Hazards during the preoperative diagnosis of Hepatic Angiomyolipoma

Abstract

In practice, the diagnosis of Hepatic Angiomyolipoma (HAML) is often difficult to make preoperatively, because of the highly variable histological composition. We describe a HAML in a 54 years old female who presented with right upper quadrant pain for one month and moderate fever for five days. Antibiotic treatment is effective. Abdominal ultrasonography revealed a well-defined hypoechoic mass without flow signals in it. Computed tomography showed a inhomogeneous mass, enhanced reticulately, without fat and vascular components. These were diagnosed to be either HAML or Inflammatory pseudotumor (IPT) of the liver. An Intraoperative ultrasound also found the anechoic lesions of the mass and suggested hemangioma. The cut surface of the specimen showed an encapsulated yellowish tumor consisting scattered intratumoral hemorrhagic focus. Pathological examination and HMB45 marker confirmed the diagnosis of Hepatic AML. The present case indicates that intratumoral hemorrhage led to the imaging diversity and IPT should be added to the list of differential diagnoses for HAML.