A Case of Hepatic Angiomyolipoma Presented with Rupture and Intraabdominal Hemorrhage

Masaaki Awane, Masato Naito¹⁾, Satoru Matsusue¹⁾, Gen Honjo²⁾, Youichiro Kobashi²⁾ and Hiroaki Maeda³⁾

Department of Surgery, Kansai Electric Power Hospital
Department of Abdominal Surgery¹⁾ and Department of Clinical Pathology²⁾, Tenri Hospital
Department of Surgery, Yao General Hospital³⁾

A 48-year old lady followed up for elevated liver enzyme and reporting severe right hypochondralgia was found in Computed tomography (CT) to have a hepatic mass at section 8 and a relatively high-density fluid collection in the abdominal cavity. Further examination detected a hypervascular hepatic tumor at right lobe roughly compatible with hepatocellular carcinoma. Based on a diagnosis of spontaneously ruptured hepatocellular carcinoma, we conducted elective tumor resection. Histological examination showed solid epithelioid cell growth without adipose tissue. The unexpected definitive diagnosis was hepatic monotypic angiomyolipoma (AML) made because tumor cells were positive for melanocytic marker HMB-45 in immunohistochemistry. Hepatic angiomyolipoma, a rare benign tumor, consists of highly diversified blood vessel, smooth muscle, and mature adipose tissue. It is frequently misdiagnosed as malignant. Compared to renal AML, hepatic AML rupture is rare. Although this tumor is believed to have been benign, few malignant hepatic AML cases are reported. Resection should be considered in the selected cases, due to the risk of rupture and malignant potential.

Key words
hepatic angiomyolipoma, spontaneous rupture, hemorrhage

Reprint requests
Masaaki Awane Department of Surgery, Kansai Electric Power Hospital
2-1-7 Fukushima, Fukushima, Osaka, 553-0003 JAPAN

Accepted
November 18, 2009

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