Case Report Open Access
Copyright ©The Author(s) 2000. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 15, 2000; 6(4): 608-612
Published online Aug 15, 2000. doi: 10.3748/wjg.v6.i4.608
Hepatic angiomyolipoma-misdiagnosis as hepatocellular carcinoma: A report of 14 cases
Ding-Rong Zhong, Xiao-Long Ji
Ding-Rong Zhong, Xiao-Long Ji, Department of Pathology, General Hospital of PLA, Beijing 100853, China
Ding-Rong Zhong, male, graduated from West China University of Medical Sciences in 1994, presently working in the Department of Pathology, General Hospital of PLA.
Author contributions: All authors contributed equally to the work.
Correspondence to: Xiao-Long Ji, Department of Pathology, Gener al Hospital of PLA, Beijing 100853, China.
Telephone: +86-10-6822-8362
Received: February 12, 2000
Revised: February 23, 2000
Accepted: March 5, 2000
Published online: August 15, 2000

Key Words: angiomyolipoma, liver neoplasms/ diagnosis, immunohistochemistry, microscopy, electron, carcinoma, hepatocellular/pathology, case-control studies


Angiomyolipoma (AML) is a rare benign mesenchymal tumor of the liver, composed o f a varying heterogeneous mixture of three tissue components: blood vessels, smooth muscle, and adipose cells. It has recently been proposed that the perivascula r epithelial cell (PEC) is the common progenitor[1,2]. Since its first d escription by Ishak in 1976 [3], there have been more than 100 cases repo rted in the English literature[4-6]. With the advance of radiological techniques, many more tumors are being diagnosed by the means. But radiological findings of AML may only be suggestive of the lesion; its definitive diagnosis r equires histological confirmation[9-19]. Some authors regard renal and hepatic AMLs, pulmonary and soft tissue lymphangiomyomatosis[2], pulmon ary and pancreatic clear cell “sugar” tumor, and cardiac rhabdomyoma as closely related groups of tumors, based on their morphologic overlap and common immuno reactivity for HMB-45[1]. They show different microscopic appearances, however, according to their organ of origin. The goals of this study were to hig hlight more subtle morphology and to gain possible insights into the differential diagnosis that could provide important information about this disease.


Fourteen cases of AML were identified in the pathology files at the Department of Path ology, Chinese Military General Hospital, four of which were consulted cases. All the cases were independently reviewed by two pathologists, and the most import ant diagnostic criterion was the presence of HMB-45-positive cells. The clinical data and follow-up information were obtained in each case (Table 1). All the tumor tissues had been fixed in neutral buffered formalin and were routinelyem bedded in paraffin. Hematoxylin and eosin-stained sections were examined. Accor ding to the morphological aspect, one block was selected for each of these cases. Immunohistochemical study was performed on representative blocks by using an a vidin-biotin peroxidase complex technique. Selective cases were also examined w ith antibodies to CD68, CD31, CD34, factor VIII-related antigen.

Table 1 The clinical findings in all 14 patients.
NO.SexAge(years)Tumor size (CM)Location (LOBE)Primary diagnosisFollow-up
1F384.5RAngiosarcomaWell 44 mo after excision
2F332.5RHepatic carcinomaWell 35 mo after excision
3F336.0RHepatic carcinomaWell 33 mo after excision
4F4926.0R,LHemangiomaWell 153 mo after excision
5F483.5RHepatic carcinomaWell 31 mo after excision
6F3812.5LHepatic carcinomaWell 12 mo after excision
7F3514.5LHepatic carcinomaWell 9 mo after excision
8M6317.0RCystic adenoma or cystic adenocarcinomaWell 9 mo after excision
9M373.5RHepatic carcinomaWell 16 mo after excision
10M3410.0RHepatic carcinomaWell 11 mo after excision
11M307.5LHepatic carcinomaWell 16 mo after excision
12F436LHepatic carcinomaWell 3 mo after excision
13M3712LHepatic carcinomaWell 2 mo after excision
14F436LAngiosarcomaWell 1 mo after excision
Clinical findings

The clinical findings in all 14 patients are summarized in Table 1.There was am arked female predominance (women: men = 9:5) and the average age of patients at diagnosis was 40.07 years (range 30-63 years). Only four cases (case 4,7,10,13) had symptoms of space - occupying lesions while others were incidentally discovered on imaging studies (Figure 1). Two cases had two masses each (the other m ass was diagnosed as a hemangioma by a pathologist) and one of them had calcifi ed nodes (confirmed by a pathologist). None of 14 cases had tuberous sclerosis syndrome, angiomyolipoma of kidney, lymphangiomyoma or clear cell tumor of lung or other parts. For patients with complete follow-up data,all were well with no tumor recurrence and metastasis after excision.

