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Hwang, Yu, and Cho: Hepatic Angiomyolipoma with Variable Histologic Features: 8 Cases Resembling Hepatocellular Carcinoma or Inflammatory Pseudotumor
Original Article
Liver
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(4): 242-248.

Published online: 20 October 2012

DOI: https://doi.org/10.4166/kjg.2012.60.4.242

Hepatic Angiomyolipoma with Variable Histologic Features: 8 Cases Resembling Hepatocellular Carcinoma or Inflammatory Pseudotumor

Ilseon Hwang, Eunsil Yu1, Kyung-Ja Cho1

Department of Pathology, Keimyung University School of Medicine, Daegu, Korea.

1Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.

Correspondence to: Kyung-Ja Cho, Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-4545, Fax: +82-2-472-7898, kjc@amc.seoul.kr

Received 27 March 2012       Revised 19 June 2012       Accepted 20 June 2012

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Hepatic angiomyolipoma (AML) is a rare mesenchymal tumor of the liver and demonstrates a marked histologic diversity. HMB-45 is a promising immunomarker for this tumor and especially helpful to diagnosis of some AMLs with unusual morphology. The purpose of this study was to better define the variable histologic feature of hepatic AML.

Methods

Eight hepatic AMLs were examined, and all of that were resection specimens. The diagnosis was confirmed by the presence of HMB-45 positive cells. Median age was 41.5 years old, and mean size of tumor was 8.94 cm.

Results

Conventional mixed type was 5 cases which showed myomatous, angiomatous and lipomatous component, and 3 cases were myomatous predominant. Variable patterns including spider web cell morphology, solid sheet-like and trabecular pattern were identified on myomatous component and variable amount and patterns of inflammatory cell infiltration was identified.

Conclusions

With only histologic features, it is difficult to distinguish hepatic AML from other hepatic tumor including hepatocellular carcinoma or inflammatory pseudotumor. A correct diagnosis of hepatic AML is possible by a close histologic examination with immunohistochemical stainings such as HMB-45 which is important to patient's prognosis.

Keywords: Liver, Angiomyolipoma, HMB-45, Histology

Figures and Tables

Fig. 1
Gross and radiologic findings of hepatic angiomyolipoma. (A-C) Well-defined ovoid soft masses were identified on the hepatic parenchyma with variable sizes and colors. (D) A well demarcated hypervascular mass was identified in the posterior segment of the right lobe (CT, enhanced).
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Fig. 2
Variable histologic features of hepatic angiomyolipoma (H&E stain). (A) Predominantly lipomatous component was identified in one case (×40). (B) Spider web pattern was identified in predominantly myomatous component cases (×100). (C) Epithelioid cells of myomatous component showed solid and sheet-like pattern (×40). (D) One case had predominantly trabecular pattern of myomatous component (×40).
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Fig. 3
(A) Vesicular nuclei with predominant nucleoli (arrows) were identified on the myomatous cells (H&E, ×400). (B) Some myomatous cells had intranuclear pseudoinclusions (arrow heads) (H&E, ×400). (C) Melanin pigments (arrows) were present in the cytoplasm of some myomatous cells (H&E, ×400). (D) Tumor cells were positive for HMB-45 immunohistochemical staining (×400).
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Table 1
Clinical Manifestations of 8 Hepatic AMLs
kjg-60-242-i001

AML, angiomyolipoma; RUQ, right upper quadrant; HCC, hepatocellular carcinoma.

Table 2
Microscopic Findings of 8 Hepatic Angiomyolipomas
kjg-60-242-i002

A, abundant; CC, coarse chromatin; D, diffuse pattern; E, eosinophilic; EG, eosinophilic granular; L, localized pattern; Mu, multifocal; NF, nest formation; PV, perivascular infiltrative pattern; SH, sheet-like pattern; SW, spider web pattern; T, trabecular pattern; VN, vesicular nuclei.

Notes

Financial support: None.

Conflict of interest: None.

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