Skip to main content
SpringerLink
Log in

Hepatic angiomyolipoma with early drainage veins into the hepatic and portal vein

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Hepatic angiomyolipoma (AML) is a rare stromal tumor composed of variable admixtures of thick-walled vessels, smooth muscles and adipose tissue. One of the specific radiological findings of hepatic AML is an early drainage vein noted via enhanced computed tomography (CT). We report a case of hepatic AML showing early drainage veins into both the hepatic and portal vein. The case involved a 46-year-old woman who was referred to our hospital because of a giant hepatic tumor. CT revealed well-enhanced 14 cm and 1 cm tumors in the left and right lobes, respectively. Magnetic resonance imaging demonstrated the existence of adipose tissues in the larger tumor. Hepatic arteriography revealed early drainage veins draining into both the hepatic and portal vein. Based on a diagnosis of hepatic AML, left hepatectomy and partial hepatectomy were performed. Pathology revealed both tumors as hepatic AML based on human melanoma black-45 immuno-positivity. Hepatic AML with early drainage veins into both the hepatic and portal vein is rare. The dilated and retrogressive vein drains the abundant arterial blood flow of the tumor. The finding of early drainage veins into not only the hepatic vein but also the portal vein should be helpful for diagnosing hepatic AMLs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Goodman ZD, Ishak KG. Angiomyolipomas of the liver. Am J Surg Pathol. 1984;8:745–50.

    Article  CAS  PubMed  Google Scholar 

  2. Ishak K. Mesenchymal tumors of the liver. In: Okuda K, Peters RL, editors. Hepatocellular carcinoma. New York: Wiley; 1976. pp. 228–304.

    Google Scholar 

  3. Zheng RQ, Kudo M. Hepatic angiomyolipoma: identification of an efferent vessel to be hepatic vein by contrast-enhanced harmonic ultrasound. Br J Radiol. 2005;78:956–60.

    Article  CAS  PubMed  Google Scholar 

  4. Jeon TY, Kim SH, Lim HK, et al. Assessment of triple-phase CT findings for the differentiation of fat-deficient hepatic angiomyolipoma from hepatocellular carcinoma in non-cirrhotic liver. Eur J Radiol. 2010;73:601–6.

    Article  PubMed  Google Scholar 

  5. Yoshioka M, Watanabe G, Uchinami H, et al. Hepatic angiomyolipoma: differential diagnosis from other liver tumors in a special reference to vascular imaging - importance of early drainage vein. Surg Case Rep. 2015;1:11.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Saito Y, Shimada M, Utsunomiya T, et al. Hepatic epithelioid angiomyolipoma with arterioportal venous shunting mimicking hepatocellular carcinoma: report of a case. J Med Investig. 2013;60:262–6.

    Article  Google Scholar 

  7. Tsui WM, Colombari R, Portmann BC, et al. Hepatic angiomyolipoma: a clinicopathologic study of 30 cases and delineation of unusual morphologic variants. Am J Surg Pathol. 1999;23:34–48.

    Article  CAS  PubMed  Google Scholar 

  8. Martignoni G, Pea M, Reghellin D, et al. PEComas: the past, the present and the future. Virchows Arch. 2008;452:119–32.

    Article  PubMed  Google Scholar 

  9. Weeks DA, Malott RL, Arnesen M, et al. Hepatic angiomyolipoma with striated granules and positivity with melanoma–specific antibody (HMB-45): a report of two cases. Ultrastruct Pathol. 1991;15:563–71.

    Article  CAS  PubMed  Google Scholar 

  10. Makhlouf HR, Ishak KG, Shekar R, et al. Melanoma markers in angiomyolipoma of the liver and kidney: a comparative study. Arch Pathol Lab Med. 2002;126:49–55.

    PubMed  Google Scholar 

  11. Kudo M, Okuno T, Tomita S, et al. Hepatic angiomyolipoma pre-operatively diagnosed by imaging. J Gastroenterol Hepatol. 1993;8:483–8.

    Article  CAS  PubMed  Google Scholar 

  12. Ahmadi T, Itai Y, Takahashi M, et al. Angiomyolipoma of the liver: significance of CT and MR dynamic study. Abdom Imaging. 1998;23:520–6.

    Article  CAS  PubMed  Google Scholar 

  13. Yan F, Zeng M, Zhou K, et al. Hepatic angiomyolipoma: various appearances on two-phase contrast scanning of spiral CT. Eur J Radiol. 2002;41:12–8.

    Article  PubMed  Google Scholar 

  14. Yoshimura H, Murakami T, Kim T, et al. Angiomyolipoma of the liver with least amount of fat component: imaging features of CT, MR, and angiography. Abdom Imaging. 2002;27:184–7.

    Article  CAS  PubMed  Google Scholar 

  15. Wang S, Kuai X, Meng X, et al. Comparison of MRI features for the differentiation of hepatic angiomyolipoma from fat-containing hepatocellular carcinoma. Abdom Imaging. 2014;39:323–33.

    Article  PubMed  Google Scholar 

  16. Iwao Y, Ojima H, Onaya H, et al. Early venous return in hepatic angiomyolipoma due to an intratumoral structure resembling an arteriovenous fistula. Hepatol Res. 2014;44:700–6.

    Article  PubMed  Google Scholar 

  17. Murakami T, Nakamura H, Hori S, et al. Angiomyolipoma of the liver. Ultrasound, CT, MR imaging and angiography. Acta Radiol. 1993;34:392–4.

    Article  CAS  PubMed  Google Scholar 

  18. Dalle I, Sciot R, de Vos R, et al. Malignant angiomyolipoma of the liver: a hitherto unreported variant. Histopathology. 2000;36:443–50.

    Article  CAS  PubMed  Google Scholar 

  19. Mizuguchi T, Katsuramaki T, Nobuoka T, et al. Growth of hepatic angiomyolipoma indicating malignant potential. J Gastroenterol Hepatol. 2004;19:1328–30.

    Article  PubMed  Google Scholar 

  20. Deng YF, Lin Q, Zhang SH, et al. Malignant angiomyolipoma in the liver: a case report with pathological and molecular analysis. Pathol Res Pract. 2008;204:911–8.

    Article  PubMed  Google Scholar 

  21. Nguyen TT, Gorman B, Shields D, et al. Malignant hepatic angiomyolipoma: report of a case and review of literature. Am J Surg Pathol. 2008;32:793–8.

    Article  PubMed  Google Scholar 

  22. Kamimura K, Oosaki A, Sugahara S, et al. Malignant potential of hepatic angiomyolipoma: case report and literature review. Clin J Gastroenterol. 2010;3:104–10.

    Article  PubMed  Google Scholar 

  23. Fukuda Y, Omiya H, Takami K, et al. Malignant hepatic epithelioid angiomyolipoma with recurrence in the lung 7 years after hepatectomy: a case report and literature review. Surg Case Rep. 2016;2:31.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Makhlouf HR, Remotti HE, Ishak KG. Expression of KIT (CD117) in angiomyolipoma. Am J Surg Pathol. 2002;26:493–7.

    Article  PubMed  Google Scholar 

  25. Parfitt JR, Bella AJ, Izawa JI, et al. Malignant neoplasm of perivascular epithelioid cells of the liver. Arch Pathol Lab Med. 2006;130:1219–22.

    PubMed  Google Scholar 

  26. Folpe AL, Mentzel T, Lehr H-AA, et al. Perivascular epithelioid cell neoplasms of soft tissue and gynecologic origin: a clinicopathologic study of 26 cases and review of the literature. Am J Surg Pathol. 2005;29:1558–75.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Second Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handa-yama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan

    Ryota Kiuchi, Takanori Sakaguchi, Ryo Kitajima, Satoru Furuhashi, Makoto Takeda, Takanori Hiraide, Yoshifumi Morita & Hiroya Takeuchi

  2. Department of Radiology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan

    Takasuke Ushio

  3. Department of Diagnostic Pathology, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan

    Rei Ishikawa & Satoshi Baba

Authors
  1. Ryota Kiuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takanori Sakaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ryo Kitajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoru Furuhashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Makoto Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takanori Hiraide
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yoshifumi Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Takasuke Ushio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rei Ishikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Satoshi Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Hiroya Takeuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ryota Kiuchi.

Ethics declarations

Conflict of interest

Ryota Kiuchi, Takanori Sakaguchi, Ryo Kitajima, Satoru Furuhashi, Makoto Takeda, Takanori Hiraide, Yoshifumi Morita, Takasuke Ushio, Rei Ishikawa, Satoshi Baba and Hiroya Takeuchi declare that we they have no conflict of interest.

Human/animal rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kiuchi, R., Sakaguchi, T., Kitajima, R. et al. Hepatic angiomyolipoma with early drainage veins into the hepatic and portal vein. Clin J Gastroenterol 12, 361–366 (2019). https://doi.org/10.1007/s12328-019-00946-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-019-00946-2

Keywords

Search

Navigation