Published online Mar 16, 2021. doi: 10.12998/wjcc.v9.i8.1931
Peer-review started: November 10, 2020
First decision: December 13, 2020
Revised: December 25, 2020
Accepted: January 14, 2021
Article in press: January 14, 2021
Published online: March 16, 2021
Processing time: 115 Days and 9.1 Hours
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.
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.
The preoperative diagnosis of pancreatic AML is extremely difficult. Imaging techniques are essential for providing valuable morphological features for differential diagnosis.
Core Tip: We present a rare case of pancreatic epithelioid angiomyolipoma diagnosed after an anatomopathological examination. The patient was asymptomatic. Here are several findings from multiple modalities, including multidetector computed tomography, ultrasound, endoscopic ultrasound, magnetic resonance imaging, and providing a pathologic correlation. Awareness of the characteristic features, including immunoreactivity for the human melanoma black-45 marker, may help in the diagnosis of this rare entity. This report represents, to our knowledge, the first epithelioid angiomyolipoma arising in the pancreas.