Liver transplantation for recurrent posthepatectomy malignant hepatic angiomyolipoma: a case report

Abstract

Hepatic angiomyolipomas (AMLs) are typically benign tumors containing varying amounts of smooth muscle cells, adipose tissue, and vessels, and are commonly found in the kidney and occasionally in the liver. The preoperative diagnosis of hepatic AML is primarily made from imaging and fine-needle aspiration biopsy results, though limited experience for such diagnoses can result in misdiagnosis. Some uncommon features of hepatic AML have been reported in the literature without an objective or qualitative consensus. As the majority of cases are benign, conservative treatment of AMLs is recommended. However, in rare cases, liver transplantation has been implemented. Only five cases of malignant hepatic AML have been reported. We report a rare case of recurrent posthepatectomy malignant hepatic AML that was misdiagnosed as liver cancer in a 37-year-old woman, which was treated by liver transplantation. The imaging and pathologic findings are presented in order to provide a more concise description to aid in future diagnoses.

Keywords: Angiomyolipoma; Hepatectomy; Liver transplantation; Malignant; Recurrence.

Figure 1

Imaging findings. A: The tumor was hypoechoic on computed tomography (CT); B, C: Enhanced CT showed a tumor (7.0 cm × 9.0 cm) with early-phase hyperattenuation and late-phase hypoattenuation; D, E: Magnetic resonance imaging showed a tumor with hypointensity on T1-weighted, hyperintensity on T2-weighted; F, G: Enhanced CT showed two hepatic masses (13.0 cm × 12.0 cm and 2.3 cm × 1.8 cm) in the right lobe; H: Angiography revealed a circumscribed hypervascular mass.

Figure 2

Pathologic findings. A: The tumor occupied a large area of the liver; The tumor was immunopositive for B: Human melanoma black-45 (20 ×); C: Ki-67 (10 ×); D: Smooth muscle actin (10 ×); E: CD68 (20 ×); F: Hematoxylin and eosin staining showed neoplasm necrosis (4 ×).