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Presented by Pedram Argani, M.D. and prepared by Aatur Singhi, M.D., Ph.D.
Case 5: A 50 year old female with a liver mass.
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1. Question
Week 432: Case 5
A 50 year old female with a liver mass.images/1Alex/04192010case4image1.jpg
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images/1Alex/04192010case4image5.jpgCorrect
Answer: Angiomyolipoma
Histology: Within the liver, there is nodule composed predominantly of eosinophilic polygonal cells with eosinophilic vacuolated cytoplasm which simulate hepatocytes with lipid deposition. Elsewhere within this nodule, one can identify abnormally shaped blood vessels along with fat. The lesion is immunoreactive for HMB45 and Melan A, and not for HEPAR-1.
Discussion: All the lesions are in differential diagnosis are composed of hepatocytes, and would therefore label for HEPAR-1 and not for HMB45 or Melan A. The fibrosis present within the central portion of the lesion simulates the architecture of focal nodular hyperplasia. The lack of atypia and mitotic activity argue against carcinomas such as hepatocellular carcinoma.
Angiomyolipoma may simulate a variety of other lesions. Spindle cell predominant angiomyolipoma with pleomorphism may simulate leiomyosarcoma. Extensively fatty angiomyolipomas may simulate liposarcoma.
Incorrect
Answer: Angiomyolipoma
Histology: Within the liver, there is nodule composed predominantly of eosinophilic polygonal cells with eosinophilic vacuolated cytoplasm which simulate hepatocytes with lipid deposition. Elsewhere within this nodule, one can identify abnormally shaped blood vessels along with fat. The lesion is immunoreactive for HMB45 and Melan A, and not for HEPAR-1.
Discussion: All the lesions are in differential diagnosis are composed of hepatocytes, and would therefore label for HEPAR-1 and not for HMB45 or Melan A. The fibrosis present within the central portion of the lesion simulates the architecture of focal nodular hyperplasia. The lack of atypia and mitotic activity argue against carcinomas such as hepatocellular carcinoma.
Angiomyolipoma may simulate a variety of other lesions. Spindle cell predominant angiomyolipoma with pleomorphism may simulate leiomyosarcoma. Extensively fatty angiomyolipomas may simulate liposarcoma.