Xie Linjun, Jessurun Jose, Manivel J Carlos, Pambuccian Stefan E
Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA.
Diagn Cytopathol. 2012 Jul;40(7):639-50. doi: 10.1002/dc.21703. Epub 2011 May 11.
Epithelioid angiomyolipomas (AMLs) of the liver are rare tumors with imaging and cytologic features overlapping with those of hepatocellular carcinomas. We report the fine needle aspiration and core biopsy findings of an epithelioid AML in the right hepatic lobe of a 32-year-old female with tuberous sclerosis. She had undergone renal transplantation 8 years previously after bilateral nephrectomy for renal AMLs and a 3-cm chromophobe renal cell carcinoma. Hepatocellular carcinoma was suspected during the initial cytologic and histologic examination based on the presence of numerous large polygonal cells with ample finely vacuolated or granular cytoplasm, low nucleocytoplasmic ratio, and mild nuclear pleomorphism in the smears, as well as a distinctive trabecular histologic pattern in the core biopsies. Immunoperoxidase stains showed that the neoplastic cells were negative for cytokeratins and positive for HMB45, Melan-A, and smooth muscle actin, establishing the diagnosis of epithelioid AML. To determine the distinguishing cytomorphologic features between epithelioid AML and HCC, we have compared the cytologic features of 15 cases of hepatic AML reported in the literature, including the present case, to the FNA cytologic findings of 38 consecutive cases of HCC diagnosed at out institution.
肝脏上皮样血管平滑肌脂肪瘤（AMLs）是一种罕见肿瘤，其影像学和细胞学特征与肝细胞癌重叠。我们报告了一名32岁患结节性硬化症女性右肝叶上皮样AML的细针穿刺抽吸和粗针活检结果。她8年前因双侧肾AMLs及1例3cm嫌色性肾细胞癌行双侧肾切除术后接受了肾移植。在最初的细胞学和组织学检查中，由于涂片中有大量大的多边形细胞，胞质丰富、细颗粒状或有空泡，核质比低，核轻度异形，以及粗针活检中有独特的小梁状组织学模式，怀疑为肝细胞癌。免疫过氧化物酶染色显示肿瘤细胞细胞角蛋白阴性，HMB45、Melan-A和平滑肌肌动蛋白阳性，从而确诊为上皮样AML。为了确定上皮样AML与HCC之间的鉴别性细胞形态学特征，我们将文献报道的15例肝脏AML（包括本例）的细胞学特征与本院连续诊断的38例HCC的FNA细胞学结果进行了比较。
