Clinical review and literature analysis of hepatic epithelioid angiomyolipoma in alcoholic cirrhosis: A case report

BACKGROUND Hepatic epithelioid angiomyolipoma(HEA)has a low incidence and both clinical manifestations and imaging lack specificity.Thus,it is easy to misdiagnose HEA as other tumors of the liver,especially in the presence of liver diseases such as hepatitis cirrhosis.This article reviewed the diagnosis and treatment of a patient with HEA and alcoholic cirrhosis,and analyzed the literature,in order to improve the understanding of this disease.CASE SUMMARY A 67-year-old male patient with a history of alcoholic cirrhosis was admitted due to the discovery of a space-occupying lesion in the liver.Based on the patient’s history,laboratory examinations,and imaging examinations,a malignant liver tumor was considered and laparoscopic partial hepatectomy was performed.Postoperative pathology showed HEA.During outpatient follow-up,the patient showed no sign of recurrence.CONCLUSION HEA is difficult to make a definite diagnosis before surgery.HEA has the poten-tial for malignant degeneration.If conditions permit,surgical treatment is recom-mended.

Fat-poor renal angiomyolipoma with prominent cystic degeneration:A case report and review of the literature

BACKGROUND Angiomyolipoma(AML),the most common benign tumor of the kidney,is usually composed of dysmorphic blood vessels,smooth muscle,and mature adipose tissue.To our knowledge,AML with cystic degeneration has rarely been documented.Cystic degeneration,hemorrhage,and a lack of fat bring great challenges to the diagnosis.CASE SUMMARY A 60-year-old man with hypertension presented with a 5-year history of cystic mass in his left kidney.He fell 2 mo ago.A preoperative computed tomography(CT)scan showed a mixed-density cystic lesion without macroscopic fat density,the size of which had increased compared with before,probably due to hemorrhage caused by a trauma.Radical nephrectomy was performed.Histopathological studies revealed that the lesion mainly consisted of tortuous,ectatic,and thick-walled blood vessels,mature adipose tissue,and smooth muscle-like spindle cells arranged around the abnormal blood vessels.The tumor cells exhibited positivity for human melanoma black-45,Melan-A,smooth muscle actin,calponin,S-100,and neuron-specific enolase,rather than estrogen receptor,progesterone receptor,CD68,and cytokeratin.The Ki-67 labeling index was less than 5%.The final diagnosis was a fat-poor renal AML(RAML)with prominent cystic degeneration.CONCLUSION When confronting a large renal cystic mass,RAML should be included in the differential diagnosis.

Giant Angiomyolipoma Masquerading as Perinephric Abscess: A Diagnostic Conundrum

Renal angiomyolipomas are the most common benign tumours of the kidney accounting for up to 1% of all renal masses. Giant angiomyolipomas which have a size greater than 10 centimetres are rare entities with few cases reported in literature. Small angiomyolipomas are usually a symptomatic and increasing size correlates with symptomatology. These are usually incidentally detected or when symptomatic may present with an abdominal lump, flank pain or hemorrhage. Herein, we report a rare case of 45-year-old lady with giant angiomyolipoma with clinical presentation indistinguishable from perinephric abscess. The case is rare with regards to the large size of tumour and the discordant presentation unusual for an angiomyolipoma.

Primary hepatic epithelioid angiomyolipoma: A malignant potential tumor which should be recognized

AIM: To improve the clinical diagnosis and recognition of hepatic epithelioid angiomyolipoma(HEAML).METHODS: Four cases of primary HEAML were confirmed based on the pathology archive system in our hospital from January 2009 to November 2015. The general state, clinical symptoms, imaging manifestations, histological results and immunohistochemistry of these patients were retrospectively reviewed and analyzed. Studies of HEAML published in the last 15 years were collected from Pub Med and MEDLINE to summarize the clinical symptoms, imaging characteristics, pathological features and management of HEAML.RESULTS: Four cases of primary HEAML were retrieved from our archives. These included three female patients and one male patient, with a mean age of 41.8 ± 11.5 years(ranging from 31 to 56 years). The meantumor size was 7.3 ± 5.5 cm(ranging from 3.0 to 15 cm). In the contrast-enhanced imaging, the tumor was obviously enhanced in the arterial phase, but enhanced continuously or exhibited a slow-density masse during the venous and delayed phases. Histologically, the tumors mainly consisted of epithelioid cells that comprised approximately 95% of the total neoplastic mass. Although no metastases occurred in our patients, pathological studies revealed necrosis, mitotic figures and liver invasion in two patients, which indicates aggressive behavior. Immunohistochemical staining revealed that human melanoma black 45(HMB-45) and Melan-A were positive in 4 cases. We only identified 81 cases with primary HEAML, including our present patients, from 26 articles available from Pub Med and MEDLINE. The majority of the papers were published as case reports. Only 5(5/75, 6%) cases were associated with tuberous sclerosis complex(TSC). More than half(35/66) were discovered incidentally upon physical examination. Approximately 65%(22/34) of the patients were misdiagnosed with HCC or other tumors before surgery. Approximately 10%(8/81) of the patients with HEAML had recurrence or metastasis after surgery, which was a very high and alarming rate.CONCLUSION: HEAML is a very rare primary hepatic tumor that is often misdiagnosed before surgery. Patients should be followed closely after surgery because of its malignant potential.

Hepatic angiomyolipoma-misdiagnosis as hepatocellular carcinoma:A report of 14 cases

INTRODUCTIONAngiomyolipoma(AML)is a rare benign mesenchymaltumor of the liver,composed of a varying heterogeneousmixture of three tissue components:blood vessels。

Multi-slice computed tomography manifestations of hepatic epithelioid angiomyolipoma

AIM:To explore the characteristics of multi-slice computed tomography(CT)manifestations of hepatic epithelioid angiomyolipoma(HEA),improve the rate of accurate diagnosis,and reduce the misdiagnostic rate.METHODS:The multi-slice CT manifestations in five patients who were diagnosed with HEA definitely by postoperative pathological examination were analysed retrospectively.Three female patients and two male patients were included.Before operation,four patients received plain CT scanning and dynamic enhancement scanning,and the other patient only received enhancement scanning,with immunohistochemical analysis conducted after postoperative pathological examination.Four patients were misdiagnosed by CT,including three patients misdiagnosed with hepatic cell carcinoma and one patient with focal nodular hyperplasia.RESULTS:Upper abdominal multi-slice spiral CT scanning and three-stage enhancement scanning were conducted in five patients with HEA before operation.HEA had certain characteristic CT manifestations:low density masses,a few relatively high-density masses or fatdensity masses diffusely shown in foci,clear boundary,round or oval and large focus,and tumour size ranging from 3.1 cm×2.5 cm to 7.0 cm×5.2 cm.During enhancement scanning,the foci were significantly enhanced uniformly or non-uniformly during the arterial phase,while during the venous and equilibrium phases,the foci were enhanced continuously or showed obvious low-density masses.Obviously enhanced and widened vessels could be found adjacent to foci or in the central area of foci during the arterial phase.CONCLUSION:CT manifestations of HEA have certain characteristics.Primary diagnosis can be obtained by combining CT findings with clinical data,but pathological examination is still needed for a definite diagnosis.

Liver transplantation for recurrent posthepatectomy malignant hepatic angiomyolipoma:A case report

Hepatic angiomyolipomas(AMLs) are typically benign tumors containing varying amounts of smooth musclecells, adipose tissue, and vessels, and are commonly found in the kidney and occasionally in the liver. The preoperative diagnosis of hepatic AML is primarily made from imaging and fine-needle aspiration biopsy results, though limited experience for such diagnoses can result in misdiagnosis. Some uncommon features of hepatic AML have been reported in the literature without an objective or qualitative consensus. As the majority of cases are benign, conservative treatment of AMLs is recommended. However, in rare cases, liver transplantation has been implemented. Only five cases of malignant hepatic AML have been reported. We report a rare case of recurrent posthepatectomy malignant hepatic AML that was misdiagnosed as liver cancer in a 37-year-old woman, which was treated by liver transplantation. The imaging and pathologic findings are presented in order to provide a more concise description to aid in future diagnoses.

Clinical features of hepatic angiomyolipoma

BACKGROUND: Hepatic angiomyolipoma (HAML) is a rare hepatic mesenchymal tumor. This study was designed to explore its clinical features. METHODS: Clinical data from 26 patients who had been pathologically confirmed with HAML and had received surgical resection at our hospital were analyzed retrospectively. RESULTS: HAML was seen more frequently in females (18/26) in this series, and most of the patients presented no significant symptoms except for one who had a spontaneous rupture hemorrhage. Serum alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were negative in all patients. Imaging presentations were diverse. Pre-operative diagnosis was made in only 3 patients. Pathological study showed that the tumor was composed of adipose tissue, smooth muscle and blood vessels in different proportions. One patient showed hepatic vessel invasion. HMB-45 immunohistochemical staining was positive in all tumors. All patients underwent surgical resection without significant complications. Except for one patient who died 14 months after operation because of recurrent disease, no tumor recurrence was observed in the remaining 25 patients during a 2-3 years follow-up. CONCLUSIONS: Pre-operative diagnosis of HAML is difficult. There are potential risks of spontaneous rupture and malignant transformation. Surgical resection is the treatment of choice for HAML.

Two case reports and literature review for hepatic epithelioid angiomyolipoma: Pitfall of misdiagnosis

BACKGROUND Hepatic epithelioid angiomyolipoma(HEAML) is a rare liver disease and is easily misdiagnosed. Enhanced recognition of HEAML is beneficial to the differential diagnosis of rare liver diseases.CASE SUMMARY We presented two cases of HEAML in Changzheng Hospital, Naval Medical University, and then collected and analyzed all reports about HEAML recorded in PubMed, MEDLINE, China Science Periodical Database, and VIP database from January 2000 to March 2018. A total of 409 cases of HEAML in 97 reports were collected, with a ratio of men to women of 1:4.84 and an age range from 12 years to 80 years(median 44 years). Among the patients with clinical symptoms mentioned, 61.93%(205/331) were asymptomatic, 34.74%(115/331) showed upper or right upper quadrant abdomen discomfort, while a few of them showed abdominal mass, gastrointestinal symptoms, low fever, or weight loss. The misdiagnosis rate of HEAML was as high as 40.34%(165/409) due to its nonspecific imaging findings. Most of the tumors were solitary and round in morphology, with clear boundaries. Ultrasound scan indicated low echo with internal nonuniformity and rich blood supply in most cases. Computer tomography/magnetic resonance imaging enhanced scan showed varied characteristics. The ratio of fast wash-in and fast wash-out, fast wash-in and slow wash-out, and delayed enhancement was roughly 4:5:1. A definite diagnosis of HEAML depended on the pathological findings of the epithelioid cells in lesions and the expression of human melanoma black 45, smooth muscle actin,melanoma antigen, and actin by immunohistochemical staining. HEAML had a relatively low malignant rate of 3.91%. However, surgical resection was the main treatment for HEAML, due to the difficulty diagnosing before operation.CONCLUSION HEAML is a rare and easily misdiagnosed disease, and it should be diagnosed carefully, taking into account clinical course, imaging, pathological,and immunohistochemical findings.

Granulomatous reaction in hepatic inflammatory angiomyolipoma after chemoembolization and spontaneous rupture

A 77-year-old Japanese woman was transported to a nearby hospital due to sudden abdominal pain and transient loss of consciousness. Abdominal computed tomography(CT) suggested hemoperitoneum and hepatic nodule. She was conservatively treated. Contrast-enhanced CT two months later revealed an increased mass size, and the enhancement pattern suggested the possibility of hepatocellular carcinoma(HCC). Under a clinical diagnosis of HCC, transcatheter arterial chemoembolization(TACE) was performed. A subsequent imaging study revealed that most of the lipiodol used for the embolization was washed out. Therefore, surgical resection was performed. Histologically, the nodule contained numerous inflammatory cells including small lymphocytes, plasma cells and macrophages. Notably, epithelioid granulomatous features with multinucleated giant cells were observed in both the nodule and background liver. Some of the multinucleated giant cells contained oil lipid. Among the infiltrating inflammatory cells,spindle-shaped, histiocytoid or myoid tumor cells with eosinophilic cytoplasm were found. The tumor cells were positive for Melan A and HMB45. The nodule contained many Ig G4-positive plasma cells; these were counted and found to number 72.6 cells/HPF(range: 61-80). The calculated Ig G4:Ig G ratio was 33.2%. The nodule was finally diagnosed as previously ruptured inflammatory angiomyolipoma modified by granulomatous reaction after TACE.

