Analysis of clinicopathological findings and imaging features of hepatic epithelioid angiomyolipoma on contrast-enhanced ultrasound

doi:10.3877/cma.j.issn.1674-0793.2017.04.009

Abstract

Abstract:

Objective

To evaluate the clinicopathological findings and imaging features of hepatic epithelioid angiomyolipoma (EAMLs) on contrast-enhanced ultrasound (CEUS).

Methods

From January 2004 to December 2015, six patients with hepatic EAMLs were confirmed by operation in the First Affiliated Hospital of Sun Yat-sen University. The CEUS imaging findings and clinicopathological characteristics of EAMLs were retrospectively analyzed.

Results

The six patients were female, and the mean age was (43.5±12.8) years. All hepatic EAMLs were solitary. No patients had specific symptoms, and laboratory tests were normal in all patients. Under the microscope, the percentage of epithelioid cells varied from 25% to 98%. Immunohistochemical staining showed that the tumour cells were positive for myogenic markers (actin) and melanocytic markers (melan-A, HMB-45). Baseline ultrasound revealed that the maximal diameter of the lesions ranged from 3.1 to 6.5 cm [mean (4.4±1.3) cm], 3 cases were hypo-echoic and 3 were mixed-echoic. CEUS showed that 100.0% (6/6) of homogeneous hyper-enhancement in the arterial phase and 66.7% (4/6) of hypo-enhancement in the late phase. In the portal phase, there were 2 cases (33.3%) with hyper-, 2 with iso-, and 2 with hypo-enhancement, respectively.

Conclusion

The CEUS findings of liver EAMLs are similar to those of hepatocellular carcinoma, and the differential diagnosis should be made for the patients with no history of hepatitis.

Key words: Liver neoplasms, Ultrasonography, Contrast-enhanced ultrasound, Epithelioid angiomyolipoma

Guangliang Huang, Yang Tan, Yuan Lin, Jieyi Ye, Xiaoyan Xie. Analysis of clinicopathological findings and imaging features of hepatic epithelioid angiomyolipoma on contrast-enhanced ultrasound[J]. Chinese Archives of General Surgery(Electronic Edition), 2017, 11(04): 251-254.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2017.04.009

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2017/V11/I04/251

Figures/Tables 3

References 12

[1]	Eble JN, Amin MB, Young RH. Epithelioid angiomyolipoma of the kidney: a report of five cases with a prominent and diagnostically confusing epithelioid smooth muscle component[J]. Am J Surg Pathol, 1997, 21(10):1123-1130.
[2]	Mai KT, Perkins DG, Collins JP. Epithelioid cell variant of renal angiomyolipoma[J]. Histopathology, 1996, 28(3):277-280.
[3]	Jafari A, Fischer H, von Websky M, et al. Primary perivascular epitheloid cell tumour (PEComa) of the liver: case report and review of the literature[J]. Z Gastroenterol, 2013, 51(9):1096-1100.
[4]	Aydin H, Magi-Galluzzi C, Lane B, et al. Renal angiomyolipoma: clinicopathologic study of 194 cases with emphasis on the epithelioid histology and tuberous sclerosis association[J]. Am J Surg Pathol, 2009, 33(2):289-297.
[5]	Brimo F, Robinson B, Guo C, et al. Renal epithelioid angiomyolipoma with atypia: a series of 40 cases with emphasis on clinicopathologic prognostic indicators of malignancy[J]. Am J Surg Pathol, 2010, 34(5):715-722.
[6]	唐艳琼，李加伍，凌文武, 等. 肝脏上皮样血管平滑肌脂肪瘤声像图特征[J]. 中国医学影像技术, 2015, 31(5):746-749.
[7]	Xu PJ, Shan Y, Yan FH, et al. Epithelioid angiomyolipoma of the liver: Cross-sectional imaging findings of 10 immunohistochemically-verified cases[J]. World J Gastroenterol, 2009, 15(36):4576.
[8]	Liu W, Meng Z, Liu H, et al. Hepatic epithelioid angiomyolipoma is a rare and potentially severe but treatable tumor: a report of three cases and review of the literature[J]. Oncol Lett, 2016, 11(6):3669-3675.
[9]	Flor N, Sardanelli F, Serantoni S, et al. Low-fat angiomyolipoma of the liver studied with contrast-enhanced ultrasound and multidetector computed tomography[J]. Acta Radiologica, 2006, 47(6):543-546.
[10]	Akitake R, Kimura H, Sekoguchi S, et al. Perivascular epithelioid cell tumor (PEComa) of the liver diagnosed by contrast-enhanced ultrasonography[J]. Intern Med, 2009, 48(24):2083-2086.
[11]	王健，张万广. 小于2 cm的肝脏肿块的影像学诊断比较分析[J/CD]. 中华普通外科学文献（电子版）, 2017, 11(1):23-27.
[12]	Della Vigna P, Preda L, Monfardini L, et al. Growing perivascular epithelioid cell tumor of the liver studied with contrast-enhanced ultrasonography and magnetic resonance imaging[J]. J Ultrasound Med, 2008, 27(12):1781-1785.

