The Difficulties of Diagnosis Giant Angiomyolipoma of the Liver: Clinical Case and Literature Review

Abstract

Purpose: To report a clinical case demonstrating difficulties of diagnosis and successful surgical treatment of myomatous type of angiomyolipoma of the liver without simultaneous damage to the kidneys.Material and methods: A female patient, 49 years old, was admitted to the hospital in August 2023, had no specific complaints, an abdominal ultrasound revealed extraperitoneal extraorgan mass in the epigastrium and mesogastrium and masses in the right lobe of liver, most likely hemangioma. The contrast-enhanced MSCT was performed on admission. Patient was rehospitalized for a surgery in September. During the operation the tumor was removed and sent for histological examination, a further immunohistochemical study was also carried out.Results: According to the results of MSCT in S3, S4, S5 of the liver oval-shaped mass (198×104×177 mm) with heterogeneous density and solid, cystic and fat features was found. Three hypovascular hypodense inclusions sizes up to 11 mm was also identified in S7/8. There was no pathologic formation in the kidneys. The liver tumor was surgically removed, the resected material was directed to a scheduled histological examination. To confirm the diagnosis an IHC analysis was also done and it revealed the expression of melanocytic (HBM-45) and smooth muscle (SMA) markers.Discussion: In this case we encountered very sparsely described in the world literature localization of angiomyolipoma — isolated hepatic one (without kidney damage). Like other authors we encountered the similarity of muomatous tumor type to the HCC and adenoma of the liver due to the characteristic features of visualization: hypervascularity, early contrast enhancement into an arterial phase and reduced density relative to the preserved parenchyma of the liver into a delayed phase of contrast.Conclusion: This case demonstrates the difficulty of diagnosing the myomatous type of AML simulating the HCC. As one of the most informative methods of diagnosis, we single out MSCT, which allowed us to think about the possibility of a benign nature of the tumor. In our case the main features excluding HCC were the absence of rapid “washout” of contrast drug, the presence of lipomatous areas and no accumulation of contrast agent by the capsule.