Figure 1
Figure 1 MRI image of case 7.
Gross findings

Thirteen cases were solid and one was cystic (the content of cyst was a brown liquid). All tumors were well circumscribed, but not encapsulated (Figure 2). T he average size of all thirteen cases was 9.4 cm (range 2.5 cm-26 cm). The surfaces of tumor sections were yellowish but not uniform and some parts of tumors were fish-like.

Figure 2
Figure 2 Macroscopic appearance of AML with yellowish fatty areas (case 7).
Histological features

The most common pattern was that of solid sheets of myoid cells intermixed with areas of adipose cells and vessles,most of which were thin-walled (Figure 3) and few of which were thick-walled but had to be carefully observed. In 12 out of-14-cases there were clusters of hematopoietic cells and in 1 of 14 cases there were lots of multinu clear cells (Figure 4). The myoid cells usually predominated and their morphology varied from epithelioid to intermediate (ovoid or short s pindle) spindle. The epithelioid cells in our 12 cases were main cell patter, cytoplasm of which varied from clear to vacuolated and eosinophilic granular, nuclei of which were partly normalchromatic with moderate pleomorphism, with delicate chromatin,and a single distinct eosinophilic nucleolus. Furthermore, there were some large bizarre cells in 10 cases out of 14 cases but without nucleus mitoses (Figure 5). Long spindle cells with elongated eosinophilic cytoplasm could be seen but very rarely lipoblast-like cells were observed in sheets in local areas. Only two cases had multiple local necrotic areas but their total size was smaller than 5 percent of the tumor (Figure 6).

Figure 3
Figure 3 Thin-walled vessles and trabecular tumor cells of AML. IH: CD31 × 100
Figure 4
Figure 4 Multinucleus cells in a large number in AML of case 9. HE × 100
Figure 5
Figure 5 Pleomorphistic and large bizarre cells. HE × 200
Figure 6
Figure 6 Local necrotic area of case 9. HE × 50

Immunohistochemical findings (Summarized in Table 2) The tumor cells were positive for HMB-45, but negative for EMA and AFP in all cases.Local tumor cells were positive for Actin and S-100. HMB-45 staining was intense, granular, and concentrated in the perinuclear pink cytoplasm. Although the epithelioid cell s were most consistently stained, the spindle cells were also weakly positive. A ctin staining in spindle tumor cells was more intense than in other cells. The l ipoblast-like cells were positive for both HMB-45 and S-100 protein. Lots of multinucleus cells presenting in 1 of 12 cases were positive for HMB45, Actin, S-100 and CD68. Furthermore, positive rate for Ki-67 of tumor cells in all 12 cases was no more than 1 percent.

Table 2 Immunohistochemical findings in 12 cases.
Serial numberHMB45ActinS-100EMAAFPKi-67%
1++++local+--< 1
2++++Local+--< 1
3++++Local+--< 1
4+++Local+--< 1
5+++Local+--< 1
6+++Local+--< 1
7+++Local+--< 1
8++Local+--< 1
11+++Local+--< 1
12++++Local+--< 1
13++++Local+--< 1
14+++++--< 1

Ultrastructural finding Six cases were examined under H-7000 electron microscopy. Neoplastic cells gene rally were polygonal and closely arranged with minimum intercellular material. In the cytoplasm, glycogen and round-to-oval mitochondria were common features, together with a characteristic finding of lots of electron-dense, membrane-bound granules (these granules were 60-100 nm in diameter with some filament-like structures in them which could be seen under high magnification. These were de emed to be either premelanosomes or atypical lysosomal bodies) (Figure 7).

Figure 7
Figure 7 Ultrastructure of neoplastic tissue: glycogen, electron-dense granules. EM × 20000

Angiomyolipoma, which occurs frequently in kidney but rarely in other sites[7,8], previously considered as a hamartomatous growth rather than a true neoplasm, is a rare benign mixed mesenchymal clonal neoplasm of the liver. Since the first case described by Ishak[3], AML has been diagnosed with increas ing frequency with advances in MRI, CT, CD-SO and angiography. Despite the claim that the imaging features are highly characteristic[9-19], the preoperative diagnoses are erroneous in more than half of the cases in the present s eries. None of our 14 cases were correctly diagnosed before operating, furthermore, 5 cases were misdiagnosed as hepatic cell carcinoma or sarcoma by pathologist even after operating.

The diagnosis of AML is usually made on recognition of three or four components of the tumor, namely blood vessels, smooth muscle, mature fat, and hematopoietic tissue[4-6,20]. These elements, however, are variable in proportion and distribution. The adipose cells have no characteristic features in themselves to distinguish between various lipomatous tumors. Extramedullary hematopoiesis is not an integral part of AML and is seen in many primary benign and malignant hepatic tumors. Its occurrence is probably more closely related to the hepatic s inusoidal endothelium which plays an important part in hematopoiesis in the feta l liver. This also explains that hematopoietic cells are found only in hepatic but not renal AMLs. Blood vessels are present in all kinds of tumors which easily escape attention. The more distinctive features in AML are their tortuosity, thick walls (but rare in AML of live) and perivascular muscle proliferation. It th us appears that the myoid component is the only specific and diagnostic component in AML and it can exist in epithelioid, spindle, and intermediate forms. The e ssential component in this tumor appears to be PECs[1-6]. It has been speculated that the distinctive epithelioid cells are primitive mesenchymal cells that have an ability to differentiate towards both myoid and fat cells. Spindle myoid cells and lipocytes probably represent the mature derivatives of the epi thelioid cells. Immunohistochemistry is particularly useful for diagnosing, as m any authors have found. HMB-45 has been shown to be a promising marker for renal and hepatic AMLs and can even be applied to minute samples such as fine-needle aspirates[21,22].

Because of the rarity and the pleomorphism of histological features of hepatic A MLs, histological diagnosis may be difficult, especially with needle biopsy (one of our cases was diagnosed by this means). Many features in AML can mislead the unwary pathologist to a diagnosis of HCC: polygonal cells in trabecular arrange ment, peliosis, nuclear pleomorphism, prominent eosinophilic nucleoli, deficient reticulin framework, presence of glycogen, eosinophilic globules, and tumor nec rosis. Four of our cases were misdiagnosed by pathologists because of causes mentioned above. In AML with spindle cells and pleomorphic features, sarcoma is the most common incorrect diagnosis. For this reason, one case in our series was midiagnosed as angiosarcoma. Lipomatous AML has to be differentiated from true lipoma and focal fatty change. Evidently, a careful histologic survey of the entire specimen usually reveals the presence of the classic mixed pattern of the tumor. Immunohistochemical result (positive for HMB45 and Actin but negative for AFP or EMA), ultrastructural stucture and the low proliferation of tumor cells can further confirm the diagnosis[25-35]. The histogenesis of AML is unclear, but immunohistochemical and ultrastructural studies provide important insights into its cell differentiation[4-6,20,23,24]. The concept of “perivascular epithelioid cells” as the unified feat ure has been proposed[1]. Presumably, the PECs are an aberrant type of mesenchymal cells proliferating to form tumorous lesions, possibly due to chromos omal aberrations in the tuberous sclerosis (TS) complex gene. Because they are capable of dual differentiation, the argument for a hamartomatous proliferation is unsound. Recent molecular studies have shown tumor clonality and 5q deletions with a common region of deletion spanning 5q33 to 5q34, indicating a clonal neop lastic process[36-40].

Preoperative identification of AML is desirable because of differences in clinic al course and treatment between this disease and other hepatic neoplasms[41]. Although some imaging features may suggest hepatic AML, in such cases, his tological analysis must be performed. No matter whether or not the liver biopsy contains fat component, the diagnosis can be established based on myoid component positive for HMB45.


