Cha I, Cartwright D, Guis M, Miller T R, Ferrell L D
Department of Pathology, University of California-San Francisco, 94143, USA.
Cancer. 1999 Feb 25;87(1):25-30.
Angiomyolipoma (AML) of the liver is an uncommon benign lesion that may be difficult to distinguish clinically, radiographically, and morphologically from hepatocellular carcinoma (HCC).
Fine-needle aspiration biopsies (FNAB) of three AMLs of the liver were compared with FNABs from eight cases of HCC. Immunoperoxidase stains for HMB-45, muscle specific actin, and CAM 5.2 were performed on two cell blocks and one resection of AML.
All three AMLs yielded cellular aspirates. They were composed of clusters of cells with arborizing transgressing endothelium but no peripherally wrapping endothelium. Smooth muscle cells of AML showed fibrillar cytoplasm and indistinct cytoplasmic borders; HCC showed granular cytoplasm and distinct cytoplasmic borders. Extramedullary hematopoiesis was present only in AML. Mitotic figures were seen only in HCC. Intranuclear inclusions, nucleoli, and large, atypical cells were present in both AML and HCC. Fat was seen in only one case of AML and was scant. Immunoperoxidase stains for HMB-45 and smooth muscle actin were positive in AML and negative in adjacent normal liver. CAM 5.2 stain was negative in AML.
The cytologic features seen on FNABs of AML are distinct from those of HCC. Immunoperoxidase stains can aid in the definitive diagnosis on FNAB. It is important to recognize AML on FNAB to allow conservative clinical management.
肝脏血管平滑肌脂肪瘤（AML）是一种罕见的良性病变，在临床、影像学及形态学上可能难以与肝细胞癌（HCC）相区分。
对3例肝脏AML的细针穿刺活检（FNAB）与8例HCC的FNAB进行比较。对两个细胞块及1例AML切除标本进行HMB-45、肌肉特异性肌动蛋白及CAM 5.2的免疫过氧化物酶染色。
所有3例AML均获得细胞抽吸物。它们由具有分支状穿行内皮但无外周包裹内皮的细胞簇组成。AML的平滑肌细胞显示出纤维状细胞质和不清晰的细胞质边界；HCC显示出颗粒状细胞质和清晰的细胞质边界。髓外造血仅见于AML。有丝分裂象仅见于HCC。核内包涵体、核仁及大的非典型细胞在AML和HCC中均有出现。脂肪仅在1例AML中可见且量少。AML中HMB-45和平滑肌肌动蛋白的免疫过氧化物酶染色呈阳性，而在相邻正常肝脏中呈阴性。AML中CAM 5.2染色呈阴性。
AML的FNAB所见细胞学特征与HCC不同。免疫过氧化物酶染色有助于FNAB的明确诊断。在FNAB上识别AML以进行保守的临床处理很重要。
