Hepatic angiomyolipoma: Report of two cases with emphasis on smear cytomorphology and the use of cell block with immunohistochemical stains

Abstract

Angiomyolipoma is a benign mesenchymal lesion that occurs most commonly in the kidney. Its occurrence in the liver is relatively rare. We report two cases of hepatic angiomyolipoma diagnosed by ultrasound-guided, needle aspiration biopsy. One of the patients was a previously healthy 62-yr-old woman who presented with a hepatic mass incidentally during a healthy examination. The other patient was a 67-yr-old man, a victim of chronic hepatitis C, who was found to have a hepatic tumor in the right lobe during regular follow-up. Cytologic preparations of the two hepatic masses showed some mature adipocytes admixed with clusters of variable-sized mesenchyme-like cells with fibrillar cytoplasm and indistinct cytoplasmic borders. Some of the cells were round to oval and others were spindle shaped with oval, cigar-shaped or elongated nuclei. The nuclear chromatin was fine and some cells showed round nucleoli. No thick-walled blood vessels were noted in the cytological smears. In the cell block preparations, a mixture of thick-walled blood vessels, mature adipose tissue, and bundles of variable-sized smooth muscle cells were noted. The spindle or epithelioid smooth muscle cells were positive for vimentin, alpha-smooth muscle actin, and human melanoma black (HMB)-45 but negative for desmin and S100 protein in immunohistochemical stains. The purpose of the current study is to describe cytological features of this lesion with differential diagnosis because pathologists may be called on to render a diagnosis on needle aspiration. HMB-45 has been proved to be a sensitive marker for the smooth muscle component of angiomyolipoma. Cell block preparations assisted with immunohistochemical staining should be emphasized for definite diagnosis. Although a surgical procedure may still be necessary once a diagnosis of angiomyolipoma is made, treatment may be tailored for a less aggressive procedure than for malignant hepatic nodules.

Transcatheter coil occlusion of perimembranous ventricular septal defects

“…Fine needle aspiration cytologic findings of renal AMLs (reviewed in Ref. 37) and hepatic AMLs 2, 16, 22–31 are well described (Table I). However, most reported cases are examples of classic triphasic AMLs.…”

“…Our case had many of the cytologic features previously reported in epithelioid hepatic AMLs. 2, 16, 22–31 These included the presence of naked nuclei, epithelioid cells in clusters and as single cells, low nucleocytoplasmic ratio, fibrillary, frothy or finely granular cytoplasm, and indistinct cell borders, bland nuclei with indistinct nucleoli, focal intranuclear pseudoinclusions and mild pleomorphism, as well as the presence of extramedullary hematopoiesis. In addition, our case also showed some unusual cytologic features, such as the presence of mast cells, intracytoplasmic erythropoietic elements and hyaline inclusions.…”

Imprint Cytology of Hepatic Angiomyolipoma -A Case Report-

“…The cytologic findings of hepatic angiomyolipoma have rarely been reported on. [1][2][3][4][5][6][7] We report here on a case of hepatic angiomyolipoma in a 47-year-old-man, and the tumor was examined by touch imprint cytology.…”

Challenge of FNA diagnosis of angiomyolipoma: A study of 33 cases

“…Fine‐needle aspiration biopsy (FNA) is a simple and cost‐effective procedure that is often used as an initial diagnostic tool to evaluate mass lesions. To date, the published FNA cytologic studies of AML have been mostly single case reports or small series containing 2 to 8 cases . An FNA diagnosis of AML can be challenging because of sampling error and a lack of intact histologic architecture.…”

“…To date, the published FNA cytologic studies of AML have been mostly single case reports or small series containing 2 to 8 cases. [9][10][11][12][13][14][15][16] An FNA diagnosis of AML can be challenging because of sampling error and a lack of intact histologic architecture. The current study included a large number of AML cases sampled with FNA in various clinical scenarios.…”