Hepatic epithelioid angiomyolipoma treated with laparoscopic resection and transcatheter arterial embolization first time: A case report and review of literature

Abstract

BACKGROUND

Hepatic epithelioid angiomyolipoma (HEAML) is rare subtype of perivascular epithelioid cell tumor that is typically benign but has malignant potential. Misdiagnosis is common due to imaging similarities with other hypervascular hepatic neoplasms, such as hepatic hemangioma and hepatocellular carcinoma. An early biopsy should be considered when radiological findings raise suspicion of HEAML. A definitive diagnosis requires a histopathological assessment and immunohistochemical profile that confirm positivity for human melanoma black and smooth muscle actin and negativity for S-100.

CASE SUMMARY

This article presents a case of multifocal HEAML in a 37-year-old woman. Five years prior, abdominal ultrasound incidentally detected two hyperechoic lesions in the liver, which were initially diagnosed as hemangiomas and managed with routine imaging surveillance. At a recent follow-up, the progressive enlargement of both lesions was noted, and contrast-enhanced computed tomography raised the possibility of AML. The patient had a laparoscopic procedure to remove the tumor in the left liver lobe after the lesion progressed. Postoperative histopathological analysis confirmed the diagnosis of HEAML. Transarterial embolization was chosen as an alternative to surgical resection because of the high operative risk associated with the proximity of the right lobe lesion to the hepatic hilum. The patient had an uneventful recovery, and no recurrence was detected at follow-up.

CONCLUSION

Surgical resection combined with interventional embolization has proven effective for managing multifocal HEAML, a rare tumor with a high risk of misdiagnosis.

Keywords: Hepatic epithelioid angiomyolipoma; Perivascular epithelioid cell tumor; Laparoscopic hepatectomy; Transarterial embolization; Surgical resection and interventional embolization; Hypervascular hepatic tumor; Case report

Core Tip: We report a case of multifocal hepatic epithelioid angiomyolipoma successfully managed with a multimodal approach combining laparoscopic resection and transarterial embolization. The predominant left lobe lesion was resected, while the high-risk hilar lesion was treated with minimally invasive transarterial embolization, interrupting arterial supply to achieve tumor control and preserve hepatic function. Follow-up showed uneventful recovery without recurrence. To the best of our knowledge, this is the first report highlighting the feasibility and therapeutic benefit of this combined strategy, providing a paradigm for the individualized management of multifocal hepatic epithelioid angiomyolipoma.