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

Table 1 Clinicopathologic data of 4 cases of hepatic epithelioid angiomyolipoma

Case	Sex/age	Size (cm)	Location of tumor in the liver	Clinical presentation	Fat	Details of imaging findings	Preoperative diagnosis	Pathologic features
								Satellite tumor	Cytologic atypia	Mitotic count	Coagulative necrosis	LI	VI
1	M/34	15.0	L	Abdominal pain and fever	No	Arterial phase enhancement and washout at portovenous phase (CT)	HCC	+	+	+	+	+	-
2	F/46	3.5	L	None	No	Arterial phase enhancement and washout at portovenous phase (CT)	HCC	-	-	-	-	-
3	F/31	3.0	R	None	No	Arterial phase enhancement and washout at portovenous phase (CT)	HCC	-	+	+	+	+	-
4	F/56	7.5	L	None	No	Arterial phase enhancement and no delayed washout at portovenous phase (MRI)	HCA	-	-	-	-	-	-

LI: Liver invasion; VI: Vascular invasion; HCC: Hepatocellular cancer; HCA: Hepatocellular adenoma. Size of the main tumor nodule.

Table 2 Summary of available reports of hepatic epithelioid angiomyolipoma from PubMed and MEDLINE

Year	Authors	Number(F/M)	Size (cm)	Location(L/R)	Clinical symptoms (n)	Diagnosis before surgery (n)	TSC (n)	Treatment	Recurrence/metastasis (n)
2015	Our study	3/1	3.0-15.0	3/1	Abdominal pain and fever (1)	HCC (3)	None	Surgery	None
					No symptoms (3)	HCA (1)
2014	Dai et al[24]	3/2	2.5-7.0	2/3	Abdominal pain (2)	HCC (4)	None	Surgery	None
					None (3)	FNH (1)
2014	Tajima et al[25]	0/1	10.5	0/1	Abdominal pain	Hepatic AML	None	Surgery	None
2014	Zhou et al[27]	1/0	30.0	1/0	Abdominal discomfort	NA	None	Surgery	None
2014	Xu et al[26]	22/3	3.0-20.0	12/13	Abdominal pain (10)	HCC or other tumor	1	Surgery	2
					Abdominal distention (3)
					No symptoms (15)
2013	Occhionorelli et al[22]	1/0	8.0	1/0	Abdominal pain	NA	NA	Surgery	None
2013	Zhao et al[23]	3/2	0.6-9.7	2/3	No symptoms	NA	None	Surgery	NA
2013	Saito et al[21]	0/1	1.2	1/0	No symptoms	HCC	None	Surgery	None
2013	Lo et al[20]	5/0	1.2-25.0	1/4	Abdominal distention (1)	HCC (1)	None	Surgery	None
					Abdominal discomfort (1)	HCA (2)
					Epigastralgia (1)	AML
					None (2)	Liver tumor with uncertain nature
2013	Ji et al[19]	6/0	5.0-9.5	5/1	None (5)	AML	None	Surgery and biopsy	NA
					Abdominal pain (1)
2012	Limaiem et al[18]	0/1	8.2	1/0	Abdominal pain	HCC	None	Surgery	None
2012	Agaimy et al[16]	1/0	2.0	1/0	Nausea	Metastatic adenocarcinoma or carcinoid	None	Surgery	None
2012	Xie et al[17]	1/0	3.4	0/1	Dyspnea	HCC	1	Biopsy	None
2010	Wen et al[15]	0/1	4.1	1/0	None	HCC	NA	Surgery	NA
2009	Leenman et al[13]	1/0	6.0	1/0	Abdominal pain	NA	NA	Surgery	NA
2009	Xu et al[14]	10/0	1.5-10.0	6/6	NA	NA	1	Surgery	2
2009	Alatasis et al[12]	1/0	11.0	Multiple	None	HCC	1	Biopsy	NA
2008	Deng et al[11]	0/1	18.0	0/1	Abdominal pain	AML	None	Surgery	1
2007	Khalbuss et al[10]	1/0	12.0	1/0	Abdominal pain	Adenoma or hamartoma	1	Surgery	None
2006	Rouquie et al[9]	1/0	7.0	1/0	None	NA	None	Surgery	None
2004	Tryggvason et al[8]	1/0	6.0	1/0	Abdominal pain	NA	None	Surgery	None
2004	Mizuguchi et al[7]	1/0	NA	0/1	None	AML	NA	Surgery	1
2000	Savastano et al[6]	1/0	1.2	1/0	NA	NA	NA	Surgery	None
2000	Flemming et al[5]	3/0	1.0-20.0	2/2	NA	HCC	None	Surgery (2)	1
								Biopsy (1)
2000	Yamasaki et al[2]	1/0	2.0	0/1	None	NA	None	Surgery	None
2000	Dalle et al[3]	1/0	15.0	0/1	Nausea and loss of appetite	HCC	NA	Biopsy	1

F/M: Female/male; L/R: Left/right; TSC: Tuberous sclerosis complex; HCC: Hepatocellular cancer; HCA: Hepatocellular adenoma; FNH: Focal nodular hyperplasia; AML: Angiomyolipoma; NA: Not available.