case_images: PMC11744629_01
case_images: A 61-year-old man with HEAML. (a) Initial ultrasound showing a hypoechoic mass, measuring approximately 27 mm x 24 mm (arrows). (b-e) CT and CECT imaging. (b) Hypoattenuating lesion in the right lobe of the liver, measuring approximately 101 mm x 99 mm with heterogeneous density. (c) Heterogeneous hyperenhancement in the arterial phase with visible vascular shadows. (d-e) Hypoenhancement in the portal and delayed phases. (f-l) MRI imaging. (f) Hypointensity in T1-weighted images. (g-h) Mixed-hyperintensity in T2-weighted and DWI. (i) Inhomogeneous enhancement in the arterial phase with thickened blood vessels in the lesion. (j-k) Decreased enhancement in the portal and delayed phases. (l) Hypointensity in the hepatobiliary phase.. CT: computed tomography; CECT: contrast-enhanced computed tomography; DWI: diffusion-weighted imaging; HEAML: hepatic epithelioid angiomyolipoma; MRI: magnetic resonance imaging.
case_images: 10.1177_2050313X251314072-fig1.jpg
case_images: PMC11744629_01_10.1177_2050313X251314072-fig1.jpg
case_images: fig1-2050313X251314072
case_images: During an abdominal ultrasound (US) performed 1 year earlier, a solitary hypoechoic mass measuring approximately 27 mm x 24 mm was detected in the right liver lobe, with a defined boundary and detectable blood flow within and around the lesion, initially suggestive of hepatic hemangioma (Figure 1(a)). Recently, while undergoing evaluation for an upper respiratory infection, a chest computed tomography (CT) scan incidentally revealed a sizable liver lesion within the right liver lobe (Figure 1(b)). During the arterial phase, the lesion demonstrated heterogeneous hyperenhancement with visible vascular structures, while the portal and delayed phases showed hypoenhancement (Figure 1(c)-(e)). The arterial phase showed inhomogeneous enhancement with multiple thickened blood vessels supplying the lesion, which decreased in the portal and delayed phases. The hepatobiliary phase showed a hypointense signal (Figure 1(f)-(l)). These imaging characteristics suggested a substantial likelihood of HCC.
case_images: (m) Pathological biopsy showing numerous epithelioid cells with eosinophilic cytoplasm, heterogeneous cells, mature adipocytes in focal areas, and a vascular interstitium (x100). (n) Highlight the different components of HEAML: adipocytic (*), vascular (**), and numerous epithelioid cells (***), (x100). (o) Macroscopic view showing a grayish-yellow, moderately soft, well-defined tumor with hemorrhages and necrosis. (p-s) Histopathological examination reveals a network of fibrillar vessels separating tumor cells in a nest-like pattern. Epithelioid hyaline cells with eosinophilic cytoplasm, multinucleated giant cells with distinct nucleoli, rare nuclear fragmentation, and significant hemorrhagic necrosis are present (p x 100, q x 200, r x 400, s x 200). (t-u) Immunohistochemical staining showing strong and diffuse positivity for HMB-45 and Melan-A (t-u x 200).. HEAML: hepatic epithelioid angiomyolipoma.
case_images: 10.1177_2050313X251314072-fig2.jpg
case_images: PMC11744629_01_10.1177_2050313X251314072-fig2.jpg
case_images: fig2-2050313X251314072
case_images: The biopsy suggested HEAML (Figure 2(m)-(n)). The Ki-67 proliferation index was <5% (Figure 2(o)-(u)). The final diagnosis was confirmed as HEAML based on histopathological and immunohistochemistry findings.