Journal of Gastrointestinal Surgery

, Volume 11, Issue 4, pp 452–457 | Cite as

Management of Hepatic Angiomyolipoma

  • Ching-Yao Yang
  • Ming-Chih Ho
  • Yung-Ming Jeng
  • Rey-Heng Hu
  • Yao-Ming Wu
  • Po-Huang Lee
Article

Abstract

Preoperative diagnosis of hepatic angiomyolipoma is difficult, and the treatment for it remains controversial. The aim of this study is to review our experience in the treatment of hepatic angiomyolipoma and to propose a treatment strategy for this disease. We retrospectively collected the clinical, imaging, and pathological features of patients with hepatic angiomyolipoma. Immunohistochemical studies with antibodies for HMB-45, actin, S-100, cytokeratin, vimentin, and c-kit were performed. Treatment experience and long-term follow-up results are summarized. During a period of 9 years, 10 patients with hepatic angiomyolipoma were treated at our hospital. There was marked female predominance (nine patients). Nine patients received surgical resection without complications. One patient received nonoperative management with biopsy and follow-up. One patient died 11 months after surgery because of recurrent disease. We propose all symptomatic patients should receive surgical resection for hepatic angiomyolipoma. 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.

Keywords

Angiomyolipoma Hepatic angiomyolipoma Liver tumor 

Notes

Acknowledgements

The authors would like to thank Dr. Kao-Lung Liu (Department of Radiology, National Taiwan University Hospital) for assistance with Fig. 1 and interpretation of radiologic pictures.

References

  1. 1.
    Ishak KG. Mesenchymal tumors of the liver. In: Okuda K, Peters RL, eds. Hepatocellular carcinoma. New York: John Wiley and Sons:, 1976 247–307.Google Scholar
  2. 2.
    Kitano Y, Honna T, Nihei K, et al. Renal angiomyolipoma in Japanese tuberous sclerosis patients. J Pediatr Surg 2004;39:1784–6.PubMedCrossRefGoogle Scholar
  3. 3.
    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.PubMedGoogle Scholar
  4. 4.
    Ma TK, Tse MK, Tsui WM, et al. Fine needle aspiration diagnosis of angiomyolipoma of the liver using a cell block with immunohistochemical study. A case report. Acta Cytol 1994;38:257–60.PubMedGoogle Scholar
  5. 5.
    Cha I, Cartwright D, Guis M, et al. Angiomyolipoma of the liver in fine-needle aspiration biopsies: its distinction from hepatocellular carcinoma. Cancer 1999;87:25–30.PubMedCrossRefGoogle Scholar
  6. 6.
    Yeh CN, Chen MF, Hung CF, et al. Angiomyolipoma of the liver. J Surg Oncol 2001;77:195–200.PubMedCrossRefGoogle Scholar
  7. 7.
    Yamada N, Shinzawa H, Makino N, et al. Small angiomyolipoma of the liver diagnosed by fine-needle aspiration biopsy under ultrasound guidance. J Gastroenterol Hepatol 1993;8:495–8.PubMedGoogle Scholar
  8. 8.
    Dalle I, Sciot R, de VR, et al. Malignant angiomyolipoma of the liver: a hitherto unreported variant. Histopathology 2000;36:443–50.PubMedCrossRefGoogle Scholar
  9. 9.
    Croquet V, Pilette C, Aube C, et al. Late recurrence of a hepatic angiomyolipoma. Eur J Gastroenterol Hepatol 2000;12:579–82.PubMedCrossRefGoogle Scholar
  10. 10.
    Flemming P, Lehmann U, Becker T, et al. Common and epithelioid variants of hepatic angiomyolipoma exhibit clonal growth and share a distinctive immunophenotype. Hepatology 2000;32:213–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Nonomura A, Mizukami Y, Kadoya M. Angiomyolipoma of the liver: a collective review. J Gastroenterol 1994;29:95–105.PubMedCrossRefGoogle Scholar
  12. 12.
    Sajima S, Kinoshita H, Okuda K, et al. Angiomyolipoma of the liver—a case report and review of 48 cases reported in Japan. Kurume Med J 1999;46:127–31.PubMedGoogle Scholar
  13. 13.
    Ren N, Qin LX, Tang ZY, et al. Diagnosis and treatment of hepatic angiomyolipoma in 26 cases. World J Gastroenterol 2003;9:1856–8.PubMedGoogle Scholar
  14. 14.
    Zhong DR, Ji XL. Hepatic angiomyolipoma—misdiagnosis as hepatocellular carcinoma: A report of 14 cases. World J Gastroenterol 2000;6:608–12.PubMedGoogle Scholar
  15. 15.
    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.PubMedCrossRefGoogle Scholar
  16. 16.
    Irie H, Honda H, Kuroiwa T, et al. Hepatic angiomyolipoma: report of changing size and internal composition on follow-up examination in two cases. J Comput Assist Tomogr 1999;23:310–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Messiaen T, Lefebvre C, Van BB, et al. Hepatic angiomyo(myelo)lipoma: difficulties in radiological diagnosis and interest of fine needle aspiration biopsy. Liver 1996;16:338–41.PubMedGoogle Scholar
  18. 18.
    Blasco A, Vargas J, de AP, et al. Solitary angiomyolipoma of the liver. Report of a case with diagnosis by fine needle aspiration biopsy. Acta Cytol 1995;39:813–6.PubMedGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    Hu RH, Lee PH, Chang YC, et al. Prognostic factors for hepatocellular carcinoma < or = 3 cm in diameter. Hepatogastroenterology 2003;50:2043–8.PubMedGoogle Scholar
  21. 21.
    Chang YC, Tsai HM, Chow NH. Hepatic angiomyolipoma with concomitant hepatocellular carcinomas. Hepatogastroenterology 2001;48:253–5.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Ching-Yao Yang
    • 1
    • 2
  • Ming-Chih Ho
    • 1
  • Yung-Ming Jeng
    • 3
  • Rey-Heng Hu
    • 1
  • Yao-Ming Wu
    • 1
  • Po-Huang Lee
    • 1
  1. 1.Department of SurgeryNational Taiwan University Hospital, and National Taiwan University College of MedicineTaipeiTaiwan
  2. 2.Department of TraumatologyNational Taiwan University Hospital, and National Taiwan University College of MedicineTaipeiTaiwan
  3. 3.Department of PathologyNational Taiwan University Hospital, and National Taiwan University College of MedicineTaipeiTaiwan

Personalised recommendations