Kubo Hidefumi, Yamazaki Hitoshi, Okada Takemichi, Takahashi Yoshihito, Nishi Yatsushi, Yokomori Hiroaki
Department of Surgery, Kitasato University Medical Center, Kitamoto, Saitama, Japan.
Department of Pathology, Kitasato University Medical Center, Kitamoto-Saitama, Japan.
J Med Case Rep. 2017 Mar 22;11(1):76. doi: 10.1186/s13256-017-1235-1.
Hepatic angiomyolipomas are a rare, benign group of mesenchymal tumors in the liver. Hepatic angiomyolipoma is sometimes misdiagnosed as hepatocellular carcinoma, and there is the possibility of a malignant transformation. Hence, the accurate diagnosis of this disorder is necessary.
A 64-year-old Japanese man was observed to have a space-occupying lesion of 15-mm diameter in the liver during a follow-up examination for a previously resected cecal carcinoma. He underwent lateral segmentectomy of the liver with a provisional diagnosis of hepatic metastatic recurrence of the carcinoma based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and diffusion-weighted imaging.
We have explored the combination of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and histological examination to confirm our diagnosis of hepatic angiomyolipoma comprising an intimate mixture of numerous abnormal blood vessels, adipocytes, and epithelioid spindle cells of various sizes. Immunohistochemical examination revealed characteristic pathological findings associated with positive qualitative immunoreactions for human melanoma black 45 and desmin. Electron microscopic findings revealed the presence of melanosomes in the epithelioid cells. Diffusion-weighted imaging provides a more accurate diagnostic image with the characteristic macroscopic appearance of hepatic angiomyolipoma. Through immunohistochemistry and electron microscopy, we also show that this benign tumor comprises tissue elements.
肝血管平滑肌脂肪瘤是肝脏中一种罕见的良性间叶性肿瘤。肝血管平滑肌脂肪瘤有时会被误诊为肝细胞癌，并且存在恶变的可能性。因此，准确诊断这种疾病很有必要。
一名64岁的日本男性在对先前切除的盲肠癌进行随访检查时，被发现肝脏有一个直径15毫米的占位性病变。基于乙氧基苄基二乙三胺五乙酸钆增强磁共振成像和扩散加权成像，初步诊断为癌肝转移复发，随后他接受了肝左外叶切除术。
我们探索了乙氧基苄基二乙三胺五乙酸钆增强磁共振成像与组织学检查相结合的方法，以确诊我们对肝血管平滑肌脂肪瘤的诊断，该肿瘤由大量异常血管、脂肪细胞和各种大小的上皮样梭形细胞紧密混合组成。免疫组织化学检查显示了与人类黑色素瘤黑色45和结蛋白阳性定性免疫反应相关的特征性病理结果。电子显微镜检查发现上皮样细胞中存在黑素小体。扩散加权成像通过肝血管平滑肌脂肪瘤的特征性宏观表现提供了更准确的诊断图像。通过免疫组织化学和电子显微镜检查，我们还表明这种良性肿瘤包含多种组织成分。