Edited by Zhou XH proofread by Mittra S

1.  Bonetti F, Pea M, Martigoni G, Zamboni G, Manfrin E, Colombari R, Mariuzzi GM. New unifying concept-the perivascular epithe lioid cell and related lesions. Ad Anato Pathol. 1997;4:343-358.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 117]  [Cited by in F6Publishing: 118]  [Article Influence: 4.5]  [Reference Citation Analysis (0)]
2.  Zhong DR, Li XH, Zhao SH. Pulmonary lymphangiomyomatosis. Chin J Clin and Exp Pathol. 1999;15:258-259.  [PubMed]  [DOI]  [Cited in This Article: ]
3.  Ishak KG. Mesenchymal tumors of the liver. In Okuda K and Peters RL, eds. Hepatocellular carcinoma. New York: John Wiley & Sons. 1976;247-307.  [PubMed]  [DOI]  [Cited in This Article: ]
4.  Tsui WM, Colombari R, Portmann BC, Bonetti F, Thung SN, Ferrell LD, Nakanuma Y, Snover DC, Bioulac-Sage P, Dhillon AP. Hepatic angiomyolipoma: a clinicopathologic study of 30 cases and delineation of unusual morphologic variants. Am J Surg Pathol. 1999;23:34-48.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 283]  [Cited by in F6Publishing: 291]  [Article Influence: 11.8]  [Reference Citation Analysis (0)]
5.  Sajima S, Kinoshita H, Okuda K, Saito N, Hashino K, Sugimoto R, Eriguchi N, Aoyagi S. Angiomyolipoma of the liver--a case report and review of 48 cases reported in Japan. Kurume Med J. 1999;46:127-131.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 20]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
6.  Huang PC, Chen JT, HO WL. Clinicopathologic analysis of renal and extrarenal angiomyolipomas: report of 44 cases. Zhonghua Yixue Zazhi. 2000;63:37-44.  [PubMed]  [DOI]  [Cited in This Article: ]
7.  Mogi Y, Takimoto R, Kura T, Tamakawa M, Sakamaki S, Niitsu Y. Retroperitoneal extrarenal angiomyolipoma with early gastric carcinoma. J Gastroenterol. 1998;33:86-90.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 8]  [Cited by in F6Publishing: 9]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
8.  Watanabe K, Suzuki T. Mucocutaneous angiomyolipoma. A report of 2 cases arising in the nasal cavity. Arch Pathol Lab Med. 1999;123:789-792.  [PubMed]  [DOI]  [Cited in This Article: ]
9.  Li L, Wu PH, Mo YX, Lin HG, Zheng L, Li JQ, Lu LX, Ruan CM, Chen L. CT arterial portography and CT hepatic arteriography in detection of micro liver cancer. World J Gastroenterol. 1999;5:225-227.  [PubMed]  [DOI]  [Cited in This Article: ]
10.  Zhu XX, Chen JK, Lu GM. Magnetic resonance imaging of portal vein invasi on in hepatocellular carcinoma: A corroboration of 25 cases. China Natl J New Gastroenterol. 1996;2:167-170.  [PubMed]  [DOI]  [Cited in This Article: ]
11.  Chang JC, Lee YW, Kim HJ. Preoperative diagnosis of angiomyolipoma of the liver. Abdom Imaging. 1994;19:546-548.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 21]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
12.  Arslan A, Ciftçi E, Cetin A, Selçuk H, Demirci A. Tuberous sclerosis: ultrasound, CT and MRI features of two cases with multiple organ involvement. Australas Radiol. 1998;42:379-382.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 6]  [Cited by in F6Publishing: 7]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
13.  Saito K, Koizumi K, Abe K, Goto Y, Seki T. Potential for qualitative diagnosis of tumors and tumorous lesions in the liver with Tc-99m-GSA SPECT--correlation with pathological evaluation and MRI findings. Ann Nucl Med. 1998;12:275-280.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 5]  [Cited by in F6Publishing: 6]  [Article Influence: 0.2]  [Reference Citation Analysis (0)]
14.  Sakamoto Y, Inoue K, Ohtomo K, Mori M, Makuuchi M. Magnetic resonance imaging of an angiomyolipoma of the liver. Abdom Imaging. 1998;23:158-160.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 16]  [Article Influence: 0.6]  [Reference Citation Analysis (0)]
15.  Ahmadi T, Itai Y, Takahashi M, Onaya H, Kobayashi T, Tanaka YO, Matsuzaki Y, Tanaka N, Okada Y. Angiomyolipoma of the liver: significance of CT and MR dynamic study. Abdom Imaging. 1998;23:520-526.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 62]  [Cited by in F6Publishing: 62]  [Article Influence: 2.5]  [Reference Citation Analysis (0)]
16.  Outwater EK, Blasbalg R, Siegelman ES, Vala M. Detection of lipid in abdominal tissues with opposed-phase gradient-echo images at 1.5 T: techniques and diagnostic importance. Radiographics. 1998;18:1465-1480.  [PubMed]  [DOI]  [Cited in This Article: ]
