Diagnosis Of Hepatic Angiomyolipoma Research Articles

Diagnosis of Hepatic Angiomyolipoma by Combination of Baseline and Contrast-Enhanced Ultrasound--A Prospective Study in Non-Cirrhotic Patients.

ObjectivesHepatic angiomyolipoma (HAML) is a rare, benign mesenchymal tumor of the liver and its diagnosis has been considered challenging. The aim of this study was to investigate prospectively the diagnostic efficacy of the incorporation of both baseline ultrasound (US) and contrast-enhanced ultrasound (CEUS) features of HAML in patients without cirrhosis.Materials and MethodsConsecutive 1748 non-cirrhotic patients with focal liver lesions (FLLs) were prospectively enrolled. Baseline US and CEUS were performed before resection or biopsy. Ultrasound imaging diagnosis of FLLs was compared with the pathological results.ResultsFinal diagnoses were established in 41 patients with HAML (2.3%) with normal alpha fetal protein (AFP) level and in 1707 patients with FLL other than HAML. Diagnostic criteria for HAML was based on the combination of baseline US and CEUS appearance of the nodule: (1) Well-defined, marked hyper-echoic nodule without surrounding hypo-echoic halo on baseline US; (2) hyper-enhancement in the arterial phase (exclude initial peripheral nodular enhancement and spoke-wheel arteries) and remains hyper-enhancement or iso-enhancement in the late phase. The diagnostic criteria were fulfilled in 31 HAMLs, 1 hepatocellular adenoma and 1 hemangioma. Ten HAMLs were misdiagnosed as other liver tumors because they did not meet the diagnostic criteria mentioned above and consequently yielded a sensitivity, specificity, positive predictive values, negative predictive values and Youden index of 75.61%, 99.88%, 93.94%, 99.42%, and 0.75 respectively.ConclusionThe combination of baseline US and CEUS may lead to the correct diagnosis noninvasively in the majority of HAMLs in non-cirrhotic patients with normal AFP level.

Hepatic angiomyolipoma with special attention to radiologic imaging.

BackgroundAngiomyolipoma is a unique mesenchymal neoplasm composed of blood vessels as well as smooth muscle and adipose cells. The liver is a less common site of origin, and hepatic angiomyolipoma is often an incidental finding on diagnostic imaging or is identified on evaluation of nonspecific symptoms.Case presentationWe experienced four patients who were diagnosed histologically with hepatic angiomyolipoma. The preoperative diagnoses were angiomyolipoma in two patients, hepatocellular carcinoma in one, and cavernous hemangioma in one. Three patients were treated with hepatectomy (one laparoscopic and two open approaches), and the diagnosis was completed by histological investigation of the resected specimen. The remaining one was diagnosed from tumor needle biopsy. Diffusion-weighted magnetic resonance imaging (MRI) with respiratory triggering using b values of 0 and 800 s/mm2 was employed. An apparent diffusion coefficient map was generated from b values of 0 and 800 s/mm2 for calculation of the apparent diffusion coefficient. The apparent diffusion coefficient values were calculated as 3.66, 1.21, 1.80, and 0.91 in patients 1 to 4, respectively. In MRI imaging, fat component was clearly demonstrated with chemical shift imaging in three patients. Early venous return was detected in three patients with computed tomography angiography.ConclusionFat component and early venous return are important for a correct diagnosis of hepatic angiomyolipoma. Unfortunately, apparent diffusion coefficient values in hepatic angiomyolipoma were overlapping with those in other benign and malignant tumors.

Laparoscopic Resection of Hepatic Angiomyolipoma - An Uncommon Primary Liver Tumor: A Case Report and Literature Review

PEComas are an uncommon group of mesenchymal neoplasms that exhibit perivascular epithelioid cell differentiation. The term PEComa includes a collection of different subcategories, such as lymphangioleimyomatosis, clear cell tumor of the lung, and angiomyolipoma (AML) which is the topic of discussion in this article. The main problem concerning the diagnosis of hepatic AML is the wide non-specific imaging findings, stressing the need for a tissue diagnosis. Histological examination of a hepatic AML shows different types of tissues such as smooth muscle cells, fat cells (adipocytes), and blood vessels. The ultimate method for diagnosing an AML case is through immunohistochemical examination. AML displays positive immunoreactivity to HMB-45 and Melan- A, and negative to CAM5.2 and AE1/AE3 as well as S100 of the melanoma. The management of hepatic AML has been a matter of debate between different groups, and in this article we discuss a hepatic AML case that presented to our group and was treated with a minimally invasive surgical procedure.

