Hepatic Epithelioid Angiomyolipoma Treated with Laparoscopic Resection: Case Report and Review of the Literature

Williams, Chloe H.; Hickle, Kelli; Bakke, Katherine; Jamshed, Sarah; Bozorgzadeh, Adel

doi:10.1155/2019/2362618

Cited by 2 publications

(7 citation statements)

References 11 publications

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“…Hepatic angiomyolipoma generally occurs in non‐cirrhotic livers, and patients lack serological abnormalities 4,11 . Cytological indicators include indistinct cell outlines (flowing appearance) and an absence of endothelial cells wrapping around hepatic trabeculae, a feature indicative of HCC 13,22 .…”

Section: Discussionmentioning

confidence: 99%

“…1,2 The well-known association between tuberous sclerosis complex (TSC) and AML is stronger in renal AML: 50%-80% of renal AMLs are found in conjunction with TSC, compared to only 5%-15% of HAML. [4][5][6] HAML, first reported in 1976, has remained a rare finding. 3,[7][8][9] Recent reviews in 2016 and 2018 estimate that approximately 600 cases of HAML have been reported to date.…”

Section: Discussionmentioning

confidence: 99%

“…Hepatic angiomyolipoma generally occurs in non-cirrhotic livers, and patients lack serological abnormalities. 4,11 Cytological indicators include indistinct cell outlines (flowing appearance) and an absence of endothelial cells wrapping around hepatic trabeculae, a feature indicative of HCC. 13,22 HAML cells exhibit round-to-oval, pale nuclei with smooth nuclear contours, small nucleoli, and abundant fibrillary cytoplasm with a low nuclear/cytoplasmic ratio, whereas HCC cells typically demonstrate granular cytoplasm and distinct cytoplasmic borders.…”

Section: Discussionmentioning

confidence: 99%

“…Classic HAML 13,15 Overlap of HAML with HCC management of HAML; however, conservative treatment has been recommended for asymptomatic patients who meet the following conditions: tumours smaller than 5 cm, HAML diagnosed with fine needle aspiration biopsy, negative for hepatitis virus infection, and good compliance. 4,5,11,19,21,27 Recently, laparoscopic resection has been demonstrated as a safe, novel alternative to open surgery or clinical observation. 4,27,28…”

Section: Ta B L E 1 Cytological Features In the Differentiation Of Ha...mentioning

confidence: 99%

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Fine needle aspiration of hepatic angiomyolipoma with extramedullary hematopoiesis: A case report

et al. 2022

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Ta B L E 1 Cytological Features In the Differentiation Of Ha...mentioning

confidence: 99%

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Fine needle aspiration of hepatic angiomyolipoma with extramedullary hematopoiesis: A case report

et al. 2022

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“…In cases of HAML that require liver resection, laparoscopic hepatectomy could be a selective choice for surgical method. However, there have only been two reports about HAMLs that were removed using a laparoscopic procedure [ 9 ][ 9 ], and neither of these cases involved HAML that were misdiagnosed as other malignant liver tumors before surgery. Herein, we report 2 cases of HAML in which was removed by laparoscopic procedure after the preoperative diagnosis of other malignant tumor and was finally diagnosed as HAML depending on pathological findings of resected specimens.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic hepatectomy for hepatic angiomyolipoma with preoperative diagnosis of other malignancy: a report of 2 cases

et al. 2021

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Background Hepatic angiomyolipoma (HAML) is a rare liver tumor, and hepatectomy is the only effective treatment. Due to the difficulty of correct diagnosis of HAML before surgery by image studies, more than 36.6% of reported HAMLs are misdiagnosed as other malignant liver tumors before surgery. As there are only few reported cases in which HAMLs were removed using laparoscopic hepatectomy, the effectiveness of laparoscopic hepatectomy for such HAMLs in which are diagnosed as other malignant liver tumor before surgery has not been reported. Case presentation Case 1: a 58-year-old female with a history of treatment for autoimmune hepatitis was preoperatively diagnosed with hepatocellular carcinoma (size: 20 mm) in segment 7 (S7) of the liver. The tumor was removed by laparoscopic partial resection and was diagnosed as a HAML through a pathological examination. The patient’s postoperative course was good, and she was recurrence-free at 37 months after the hepatectomy. Case 2: a 29-year-old female with a history of surgery for a right mature cystic teratoma was referred to our department to receive treatment for a growing 20-mm liver tumor with some calcification, which arose in S3 of the liver. A metastatic liver tumor derived from the mature cystic teratoma was suspected, and laparoscopic left lateral sectionectomy was performed. The liver tumor was diagnosed as a HAML after a pathological examination. The patient’s postoperative course was unremarkable, and more than 54 months have passed since the hepatectomy without any recurrence. Conclusions Two cases in which HAMLs were preoperatively diagnosed as other malignant liver tumor were successfully removed by laparoscopic hepatectomy with a correct postoperative diagnosis. Laparoscopic hepatectomy for the present 2 cases of HAML seemed to be effective for providing a correct diagnosis after the curative removement of liver tumor with a smaller invasion compared to open hepatectomy, and for denying risk of dissemination of the malignant tumor by needle biopsy that had to be considered before ruling out malignant tumor.

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Hepatic Epithelioid Angiomyolipoma Treated with Laparoscopic Resection: Case Report and Review of the Literature

Cited by 2 publications

References 11 publications

Fine needle aspiration of hepatic angiomyolipoma with extramedullary hematopoiesis: A case report

Fine needle aspiration of hepatic angiomyolipoma with extramedullary hematopoiesis: A case report

Laparoscopic hepatectomy for hepatic angiomyolipoma with preoperative diagnosis of other malignancy: a report of 2 cases

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