Small angiomyolipoma of the liver diagnosed by fine‐needle aspiration biopsy under ultrasound guidance

Abstract

The first reported case of small hepatic angiomyolipoma to be diagnosed by fine-needle aspiration biopsy (FNAB) is described. A 53 year old man presented with a tumour in segment VI of the liver measuring 0.9 x 0.8 cm. The tumour was hyperechoic on ultrasound examination, showed relatively low density (+ 33 Hounsfield units) on computed tomography (CT), and was hypervascular on angiography. Computed tomography during arterial portography demonstrated a perfusion defect. Magnetic resonance imaging (MRI) revealed high intensity by both T1- and T2-weighted imaging. Diagnosis could not be obtained by these imaging modalities, but it was established successfully by FNAB under ultrasound guidance. Histologically, the tumour was an angiomyolipoma made up of three components: blood vessels, smooth muscle and fatty tissue. Surgery is unnecessary for this benign condition, and the patient has been followed up. Ten months later, the patient is currently doing well without growth of the hepatic angiomyolipoma.

Angiomyolipoma of the liver: Its clinical and pathological diversity

“…Seven AML tumors were detected incidentally at autopsy,3,5,8 and one at abdominal surgery;38 the remaining tumors in asymptomatic patients were incidentally detected during health examination or abdominal examination for other disease unrelated to the hepatic tumor. Of the symptomatic patients, 31 showed abdominal pain or distress ,11,13,14,16,17,19,22,23,,31,32,34,35,37,42,44,48,,54,56. 6 upper abdominal mass or hepatomegaly,11,25,27,34,35 7 malaise,8,15,18,28,46,47,51 2 night sweating,18,28 2 fever,8,40 1 tenderness8, 1 jaundice,10 1 anemia,8 1 palmar erythema,20 1 diarrhea,42 and 1 vomiting 45.…”

“…We1 previously compiled a report of 52 cases of hepatic AML presented in the world literature and reviewed their clinical and pathologic features. Since that report was published, an additional 25 cases of hepatic AML have been reported 37,. We have also experienced 3 additional cases ourselves, resulting in a total of 9 AML tumors in 8 patients 57.…”

“…However, the histogenesis of this tumor is very controversial and remains to be clarified 2. Almost 1000 cases of renal AML have been reported in the world literature, whereas hepatic AML is rare and, to our knowledge, only about 80 cases have been reported . One of the clinical characteristics of this entity is that the tumors are occasionally associated with the triad of mental retardation, epilepsy, and adenoma sebaceum (tuberous sclerosis complex) 1,2,8.…”

Management of Hepatic Angiomyolipoma

“…Therefore, several authors have suggested that this disease can be managed with conservative treatment 4–7. However, since 2000, several reports have revealed that this kind of tumor can be malignant with evidence of recurrence 8–10.…”

Fine-Needle Aspiration Cytology of Hepatic Angiomyolipoma: Case Report with Histological, Immunohistochemical and Electron Microscopic Findings

“…19 The first case diagnosed by FNA was in 1993, 20 followed by a few more papers describing the cytologic features of AML. [4][5][6][7][8] Unawareness of the existence of angiomyolipoma in the liver, and lack of experience may lead to misdiagnosis, especially on fine-needle aspirates. To complicate matters, hepatic angiomyolipoma has a resemblance to hepatocellular carcinoma in clinical presentation.…”