Clinical characteristics and outcomes of patients with hepatic angiomyolipoma:A literature review

First reported in 1976,hepatic angiomyolipoma(HAML)is a rare mesenchymal liver tumor occurring mostly in middle-aged women.Diagnosis of the liver mass is often incidental on abdominal imaging due to the frequent absence of specific symptoms.Nearly 10%of HAMLs are associated with tuberous sclerosis complex.HAML contains variable proportions of blood vessels,smooth muscle cells and adipose tissue,which renders radiological diagnosis hazardous.Cells express positivity for HMB-45 and actin,thus these tumors are integrated into the group of perivascular epithelioid cell tumors.Typically,a HAML appears on magnetic resonance imaging(or computed tomography scan)as a hypervascular solid tumor with fatty areas and with washout,and can easily be misdiagnosed as other liver tumors,particularly hepatocellular carcinoma.The therapeutic strategy is not clearly defined,but surgical resection is indicated for symptomatic patients,for tumors showing an aggressive pattern(i.e.,changes in size on imaging or high proliferation activity and atypical epithelioid pattern on liver biopsy),for large(>5 cm)biopsy-proven HAML,and if doubts remain on imaging or histology.Conservative management may be justified in other conditions,since most cases follow a benign clinical course.In summary,the correct diagnosis of HAML is challenging on imaging and relies mainly on pathological findings.

Diagnostic analysis of hepatic angiomyolipoma

BACKGROUND: Hepatic angiomyolipoma (HAML) is a rare tumor containing a variable amount of fat, vessels and smooth muscle. We report the image findings on ultra- sonography and computed tomography ( CT) of huge HAML. METHOD; The clinical, imaging and pathological data of a case of HAML were retrospectively collected and ana- lyzed. RESULTS; A huge heterogeneous hyperecho mass with anecho and hypoecho areas inside was found in the left he- patic lobe on ultrasonography. Color Doppler showed blood flow and arterial spectrum in it. CT scan showed a huge heterogeneous solid mass in the left lobe of the liver, with a low density and hypervascular area in arterial phase. The serum tumor marks were all negative. Ultrasound- guided biopsy was taken twice before resection and both showed necrosis tissue and reaction of inflammatory cells. Postoperative pathological results showed that the tumor was composed of epithelioid smooth muscle cells, thick- walled blood vessels and a few adipose cells with necrosis. The immunohistochemistry results showed appea-rance of typical HAML, with HMB-45 positive and alpha fetopro- tein (AFP) negative. CONCLUSIONS: Preoperative diagnosis of HAML relies on combination of CT, MRI and ultrasonography. Our case of HAML showed heterogeneous hyperecho image on ultra- sonography. Ultrasound-guided biopsy combined with morphological manifestation and specimen examination for HMB-45 may be helpful in the diagnosis of HAML.

Hepatocellular carcinoma with concomitant hepatic angiomyolipoma and cavernous hemangioma in one patient

The risk of developing hepatocellular carcinoma(HCC) is strongly associated with hepatitis B virus infection.Hepatic angiomyolipoma(AML),a rare benign tumor,is composed of a heterogeneous mixture of adipose cells,smooth muscle cells and blood vessels.Here,we report the case of a 44-year-old man who developed HCC with a concomitant hepatic AML and a cavernous hemangioma,in the absence of cirrhosis.To our knowledge,based on an extensive literature search using the www.pubmed.gov website,this is the first report of an HCC case with both concomitant AML and cavernous hemangioma at the same position in the liver.The presence of the hepatitis B surface antigen was detected,but the liver function was normal.Clinical and pathological data were collected before and during the treatment.Hepatic AML was diagnosed based on the typical histological characteristics and immunohistochemical staining,which revealed,a positive staining with a melanocytic cell-specific monoclonal antibody.There was no evidence of tuberous sclerosis complex in this patient.Although the HCC was poor- to moderately-differentiated,the characteristics of the AML and the cavernous hemangioma in this patient did not match any criteria for malignancy.Hepatectomy followed by transarterial chemoembolization treatment were effective therapeutic methods for the adjacent lesions in this patient.This case is an interesting coincidence.