Diagnosis of hepatic angiomyolipoma by CT and MRI

Objective To investigate the magnetic resonance imaging (MRI) and computerized tomography (CT) imaging findings of hepatic angiomyolipoma (AML).Methods Twelve cases of hepatic AML,which were confirmed by pathologists between 2009 and 2011 in our hospital,were retrospectively analyzed.Results There were 3 males and 9 females with an average age of 44.17 years (range,34 to 60 years).There were 14 lesions,8 in left lobe,6 in right lobe.All of 12 cases were confirmed as angiomyolipoma by pathologists.Nine cases were performed with MRI,2 with CT,and 1 with both CT and MRI.The border of lesions were clear in 8 cases.Fat contents were shown on CT and/or MRI in 8 cases.After administrated with contrast medium,the lesion enhancement was still apparent or slightly decreased in 9 lesions from portal phase to delayed phase.The suppression of portal vein and inferior vena cava by tumor were seen in 5 lesions.Abnormal vascular distortion was seen in 6 lesions.None of 12 lesions were found with portal vein thrombosis.Conclusion The diagnosis of hepatic angiomyolipoma should be considered when CT and MRI show good boundaries,intratumoral fat content,delayed lesion enhancement,and vascular distortion. Key words: Hepatic; Angiomyolipoma; Computerized tomography; Magnetic resonance imaging

Hepatic angiomyolipoma: CT and MR imaging findings with clinical–pathologic comparison

The objective of this study is to evaluate the clinical, pathologic, and computed tomography (CT) and/or magnetic resonance imaging (MRI) findings of hepatic angiomyolipoma (HAML) and to improve the diagnostic efficacy of the tumor. Clinical, pathologic, and imaging findings were retrospectively evaluated in 18 patients with HAML. Two patients underwent both CT and MRI, ten underwent CT alone, and six underwent MRI alone. Unenhanced and contrast-enhanced examinations were performed in all patients. Imaging characteristics, such as the lesion location, lesion diameter, presence of early draining veins, attenuation/signal intensity of the lesions on imaging, and enhancement pattern were reviewed. There were 3 male and 15 female patients. HAML was seen as a well-defined, solitary mass on imaging with medium size (mean diameter, 5.9cm). Fat was detected in ten patients. Calcification was noted in two patients and cystic degeneration was seen in one patient. Hepatic cirrhosis and capsule were not detected in all patients. The mean attenuation values exceeded 120hounsfield units (HU) in 11 patients (91.7%). Peripherally decreasing enhancement rim as well as early draining vein was seen in 15 patients (83.3%). The early draining veins were all hepatic veins. Tumor vessels were noted in all patients. The presence of early draining vein, peripheral decreasing enhancement rim, and the absence of tumor capsule in the hypervascular hepatic tumor on CT and/or MRI together with normal alpha fetal protein may be helpful for the diagnosis of HAML in non-cirrhotic liver.

Diagnosis and treatment of hepatic angiomyolipoma.

Hepatic angiomyolipoma (HAML) is a rare liver tumor. This paper summarized the clinical, radiological and pathological features of HAML. Seventeen cases of HAML were analyzed retrospectively. All patients were subjected to surgical resection of tumor, one of which was performed emergency surgery because of hemorrhage of tumor. There are 13 females and 4 males, most of whom were asymptotic except 4 had minimal abdominal discomfort. US, CT and/or MRI were taken and corresponding data was comprehensively analyzed with other clinical signs and symptoms. Correct preoperative diagnosis was able to be achieved in 9 patients. Pathological analysis and immunohistochemistry of HMB-45 was used as final diagnosis. All patients were followed up and survived without recurrence. Preoperative diagnosis of HAML can be benefited from comprehensive analysis of clinical manifestations. The malignant potential and fast growth of tumor suggested surgical removal of tumor while it was diagnosed.

