Hepatic epithelioid angiomyolipoma with trabecular growth pattern: A mimic of hepatocellular carcinoma on fine needle aspiration cytology

Authors

  • Linjun Xie M.D.,

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
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  • Jose Jessurun M.D.,

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
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  • J. Carlos Manivel M.D.,

    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
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  • Stefan E. Pambuccian M.D.

    Corresponding author
    1. Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota
    • Division of Surgical Pathology, Department of Laboratory Medicine and Pathology, University of Minnesota, 420 Delaware SE, C422 Mayo, MMC 76, Minneapolis, MN 55455
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Abstract

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. Diagn. Cytopathol. 2012. © 2011 Wiley Periodicals, Inc.

Ancillary