Two case reports and literature review for hepatic epithelioid angiomyolipoma: Pitfall of misdiagnosis

Table 1 Ultrasound and contrast-enhanced ultrasonography of hepatic epithelioid angiomyolipoma

Items	Cases
Ultrasound
Echo (low/mixed/high)	54/8/24
Internal uniformity (heterogeneity/homogeneity)	37/38
Boundary (clear/indistinct)	55/5
Hypoechoic halo (Y/N)	13/34
Blood supply (rich/abundant/rare)	22/6/7
Contrast-enhanced ultrasonography
Arterial phase (high/middle/low)	15/0/0
Portal phase (high or slightly high/middle/low or slightly low)	4/8/3
Delay phase (high or slightly high/middle/low or slightly low)	3/7/5

Table 2 Preoperative computed tomography manifestations of hepatic epithelioid angiomyolipoma

Items	Cases
Computed tomography
Plain scan phase
Uniformity (uniform/non-uniform)	15/24
Density (low density/equidensity)	63/9
Arterial phase (Obvious uniform enhancement/apparent or moderate non-uniform enhancement)	54/53
Portal phase (obvious enhancement/enhancement reduction)	33/42
Delayed phase (sustained moderate enhancement/enhancement reduction)	23/30
Characteristic manifestations
Central vessel sign (Y/N)	119/38
Early drainage veins (Y/N)	75/47
Enhancement mode (fast wash-in and fast wash-out/fast wash-in and slow wash-out/delayed enhancement)	67/83/15
Pseudocapsule (Y/N)	65/73

Table 3 Preoperative magnetic resonance imaging and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid enhanced scan manifestations of hepatic epithelioid angiomyolipoma

Items	Cases
Magnetic resonance imaging
T1WI
Low, slightly low signal/equisignal/high signal	107/1/1
Slightly uniform/non-uniform	13/26
T2WI
Slightly high signal/high signal	39/70
Slightly uniform/non-uniform	3/29
DWI
Slightly high signal/high signal	13/51
Slightly uniform/non-uniform	4/15
Gd-EOB-DTPA
Arterial phase
Homogeneous enhancement/heterogeneous enhancement	29/21
Obvious enhancement/Medium enhancement	47/7
Portal phase
Continuous enhancement/enhancement weakened	22/29
Delayed phase
Continuous enhancement/enhancement weakened	1/2

T1WI: T1 weighted imaging; DWI: Diffusion weighted imaging; Gd-EOB-DTPA: Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid.

Table 4 Gross appearance of hepatic epithelioid angiomyolipom

Items	Cases or manifestations
Section	Mostly incanus, grayish yellow or grayish red
Capsule (Y/N)	10/53
Boundary	Clear
Texture (slightly soft/medium/slightly dense)	65/6/18
Hemorrhage or necrosis (Y/N)	60/89
Fat lesions (Y/N)	23/46
Cystic degeneration (Y/N)	16/98

Table 5 Immunohistochemistry markers of hepatic epithelioid angiomyolipoma

Markers	Positive/weakly positive/negative (+/±/-)	Positive rate
HMB45	219/2/5	97.35%
S-100	19/5/63	24.71%
SMA	128/15/32	77.43%
MSA	4/10/1	60%
Actin	32/1/5	85.53%
Melan-A	91/1/22	80.70%
CD31	2/0/2	50%
CD34	38/0/34	52.78%
CD68	2/6/5	33.33%
CD117	0/0/13	0%
Vimentin	23/11/17	55.88%
Kpan	0/0/101	0%
HepPar-1	0/0/52	0%
MAC387	6/0/0	100%
EMA	0/0/30	0%
Desmin	0/20/30	20%
MART-1	24/0/1	96%
CEA	1/0/9	10%
AFP	0/1/66	0.75%
MPO	0/1/1	25%
p53	0/0/9	0%
E-cadherin, b-cadherin	0/1/4	10%
pp70S6K	1/2/1	50%
MyoD1	2/2/1	60%

HMB45: Human melanoma black 45; SMA: Smooth muscle actin; MSA: Muscle specific actin; Melan-A: Melanoma antigen; EMA: Epithelial membrane antigen; CEA: Carcino-embryonic antigen; AFP: Alpha fetoprotein; MPO: Human myeloperoxidase.