Preoperative radiological characterization of hepatic angiomyolipoma using magnetic resonance imaging and contrast-enhanced ultrasonography: a case report

IntroductionA hepatic angiomyolipoma is a rare benign tumor of the liver composed of a mixture of smooth muscle cells, blood vessels and a variable amount of adipose tissue. Differentiating them from malignant liver tumors can often be very difficult.Case presentationWe report the case of a 43-year-old Caucasian man presenting with a large liver mass in the right lobe. The results of magnetic resonance imaging and contrast-enhanced ultrasonography were consistent with a well-demarcated adipose tissue- containing tumor, showing prolonged hyperperfusion in comparison with the surrounding liver tissue. Surgery was performed and the diagnosis of hepatic angiomyolipoma was made with histopathology.ConclusionPreoperative radiological characterization using magnetic resonance imaging and contrast-enhanced ultrasonography may improve diagnostic accuracy of hepatic angiomyolipoma. Identification of smooth muscle cells, blood vessels and adipose tissue with a positive immunohistochemical reaction for HMB-45 is the final evidence for an angiomyolipoma.

Diagnosis and treatment of hepatic angiomyolipoma

Objective To analyze the clinical features and diagnosis of hepatic angiomyolipoma patients,and to investigate its treatment strategy.Methods The clinical data of 79 patients with pathologically-confirmed hepatic angiomyolipoma,who were treated in the Eastern Hepatobiliary Surgery Hospital during 1992-2006,were retrospectively reviewed.Results The patients included 58 women and 21 men with a median age of (43±8.14) years old (ranging 17 to 69 years).None of the patients was found complicated with renal angiomyolipoma or tuberous sclerosis complex.Twenty-five patients were symptomatic on presentation.All the patients had a single hepatic lesion,with the tumor size ranging 1.0-25 cm and a median of (6.1±4.08) cm.Fifty-three tumors were located in the right lobe,22 in the left lobe,and 4 in the caudate lobe.Preoperative diagnoses were correctly made in 41 (52%) patients.Spontaneous rupture of tumor occurred in 1 patient.All the patients underwent surgical treatment without operative mortality and serious morbidity.The patients were regularly followed-up for 3-13 years.Tumor recurrence occurred in one patient 6 years after the surgery,and the patient died 1 year later.Conclusion Hepatic angiomyolipoma has no specific clinical signs and symptoms.Comprehensive imaging studies can help to make correct diagnosis,but the differential diagnosis is difficult,especially for small tumors with diameter less than 5 cm.The final diagnosis depends on pathologic examination and HMB-45 special staining.Surgical resection is safe and effective for the disease.Attention should be paid to the potential of malignant transformation and risk of rupture as a life-threatening complication.Early operation is needed once a diagnosis is made,and the patients should be followed up after operation.

Unusual sonographic appearance of a huge angiomyolipoma of the liver

Hepatic angiomyolipoma is a rare, benign, hepatic mesenchymal neoplasm. We report a case of an extremely large hepatic angiomyolipoma in a 58-year-old woman with unusual sonographic features. The tumor was well demarcated from the surrounding liver and showed a heterogeneous cystic appearance with a thick echogenic rim. Color Doppler showed blood flow in the echogenic rim and around the lesion. Contrast sonography demonstrated strong enhancement in the solid rim from early arterial phase to the late phase and no enhancement in the central cystic part of the lesion. Spiral CT showed a well-defined huge heterogeneous cystic mass with fatty density. At surgery the tumor was soft and encapsulated with a thin, smooth membrane. The cut surface of the tumor revealed a cystic appearance with necrotic tissue. The diagnosis of hepatic angiomyolipoma was confirmed by immunohistochemistry.

Hepatic Angiomyolipoma

Abstract Hepatic angiomyolipoma is a rare, benign, hepatic mesenchymal neoplasm found in both males and females, and most commonly in adult females. Angiomyolipoma occurs most commonly in the kidneys. The liver represents the second most frequent site of involvement. Hepatic angiomyolipomas are composed of varying amounts of smooth muscle cells, adipose tissue, and vessels. The smooth muscle cell component is the most specific to the diagnosis. The smooth muscle cells can have varying morphologies and are positive for homatropine methylbromide–45 but are negative for hepatocyte paraffin 1 and S100 protein. The definitive diagnostic study remains the histologic examination of the surgically resected lesion coupled with immunohistochemical stains. The differential diagnosis includes hepatocellular carcinoma, hepatic adenoma, leiomyoma, hepatoblastoma, melanoma, and gastrointestinal stromal tumor. The immunohistochemical staining pattern differentiates this lesion from other malignant and benign liver lesions. If the diagnosis of hepatic angiomyolipoma has been made, it can be followed conservatively or surgically resected.

