title: Diagnostic difficulties and treatment strategy of hepatic angiomyolipoma.
abstract: OBJECTIVE
  Based on a large series of histopathologically confirmed hepatic angiomyolipomas, we retrospectively studied the typical diagnostic features of hepatic angiomyolipoma and proposed a treatment strategy for this disease.
  
  
  METHODS
  From December 1997 to December 2007, 74 consecutive patients who received definitive treatment for hepatic angiomyolipoma, at a single tertiary center, were studied.
  
  
  RESULTS
  There was a marked female predominance (54 females vs. 20 males) and the mean age was 42 years. Forty patients had no symptoms and the tumors were detected incidentally during a medical check-up. From this study, we proposed the typical diagnostic features of hepatic angiomyolipoma to be the absence of risk factors for malignancy, normal tumor marker levels, and typical imaging features on ultrasound (USG), abdominal contrast computed tomography (CT), or magnetic resonance imaging (MRI). Only 23% of patients could have been diagnosed before surgery using these features. One patient (1.4%) had a malignant angiomyolipoma, and died with distant metastases 14 months after surgery. After a median follow-up of 64 months, there was no recurrence in the other 73 patients.
  
  
  CONCLUSIONS
  Patients with typical diagnostic features suggestive of hepatic angiomyolipoma could be observed with regular surveillance. Definitive treatment should be performed when the tumor has symptoms/complications, when the tumor is enlarging, or when a malignant lesion cannot be ruled out.
authors.affiliation: The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Wei-Gao
authors.initials: WG
authors.lastname: Hu
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.forename: Hui
authors.initials: H
authors.lastname: Liu
authors.forename: Ai-Jun
authors.initials: AJ
authors.lastname: Li
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Zhou
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Fu
authors.forename: Ze-Ya
authors.initials: ZY
authors.lastname: Pan
authors.forename: Gang
authors.initials: G
authors.lastname: Huang
authors.forename: Yin
authors.initials: Y
authors.lastname: Lei
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D018207:Angiomyolipoma / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome