Angiomyolipoma of the liver in fine-needle aspiration biopsies: its distinction from hepatocellular carcinoma.
BACKGROUND
Angiomyolipoma (AML) of the liver is an uncommon benign lesion that may be difficult to distinguish clinically, radiographically, and morphologically from hepatocellular carcinoma (HCC).


METHODS
Fine-needle aspiration biopsies (FNAB) of three AMLs of the liver were compared with FNABs from eight cases of HCC. Immunoperoxidase stains for HMB-45, muscle specific actin, and CAM 5.2 were performed on two cell blocks and one resection of AML.


RESULTS
All three AMLs yielded cellular aspirates. They were composed of clusters of cells with arborizing transgressing endothelium but no peripherally wrapping endothelium. Smooth muscle cells of AML showed fibrillar cytoplasm and indistinct cytoplasmic borders; HCC showed granular cytoplasm and distinct cytoplasmic borders. Extramedullary hematopoiesis was present only in AML. Mitotic figures were seen only in HCC. Intranuclear inclusions, nucleoli, and large, atypical cells were present in both AML and HCC. Fat was seen in only one case of AML and was scant. Immunoperoxidase stains for HMB-45 and smooth muscle actin were positive in AML and negative in adjacent normal liver. CAM 5.2 stain was negative in AML.


CONCLUSIONS
The cytologic features seen on FNABs of AML are distinct from those of HCC. Immunoperoxidase stains can aid in the definitive diagnosis on FNAB. It is important to recognize AML on FNAB to allow conservative clinical management.
Cha
I
I
Department of Pathology, University of California-San Francisco, 94143, USA.
Cartwright
D
D
Guis
M
M
Miller
T R
TR
Ferrell
L D
LD
D000199:Actins / Q000032:analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018207:Angiomyolipoma / Q000737:chemistry / Q000473:pathology*; D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000737:chemistry / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006411:Hematopoiesis, Extramedullary; D006801:Humans; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000032:analysis; D008113:Liver Neoplasms / Q000737:chemistry / Q000473:pathology*; D008297:Male; D058950:Melanoma-Specific Antigens; D008875:Middle Aged; D009131:Muscle, Smooth, Vascular / Q000737:chemistry / Q000473:pathology; D009363:Neoplasm Proteins / Q000032:analysis
D000199:Actins; D000951:Antigens, Neoplasm; D014408:Biomarkers, Tumor; D058950:Melanoma-Specific Antigens; D009363:Neoplasm Proteins; D007633:Keratins