编号	性别	年龄（岁）	临床症状	EC (%)	AD (%)	免疫组织化学结果
编号	性别	年龄（岁）	临床症状	EC (%)	AD (%)	Actin	Melan-A	HMB45	Vimentin	Hepatocyte	S-100
1	女	33	上腹痛	80	0	(+)	(+)	(+)	(+)	(-)	(-)
2	女	54	无	98	0	(+)	(+)	(+)	NA	(-)	(-)
3	女	36	上腹痛	90	5	(+)	(+)	(+)	(+)	(-)	(-)
4	女	44	无	70	10	(+)	(+)	(+)	NA	NA	(+)
5	女	63	无	95	1	(+)	(+)	(+)	(+)	(-)	(-)
6	女	31	无	25	70	(+)	(+)	(+)	(+)	NA	(-)

编号	性别	年龄（岁）	临床症状	EC (%)	AD (%)	免疫组织化学结果
编号	性别	年龄（岁）	临床症状	EC (%)	AD (%)	Actin	Melan-A	HMB45	Vimentin	Hepatocyte	S-100
1	女	33	上腹痛	80	0	(+)	(+)	(+)	(+)	(-)	(-)
2	女	54	无	98	0	(+)	(+)	(+)	NA	(-)	(-)
3	女	36	上腹痛	90	5	(+)	(+)	(+)	(+)	(-)	(-)
4	女	44	无	70	10	(+)	(+)	(+)	NA	NA	(+)
5	女	63	无	95	1	(+)	(+)	(+)	(+)	(-)	(-)
6	女	31	无	25	70	(+)	(+)	(+)	(+)	NA	(-)

编号	肿瘤位置	肿瘤直径(cm)	普通超声			超声造影增强程度
编号	肿瘤位置	肿瘤直径(cm)	形态	回声	血供	动脉期	静脉期	延迟期
1	S8	3.1	不规则形	混合	稀少	高	低	低
2	S4	4.5	类圆形	低	丰富	高	低	低
3	S3	5.1	类圆形	低	丰富	高	稍高	等
4	S5	3.2	类圆形	混合	丰富	高	等	低
5	S3	3.7	不规则形	低	较丰富	高	等	稍低
6	S5.8	6.5	不规则形	混合	丰富	高	稍高	稍高

编号	肿瘤位置	肿瘤直径(cm)	普通超声			超声造影增强程度
编号	肿瘤位置	肿瘤直径(cm)	形态	回声	血供	动脉期	静脉期	延迟期
1	S8	3.1	不规则形	混合	稀少	高	低	低
2	S4	4.5	类圆形	低	丰富	高	低	低
3	S3	5.1	类圆形	低	丰富	高	稍高	等
4	S5	3.2	类圆形	混合	丰富	高	等	低
5	S3	3.7	不规则形	低	较丰富	高	等	稍低
6	S5.8	6.5	不规则形	混合	丰富	高	稍高	稍高

