The Histopathological Features and CT/MRI Imaging Performances in Hepatic Angiomyolipoma Patients

Ding, Huiguo; Wei, Hongtao; Liu, Hui; Chen, Yuhan; Xue, Xiang; Weng, Honglei

doi:10.5604/01.3001.0010.2769

Cited by 10 publications

(8 citation statements)

References 11 publications

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“…Similar to previous studies, Epi-HAML was more common in women, but patients with no clinical symptoms accounted for a higher proportion (17, 18, 23). In one study, 100% (6/6) cases were discovered by chance (16). In addition, in a review on Epi-HAML, female patients had taken up for about 70.0%, while those presenting symptoms occupied 35% (22).…”

Section: Discussionmentioning

confidence: 99%

Comparison of MRI Features of Epithelioid Hepatic Angiomyolipoma and Hepatocellular Carcinoma: Imaging Data From Two Centers

et al. 2018

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Introduction: Epithelioid hepatic angiomyolipoma (Epi-HAML) can easily be misdiagnosed as a malignant tumor such as hepatocellular carcinoma (HCC) because of the low-fat content on imaging. We analyzed and compared the magnetic resonance imaging (MRI) features of Epi-HAML and HCC, which would aid in disease diagnosis.Methods: We included 30 pathologically confirmed patients with Epi-HAML and 80 with HCC, who underwent both MRI unenhanced scan and three-phase contrast-enhanced MRI scan. The clinical and MRI features of the two groups were summarized and analyzed.Results: Epi-HAML showed significant differences compared to HCC group in terms of clinical features such as sex preference, age, concomitant diseases (hepatitis B and cirrhosis), and elevated plasma alpha-fetoprotein (AFP) (P < 0.001). In addition, there were statistically significant differences between both tumor types with regard to conventional MRI findings such as a solitary tumor (100 vs. 83.8%, P = 0.018), well-defined (93.3 vs. 71.3%, P = 0.027), mild hyperintensity (40.0 vs. 3.7%, P < 0.001) on DWI with high b-value, fat within the tumor (43.3 vs. 8.8%, P < 0.001), and rare necrosis (3.3 vs. 26.3%, P = 0.016). Besides, Epi-HAML displayed significant differences compared to HCC in terms of contrast-enhanced MRI characteristics such as draining hepatic vein (30.0 vs. 3.8%, P < 0.001), portal vein tumor thrombus (0 vs. 13.8%, P = 0.033), hypointensity at delayed phase (70.0 vs. 95%, P = 0.001), intra-tumor vessel at delayed phase (36.7 vs. 10.0%, P = 0.003), pseudocapsule (20.0 vs. 78.8%, P < 0.001), and prolonged enhancement (56.7 vs. 1.2%, P < 0.001).Conclusion: Epi-HAML frequently occurs in middle-aged women and usually lacks characteristic clinical symptoms. Typically, Epi-HAML presents as an isolated and well-defined tumor with rich vasculature. Specific MRI features such as intra-tumor fat, intra-tumor vessel, draining hepatic vein, prolonged enhancement, and lack of capsule may contribute to a more confident diagnosis of Epi-HAML.

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Section: Discussionmentioning

confidence: 99%

Comparison of MRI Features of Epithelioid Hepatic Angiomyolipoma and Hepatocellular Carcinoma: Imaging Data From Two Centers

et al. 2018

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“…When present, sound attenuation, velocity propagation device and refractive device allow distinguishing characteristic angiomyolipoma lesions from other echogenic tumors, especially hemangiomas. However, an image of greater sensitivity will always be necessary to properly characterize the lesion, so the ultrasound works in the context of an initial evaluation but not as a definitive diagnostic method [5][6][7][8].…”

Section: Ultrasonographymentioning

confidence: 99%

“…The characteristics of the resonance vary depending on the proportion of intra-tumor fat and clearly offer better performance compared to the aforementioned modalities [7,9,13]. Frequently, angiomyolipomas have a high fat content, with high signal intensity in T1-weighted images and a significant decrease in signal intensity in images with fat suppression [14].…”

Section: Magnetic Resonancementioning

confidence: 99%

“…The diffusion-weighted images are sensitive to molecular diffusion and allow tissue characterization by being able to identify the microstructural changes of the tissue in much smaller lesions. Therefore, diffusion images in addition to the images obtained from a routine resonance would increase the diagnostic performance of radiologists during the evaluation of focal liver lesions [7,9]. It should also be taken into account that high signal intensity is an expression of different pathological changes: fat deposition, copper accumulation, high protein concentration, blood degradation and sinusoidal dilation.…”

Section: Magnetic Resonancementioning

confidence: 99%

“…The cutting surfaces of the tumors were brown-yellowish, some of them showed centers of necrosis, areas of hemorrhage and cystic degeneration. In microscopic evaluation, a mixture of blood vessels, epithelial cells or even smooth muscle and mature adipose tissue is usually evident [7,14]. A large number of thin-walled venous vascular structures or blood sinuses that converge in the tumor parenchyma can be found [14].…”

Section: Pathological and Immunohistochemical Studymentioning

confidence: 99%

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Hepatic Angiomyolipoma: Case Report, Literary Review with Emphasis on Imaging Performance for the Diagnosis

Je¹

2019

CRIJ

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Angiomyolipoma is a rare mesenchymal neoplasm that is composed of: blood vessels, smooth muscle and fat cells. The kidneys are the site where they can be most commonly located, while the liver is a less common site of origin; these hepatic lesions are often discovered as an incidental finding in the search for diagnostic images for another pathology or are identified in the evaluation of non-specific symptoms. This tumor has been defined as a benign neoplasm, although it is suggested that some cases may have a malignant potential after hepatic resection. The definitive diagnosis is based on pathological findings supported by immunohistochemical staining. The cellular component of smooth muscle is the most specific for the diagnosis and, characteristically, these lesions are positive for homatropine methyl bromide 45 (HMB-45) and Melan-A. Because hepatic angiomyolipomas are rare and have several imaging characteristics that tend to be confused with other tumors due to their very similarity, it is not easy to achieve a definitive preoperative diagnosis, and more than half of patients are misdiagnosed with hepatocellular carcinoma or hepatic adenoma, which are much more common lesions. Regarding the imaging diagnosis of angiomyolipoma; the fatty component can be detected by CT and ultrasound. When the fat content is lower, the magnetic resonance images in weighted and diffusion sequences are useful due to their sensitivity. In fact, magnetic resonance using conventional sequences and weighted by diffusion have become a valuable technique for the characterization of focal solid liver lesions.

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Uncommon imaging evolutions of focal liver lesions in cirrhosis

et al. 2019

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The Histopathological Features and CT/MRI Imaging Performances in Hepatic Angiomyolipoma Patients

Abstract: The CT or MRI imaging performances of HAML patients containing more vessels and less fatty tissues in histopathology resemble the imaging performance of HCC patients. These clinical features may be of great help in the differential diagnosis in the current clinical practices.

Cited by 10 publications

References 11 publications

Comparison of MRI Features of Epithelioid Hepatic Angiomyolipoma and Hepatocellular Carcinoma: Imaging Data From Two Centers

Comparison of MRI Features of Epithelioid Hepatic Angiomyolipoma and Hepatocellular Carcinoma: Imaging Data From Two Centers

Hepatic Angiomyolipoma: Case Report, Literary Review with Emphasis on Imaging Performance for the Diagnosis

Uncommon imaging evolutions of focal liver lesions in cirrhosis

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