Giant exophytic renal angiomyolipoma masquerading as a retroperitoneal liposarcoma: A case report and review of literature

A 42-years-old lady, presented with a large retroperitoneal mass which was preoperatively diagnosed as a retroperitoneal liposarcoma following an image guided core biopsy. She underwent a margin-negative resection of the retroperitoneal mass(multi visceral resection-enbloc excision of the retroperitoneal mass with a left nephrectomy and a segmental descending colectomy). The final histopathological examination of the resected specimen confirmed an exophytic renal angiomyolipoma(AML) which was extending into the retroperitoneum. AML is a rare benign tumor arising most commonly from the kidney. It can sometimes present as a diagnostic challenge as it mimics a retroperitoneal liposarcoma or a fat-containing renal cell carcinomas closely. We present this case to share our experience of managing a case of giant exophytic AML which resembled retroperitoneal liposarcoma closely and resulted into an aggressive surgery.

Embolization of symptomatic renal angiomyolipoma with a mixture of lipiodol and PVA, a mid-term result

Objective： To evaluate the clinical effect of renal artery embolization with a mixture of lipiodol and polyvinyl alcohol （PVA） particles on symptomatic renal angiomyolipoma and to present the mid-term results from our single-center site. Methods： We performed a retrospective review of the seven patients who underwent embolization with a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma in our center between February 2011 and December 2013. Medical records and follow-up results were reviewed and analyzed. Results： Seven patients underwent eight episodes of embolization using a mixture of lipiodol and PVA particles to treat symptomatic renal angiomyolipoma. One patient required a subsequent embolization of the right kidney 9 months after the initial embolization of the left kidney. No nephrectomy was required in any of these cases during follow-up. None had recurrence of tumor bleeding or rupture during follow-up. Decreased tumor size was achieved in six patients （85.7%） during the mid-term follow-up. Conclusions： Embolization with a mixture of lipiodol and PVA particles is an effective and safe treatment for symptomatic renal angiomyolipoma. Based on the durable mid-term results of the present study, a mixture of lipiodol and PVA particles is recommended for embolization.

Epithelioid angiomyolipoma of the pancreas:A case report and review of the literature

BACKGROUND Angiomyolipomas(AMLs),belonging to the family of mesenchymal tumors,are considered benign lesions that occur mostly in the kidney or as a part of tuberous sclerosis.Epithelioid AML(EAML)is a rare type of AML that appears to have malignant potential.Extrarenal AMLs usually occur in the liver according to the retrieved literature reports.There have been only two previous reports of monofocal primary AML of the pancreas;however,no cases of primary monotypic EAML of the pancreas have been reported.CASE SUMMARY An asymptomatic 59-year-old woman incidentally revealed a tumor during abdominal ultrasound examination.Routine blood tests and physical examination were within normal limits.Abdominal ultrasound revealed a 1.9-cm hypoechogenic mass in the tail of the pancreas,clearly visualized by endoscopic ultrasound.However,contrast-enhanced abdominal computed tomography scans did not demonstrate the lesion.A subsequent gadolinium-enhanced magnetic resonance imaging scan showed that the lesion had some characteristic manifestations.The lesion was initially thought to be a neuroendocrine tumor(asymptomatic PanNET).After surgical resection,histopathology and immunohistochemistry confirmed the diagnosis of EAML.At the 6-mo follow-up,no recurrence,spread,or metastasis was identified on computed tomography or magnetic resonance imaging.CONCLUSION The preoperative diagnosis of pancreatic AML is extremely difficult.Imaging techniques are essential for providing valuable morphological features for differential diagnosis.

Angiographic and volumetric effects of mammalian target of rapamycin inhibitors on angiomyolipomas in tuberous sclerosis