[1]	Qi Lyu, Pinjing Hui, Yafang Ding, Yanhong Yan. Carotid contrast-enhanced ultrasound assessment of plaque vulnerability and its correlation with ischemic stroke [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1040-1045.
[2]	Shujie Wei, Pinjing Hui, Yafang Ding, Bai Zhang, Yanhong Yan, Peng Zhou, Yabo Huang. Evaluation of cerebral hemodynamics in patients with unilateral internal carotid artery occlusion undergoing superficial temporal artery-middle cerebral artery bypass [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1046-1055.
[3]	Xuan Zhang, Yutong Ma, Yuqian Miao, Yun Zhang, Shiwen Wu, Xiaochu Dang, Yingying Chen, Zhaoming Zhong, Xuejuan Wang, Miao Hu, Yanfeng Sun, Xiuzhu Ma, Faqin Lyu, Haiyan Kou. Ultrasound assessment of diaphragm function in pediatric patients with Duchenne muscular dystrophy [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(10): 1068-1073.
[4]	Lei Ding, Wen Luo, Xiao Yang, Lina Pang, Peidi Zhang, Haijing Liu, Jiani Yuan, Jin Liu. Application of high-frame-rate contrast-enhanced ultrasound in evaluation of imaging features of C-TIRADS 4-5 thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 887-894.
[5]	Qian Zhang, Jiahui Chen, Xuemeng Gao, Aoxue Zhao, Ying Huang. Value of radiomics features based on high-frame-rate contrast-enhanced ultrasound in differential diagnosis of benign and malignant thyroid nodules [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 895-903.
[6]	Lianhua Zhu, Xiang Fei, Peng Han, Bo Jiang, Nan Li, Yukun Luo. Value of high frame rate contrast-enhanced ultrasound in differential diagnosis of gallbladder polyp lesions [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 904-910.
[7]	Miao Li, Lianhua Zhu, Peng Han, Bo Jiang, Xiang Fei. Evaluation of relationsip between vascular morphology and risk factors for hepatocellular carcinoma by high-frame-rate contrast-enhanced ultrasound [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 911-915.
[8]	Weiping Zhang, Jingling Wang, Zhixing Liu, Li Chen, Fangqun Chen. Characteristics of time-intensity curve of high-frame-rate contrast-enhanced ultrasound in clear cell renal cell carcinoma [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 916-922.
[9]	Dan Han, Ting Wang, Huan Xiao, Lirong Zhu, Jingyu Chen, Yi Tang. Diagnostic value of contrast enhanced ultrasound versus contrast enhanced computed tomography in benign and malignant liver lesions in children [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 939-944.
[10]	Meifang Zhang, Ying Tan, Qiaozhen Zhu, Xin Wen, Ying Yuan, Yue Qin, Hongbo Guo, Lingxiu Hou, Wenlan Huang, Guiyan Peng, Shengli Li. Artificial intelligence-based quality control of mid-sagittal plane ultrasound images for first trimester fetal crown-rump length [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 945-950.
[11]	Ruina Zhao, Yuxin Jiang, Tao Chen, Li Zhang, Cheng Chen, Siqi Jin, Xueqi Chen, Xiao Yang, Jianchu Li. Present status and reform demands of continuing medical education for ultrasonic physicians in Beijing [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(09): 966-973.
[12]	Yuhan Zhou, Huan Xiao, Chunjiang Yang, Juan Zhou, Lirong Zhu, Juan Xu, Fangting Mou. Diagnostic value of ultrasound in children with temporary hip synovitis [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 795-800.
[13]	Huanyan Liu, Yang Hua, Lingyun Jia, Xinyu Zhao, Beibei Liu. Lumen structure and hemodynamic characteristics of occluded internal carotid artery [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 809-815.
[14]	Lianlian Zhang, Pinjing Hui, Yafang Ding. Clinical value of carotid Doppler ultrasonography in assessing vulnerability of atherosclerotic plaques [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 816-821.
[15]	Jianmei Li, Jingjuan Deng, Qian Yang. Safety and follow-up evaluation of the combined treatment of hepatocellular carcinoma with hepatic cirrhosis and portal hypertension [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 41-44.

Please choose a citation manager

Content to export