Diagnosis and treatment of hepatic angiomyolipoma

Abstract

Hepatic angiomyolipoma poses a diagnostic challenge clinically and radiologically. Surgical resection is a safe and effective treatment option. It is important to realize the potential of malignant transformation and risk of rupture as life-threatening complications.

Hepatocellular carcinoma with concomitant hepatic angiomyolipoma and cavernous hemangioma in one patient

“…MRI is considered to be the best modality to determine the components of AML [15] . Hyper-or hypointensity on the T1-weighted image and hyperintensity on the T2-weighted image are observed depending on the component of tumor tissue [16,17] . Contrast-enhanced US (CEUS) was reported as an effective diagnostic tool for AML [17,18] .…”

Giant Hepatic Angiomyolipoma Mimicking Hepatocellular Carcinoma

“…So, the proper treatment of hepatic AML has remained controversial. Dind and et al, proposed the indication for resection as follows: [1] all symptomatic patients should receive surgical resection, [2] tumors greater than 6 cm in size, [3] tumors show extrahepatic growth and risk of rupture, [4] tumors show a tendency to grow, [5] findings of diagnostic imaging and/or biopsy cannot make a definitive diagnosis (13). Conservative management with close follow-up is suggested in patients with asymptomatic tumors and meet the following criteria: [1] tumor size smaller than 5 cm, [2] angiomyolipoma proved through fine needle aspiration biopsy, [3] patients with good compliance, and [4] not a hepatitis virus carrier (14).…”

Laparoscopic Liver Resection

“…CT imaging will show early enhancement that remains throughout the more delayed phases. Positive staining with HMB-45, with negative staining for cytokeratins 18 and 19, help to secure the diagnosis (Ding, GH et al 2011;Sturtz, CL & Dabbs, DJ 1994). Malignant degeneration is very rare, as is rupture, with three cases reported in the world literature.…”

“…Because of the rare nature of serious complications, an initially conservative management strategy of imaging follow up is recommended when the diagnosis is established. Recently proposed guidelines for surgical resection of angiomyolipoma are as follows: symptomatic disease, tumors greater than 6cm, tumors which grow on repeated imaging, tumors showing extrahepatic growth with risk of rupture, and inability to make a definitive diagnosis on imaging or biopsy (Ding, GH et al 2011).…”