Hepatic Angiomyolipoma: Two Case Reports
of Caudate-Based Lesions and Review
of the Literature
AllenL. Hoffman,*SukruEmre,† RonP . Verham,‡ Lidija M. Petrovic,§
SusumuEguchi,‡ Jeffrey L. Silverman,? StephenA. Geller,§
MyronE. Schwartz,† CharlesM. Miller,† andLeonardMakowka*
Two case reports of hepatic angiomyolipoma,
both originating in the caudate lobe, are reported
with a review of the literature. The liver is the
second most common site of angiomyolipoma, an
uncommon benign tumor of mixed mesenchymal
origin. It is commonly diagnosed following ab-
ered on abdominal ultrasound or computed to-
mography scan. Of 74 cases reported, the lesions
ranged from 0.3 to 36 cm in diameter and are
noted between the first and eighth decade, with
predominant female predilection. The right lobe is
the most common site, with lesions arising in the
caudate lobe comprising only five cases. The
natural history of the hepatic lesion is unknown.
Malignant invasion or metastatic disease has not
been documented. Hepatic and renal angiomyoli-
poma can occur concurrently (13 of 60 cases),
although the majority are not biopsy proven.
Multicentric hepatic disease occurs. The correla-
tion between tuberous sclerosis and hepatic an-
giomyolipoma is not confirmed histologically and
occurs rarely. These lesions have a characteristic
radiographic appearance due to high fat content.
Histologically, angiomyolipoma are characterized
by an admixture of adipose tissue, blood vessels,
and smooth muscle cells. These lesions cannot
reliably be differentiated from a malignant lesion
based on clinical history, radiologic examination,
and/or pathologic interpretation. If clinical suspi-
cion for malignancy is low, then careful observa-
tion with serial radiologic follow-up is performed.
The treatment for a symptomatic or suspicious
lesion is resection, if feasible. Liver transplanta-
tion may be considered for large or centrally
located lesions not amenable to resection.
Copyright?1997 by theAmericanAssociation for
the Study of Liver Diseases
Mrs. KS-G, a 43-year-old woman was evaluated for a caudate
lobe mass. Six weeks prior to evaluation, she developed
epigastric discomfort and worsening of chronic midthoracic
back pain. Mild dyspepsia and reflux were present. An upper
endoscopy demonstratedmildgastritis, althoughZantac (Glaxo
Pharmaceuticals, ResearchTrianglePark, NC) wasineffectivein
relieving the symptoms. Her physical examination was unre-
Serum bilirubin was normal. Aspartate aminotransferase
(AST) and gamma glutamyl transferase (GGT) were slightly
elevated (98 and 112 IU/L, respectively). Tumor markers were
within the laboratory reference range and serologic studies for
hepatitis B and C were nonreactive. Other laboratory values
werewithin normal limits.
Abdominal ultrasonography demonstrated a 4-cm lesion in
oftheright kidney. Therenal lesion hadbeen unchangedin size
and character since 1987 and was most consistent with an
angiomyolipoma. Magnetic resonance imaging (MRI) demon-
not occlude it (Fig. 1A). The lesion was isointense on T1-
weighted images and hyperintense on T2-weighted images.
Central scarring and encapsulation were not present. Gadol-
ineum perfusion did not change the isointense nature of the
lesion, although postperfusion sequences showed some mild
enhancement. The liver was otherwise normal and the spleen
was not enlarged. Adenopathy, ascites, or caval thrombus were
not present. Theright renal mass was confirmed, and a12-mm
nonenhancing cyst was found in the upper pole of the left
kidney that had not been previously demonstrated. In attempt
to further define the caudate lobe lesion, a radionuclide study
using technetium99m-choletec wasperformed, which revealed
afilling defect in thecaudatelobewithout uptakeof thetracer.
Fromthe*Department of Surgery, St. Vincent Medical Center,
and the Departments of ‡Surgery, §Pathology and Laboratory
Medicine, andImaging,? Cedars-Sinai Medical Center, LosAngeles,
California; and the †Department of Surgery, Mt. Sinai Medical
Center, NewYork, NewYork.
Address reprint requests to Allen L. Hoffman MD, St. Vincent
Medical Center, Comprehensive Liver Disease and Treatment
Center, Institute Plaza, 2200 West Third Street, Los Angeles, CA
Copyright?1997by theAmericanAssociationfor theStudy of
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