryocytes suggestive of extramedullary hematopoiesis (Figure 2). Immunohistochemical staining of the cellblock showed positivity for HMB-45 and Mart-1 (weak), as well as absence of CD45,

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Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is an alternative approach to sample kidney lesions that is less commonly used compared to percutaneous CT or ultrasound guidance. In this case, we present a 70-year-old female who was diagnosed with metastatic renal cell carcinoma (RCC) 18 years postnephrectomy with EUS-FNA in conjunction with immunohistochemistry. This case report supports the use of EUS-FNA in conjunction with immunohistochemistry as a robust technique that can safely and effectively diagnose recurrent renal cell carcinoma.

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