Das Angiomyolipom der Leber - eine seltene Differenzialdiagnose der Leberraumforderung

A 22-year-old woman was treated for a hepatic lesion with a high suspicion of a liver adenoma at another hospital. The patient presented with unspecific abdominal pain. Further physical examination was unremarkable. A biopsy of the liver lesion revealed hepatic adenoma. Because of the increasing tumour size over a one-year period the patient was referred to our department for surgical therapy. On MRI scan, the liver mass measured 10 x 9 x 9 cm in the right liver lobe with contact to the right hilum. Because of the histological signs of adenoma a right hepatic lobectomy was performed. Postoperative follow-up was uneventful. The pathological diagnosis of hepatic angiomyolipoma was obtained. Angiomyolipoma of the liver is a rare benign mesenchymal tumour often mimicking other hepatic lesions. Histological features are thick-walled blood vessels, mature fat and smooth muscle in various proportions. The biological behaviour of the tumour is benign, although distant metastases are occasionally possible. Due to the potential for malignant transformation, tumour resection should be performed.

Morphologic variants and immunohistochemical features of hepatic angiomyolipoma

To study the clinicopathological characteristics, immunohistochemical features and differential diagnosis of hepatic angiomyolipoma (AML). The clinicopathological features of hepatic AML were systematically examined in 44 surgically resected tumor specimens, with additional immunohistochemistry study using 10 relevant antibodies. The tumors were composed of various amounts of three components, i.e. blood vessels, smooth muscle cells and adipose cells. According to the proportions of each of these tissue components, AML was subcategorized into the classical type (n = 13), myomatous type (n = 25), lipomatous type (n = 4), and angiomatous type (n = 2). Myoid cells displayed various morphology, including epithelioid, intermediate (ovoid or short spindle), spindle, oncocytic, and pleomorphic features. Hematopoietic elements were present as minor findings in eight tumors. Immunohistochemically, the tumor cells were strongly positive for HMB45 (44/44, 100%), SMA (38/38, 100%) and CD117 (30/38, 78.9%). A correct diagnosis of hepatic AML might be difficult due to its various growth patterns and cell types. HMB-45 positivity in the myoid cells is a key feature for hepatic AML. CD117 may be another useful ancillary marker for reaching a definite diagnosis.

Budd Chiari Syndrome associated with angiomyolipoma of the liver

We wish to report an unusual complication of hepatic angiomyolipoma. The patient was admitted to this Hospital with a two-week history of progressive abdominal pain, distension and peripheral oedema. Laboratory evaluation revealed albumin 30 g/l, bilirubin 48 μmol/l, AST 114 iu/l, INR 1.55, Cr 137 μmol/l and ascitic protein 25 g/l. CT abdomen (Fig. 1) demonstrated a 8.0×9.7×7.3 cm hypoattenuating mass in the central liver, involving segments 4a, 6, 7 and 8. There was associated extensive ascites and caudate lobe hypertrophy. Ultrasound, triphasic CT and MRI showed patent portal veins with hepatopetal flow. The hepatic veins were poorly visualised and CT scan suggested thrombus in the left hepatic vein. On subsequent venography it was not possible to cannulate the hepatic veins and there was extrinsic compression of the inferior vena cava with pressures of 20 mmHg below and 16 mmHg above the lesion. The right atrial pressure was 9 mmHg. Targeted tru-cut™ percutaneous ultrasound guided biopsy of the hepatic mass following correction of coagulopathy was consistent with the diagnosis of hepatic angiomyolipoma.

A CASE OF HEPATIC ANGIOMYOLIPOMA

A case of hepatic angiomyolipoma is reported. A 50-year-old male was pointed out to have a liver tumor by screening physical examination. Abdominal ultrasonography showed an about 6 cm in diameter, well-demarcated tumor-like lesion of high luminescence in the lateral-segment of the liver. Abdominal CT showed the lesion as a low-density area. Angiography of the celiac artery revealed laterality of branch of the left hepatic artery and a tumor stain slightly. The tumor was initially suspected to be a hepatic angiomyolipoma, but a possibility of liver cell carcinoma undergoing fatty deneration could not be denied. Lateral-segmentectomy of the liver was performed. Pathohistological examination led to a diagnosis of hepatic angiomyolipoma with thin capsule and without malignant finding. Angiomyolipoma occurred in the liver is exceedingly rare, only 14 cases having been reported so far in Japan. This case had characteristic images and no malignant case has been reported, however, some are difficult to distinguish from liver cell carcinoma undergoing fatty degeneration. In such cases histological examination of the operative specimen can first offer the definitive diagnosis, for which the surgical resection would be mandatory.