AIM: To investigate the angiographic and volumetric effects of mammalian target of rapamycin(m TOR) inhibitors on angiomyolipomas(AMLs) in a case series of patients with tuberous sclerosis complex.METHODS: All patients who underwent catheter angiography prior to and following m TOR inhibitor therapy(n = 3) were evaluated. All cross-sectional imaging studies were analyzed with three-dimensional volumetrics, and tumor volume curves for all three tissue compartments(soft tissue, vascular, and fat) were generated. Segmentation analysis tools were used to automatically create a region of interest(ROI) circumscribing the AML. On magnetic resonance images, the "fat only" map calculated from the in- and opposed-phase gradient recalled echo sequences was used to quantify fat volume within tumors. Tumor vascularity was measured by applying a thresholding toolwithin the ROI on post-contrast subtraction images. On computed tomography images, volume histogram analysis of Hounsfield unit was performed to quantify tumor tissue composition. The angiography procedures were also reviewed, and tumor vascularity based on pre-embolization angiography was characterized in a semi-quantitative manner. RESULTS: Patient 1 presented at the age of 15 with a 6.8 cm right lower pole AML and a 4.0 cm right upper pole AML. Embolization was performed of both tumors, and after a few years of size control, the tumors began to grow, and the patient was initiated on m TOR inhibitor therapy. There was an immediate reduction in the size of both lesions. The patient then underwent repeat embolization and discontinuation of m TOR inhibition, after which point there was a substantial regrowth in both tumors across all tissue compartments. Patient 2 presented at the age of 18 with a right renal AML. Following a brief period of tumor reduction after embolization, she was initiated on m TOR inhibitor therapy, with successful reduction in tumor size across all tissue compartments. As with patient 1, however, there was immediate rebound growth following discontinuation of inhibitor therapy, without sustained control despite repeat embolization. patient 3 presented at the age of 5 with a left renal AML and underwent two embolization procedures without lasting effect prior to starting m TOR inhibition. As with patients 1 and 2, following discontinuation of therapy, there was immediate rebound growth of the tumor. Repeat embolization, however, was notable for a substantial reduction in intratumoral aneurysms and vascularity.CONCLUSION: AML volume reduction as well as posttreatment rebound growth due to m TOR inhibitors involves all three tissue components of the tumor.

Diagnostic value of ultrasound in the spontaneous rupture of renal angiomyolipoma during pregnancy:A case report

BACKGROUND Spontaneous rupture and hemorrhage of renal angiomyolipoma(RAML)is a lifethreatening clinical emergency.When it occurs during pregnancy,it is compared to a"bomb explosion,"which makes the diagnosis and treatment more challenging.An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure,which is always preferred for pregnant women.Currently,cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare,as is the diagnostic value and characteristics of ultrasound.The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis.In this study,we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.CASE SUMMARY A 38-year-old woman in her 19 th wk of pregnancy(G2 P1)was referred to our clinic for a sudden,persistent pain on the left side of the waist.She had not undergone any previous related abdominal examination.Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area.The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound.Her left-side waist pain continued to be intense.Subsequently,she underwent computed tomography,which led to the same diagnosis.Based on many factors,the patient underwent left nephrectomy after the induction of labor.The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.CONCLUSION Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.

Juxta-caval hepatic angiomyolipoma masquerading as hepatocellular carcinoma

Hepatic angiomyolipoma is an uncommon primary benign epithelial liver neoplasm. Most patients with angiomyolipomas are middle-aged women who commonly present with epigastric fullness or pain. Angiomyolipomas are tumors consisting of three tissue types: blood vessels, smooth muscle, and fat. Hepatic angiomyolipomas may be difficult to differentiate from other liver neoplasms by noninvasive imaging. We report a 58-year-old asymptomatic woman with a mass in the right lobe of the liver, found incidentally on routine abdominal sonography. Preoperative radiographic evaluation revealed a 6.5-cm hypervascular lesion abutting the inferior vena cava. Preoperative histologic study demonstrated an epithelial neoplasm suspicious for hepatocellular carcinoma. Metastatic workup was negative. At resection, the tumor was found to be an angiomyolipoma composed of lipoid, vascular and smooth muscle cells. Further staining was positive for HMB-45. Resection margins were negative. The woman had an uneventful recovery and was discharged on postoperative day seven. She currently remains well several months after her right hepatectomy.

Renal Angiomyolipoma：Diagnosis with B－ultrasonography，CT Scanning，DSA and Its Interventional Treatment

From 1989.15 cases of renal angiomyolipoma (AML) have been diagnosed by ultrasonography, CT scanning and digital subtraction angiography (DSA) at our hospital. In 8 patients with uneven hyperechoes on B-mode ultrasonography (B-US)(8/15) and 7 with low density of fat on CT scanning (7/12)accurate diagnosis was established preoperatively. DSA revealed the 'berry-like'pseudoaneurysms in the arterial phase (14 cases), the defined lucent area in the nephrogram phase (10 cases) and the 'onion-peel appearances' during venous phases (8 cases),correct diagnosis was achieved in all patients. 8 cases were surgically treated and 7 treated by subselective embolization of renal artery. Effects in all cases were good. The diagnostic value of B-US. CT scanning, DSA and interventional treatment of AML was discussed. It was believed that the diagnosis with DSA was a technique with high specificity, and embolization therapy was simple and effective for AML.