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Presented by Pedram Argani, M.D. and prepared by Priya Banerjee, M.D.
Case 5: 53-year-old female with a liver mass.
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1. Question
Week 390: Case 4
53-year-old female with a liver massimages/4_27_09 5A.jpg
images/4_27_09 5B.jpg
images/4_27_09 5C.jpg
images/4_27_09 5D_melana.jpg
images/4_27_09 5E_hmb45.jpgCorrect
Answer: Epithelioid angiomyolipoma
Histology: In the background of a noncirrhotic liver there is a lesion composed of epithelioid cells with a trabecular architecture and cystic change. The epithelioid cells have fluffy, tissue paper-like cytology. Some have a central granular eosinophilic cytoplasm with peripheral clearing (spider-web appearance). Within the sinusoids separating the cells are clusters of extramedullary hematopoiesis, including erythroids, eosinophilic myelocytes, and megakaryocytes. By immunohistochemistry, these cells label for HMB45 and Melan A, but not for Hepar-1, supporting the diagnosis of angiomyolipoma.
Discussion: Hepatocellular carcinoma would demonstrate more atypia and should label for Hepar-1. Metastatic renal cell carcinoma would not label for HMB45, and would label for cytokeratin. Focal fatty change within the liver would not label for HMB45.
Incorrect
Answer: Epithelioid angiomyolipoma
Histology: In the background of a noncirrhotic liver there is a lesion composed of epithelioid cells with a trabecular architecture and cystic change. The epithelioid cells have fluffy, tissue paper-like cytology. Some have a central granular eosinophilic cytoplasm with peripheral clearing (spider-web appearance). Within the sinusoids separating the cells are clusters of extramedullary hematopoiesis, including erythroids, eosinophilic myelocytes, and megakaryocytes. By immunohistochemistry, these cells label for HMB45 and Melan A, but not for Hepar-1, supporting the diagnosis of angiomyolipoma.
Discussion: Hepatocellular carcinoma would demonstrate more atypia and should label for Hepar-1. Metastatic renal cell carcinoma would not label for HMB45, and would label for cytokeratin. Focal fatty change within the liver would not label for HMB45.