17.  Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK. CT and MR imaging of benign hepatic and biliary tumors. Radiographics. 1999;19:431-451.  [PubMed]  [DOI]  [Cited in This Article: ]
18.  Irie H, Honda H, Kuroiwa T, Yoshimitsu K, Tajima T, Jimi M, Shimada M, Taguchi K, Masuda K. Hepatic angiomyolipoma: report of changing size and internal composition on follow-up examination in two cases. J Comput Assist Tomogr. 1999;23:310-313.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 18]  [Cited by in F6Publishing: 20]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
19.  Mergo PJ, Ros PR. Benign lesions of the liver. Radiol Clin North Am. 1998;36:319-331.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 104]  [Cited by in F6Publishing: 106]  [Article Influence: 4.2]  [Reference Citation Analysis (0)]
20.  Nonomura A, Minato H, Kurumaya H. Angiomyolipoma predominantly composed of smooth muscle cells: problems in histological diagnosis. Histopathology. 1998;33:20-27.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 64]  [Cited by in F6Publishing: 69]  [Article Influence: 2.6]  [Reference Citation Analysis (0)]
21.  Ji XL. Fine-needle aspiration cytology of liver diseases. World J Gastroenterol. 1999;5:95-97.  [PubMed]  [DOI]  [Cited in This Article: ]
22.  Yamada N, Shinzawa H, Makino N, Matsuhashi T, Itasaka S, Takahashi T, Fuyama S. Small angiomyolipoma of the liver diagnosed by fine-needle aspiration biopsy under ultrasound guidance. J Gastroenterol Hepatol. 1993;8:495-498.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 10]  [Cited by in F6Publishing: 11]  [Article Influence: 0.3]  [Reference Citation Analysis (0)]
23.  Weeks DA, Malott RL, Arnesen M, Zuppan C, Aitken D, Mierau G. Hepatic angiomyolipoma with striated granules and positivity with melanoma--specific antibody (HMB-45): a report of two cases. Ultrastruct Pathol. 1991;15:563-571.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 95]  [Cited by in F6Publishing: 98]  [Article Influence: 3.0]  [Reference Citation Analysis (0)]
24.  Mukai M, Torikata C, Iri H, Tamai S, Sugiura H, Tanaka Y, Sakamoto M, Hirohashi S. Crystalloids in angiomyolipoma. 1. A previously unnoticed phenomenon of renal angiomyolipoma occurring at a high frequency. Am J Surg Pathol. 1992;16:1-10.  [PubMed]  [DOI]  [Cited in This Article: ]
25.  Vortmeyer AO, Lubensky IA, Skarulis M, Li G, Moon YW, Park WS, Weil R, Barlow C, Spiegel AM, Marx SJ. Multiple endocrine neoplasia type 1: atypical presentation, clinical course, and genetic analysis of multiple tumors. Mod Pathol. 1999;12:919-924.  [PubMed]  [DOI]  [Cited in This Article: ]
26.  Ishak KG, Anthony PP, Sobin LH. Nonepithelial tumors. In: Ishak KG, Anth ony PP, Sobin LH, eds. Histological typing of tumors of the liver. World Health Organization International Classification of tumors. 2nd ed. Berlin: Springer. 1994;22-27.  [PubMed]  [DOI]  [Cited in This Article: ]
27.  Hu SX, Fang GY. Clinical use of hepatic carcinoma associated membrane protein antigen (HAg181) for detection of primary hepatocellular carcinoma. China Natl J New Gastroenterol. 1996;2:165-166.  [PubMed]  [DOI]  [Cited in This Article: ]
28.  Zhao SL, Pan XF, Li SX, Liu DG. Study on combined assay for serum tumor markers in patients with hepatic carcinoma. China Natl J New Gastroenterol. 1996;2:185-186.  [PubMed]  [DOI]  [Cited in This Article: ]
29.  Wu QM, Hu MH, Tan YS. Histopathology and immunohistochemistry of large HCC with negative or low level serum AFP. China Natl J New Gastroenterol 199 7; 3: 64. .  [PubMed]  [DOI]  [Cited in This Article: ]
30.  Wang D, Shi JQ, Liu FX. Immunohistochemical detection of proliferating cell nuclear antigen in hepatocellular carcinoma. China Natl J New Gastroenterol. 1997;3:101.  [PubMed]  [DOI]  [Cited in This Article: ]
31.  Hu CJ, Yang DL. A detecting method for peripheral venous AFP mRNA in hepatocellular carcinoma. China Natl J New Gastroenterol. 1997;3:198.  [PubMed]  [DOI]  [Cited in This Article: ]
32.  Cai WX, Zheng H, Ye QL. Combined measurement of serum tumor markers in patients with hepatocellular carcinoma. World J Gastroenterol. 1998;4:181-182.  [PubMed]  [DOI]  [Cited in This Article: ]
33.  Wu MC. Clinical research advances in primary liver cancer. World J Gastroenterol. 1998;4:471-474.  [PubMed]  [DOI]  [Cited in This Article: ]
34.  He P, Tang ZY, Ye SL, Liu BB. Relationship between expression of alpha-fetoprotein messenger RNA and some clinical parameters of human hepatocellular carcinoma. World J Gastroenterol. 1999;5:111-115.  [PubMed]  [DOI]  [Cited in This Article: ]
35.  Terris B, Fléjou JF, Picot R, Belghiti J, Hénin D. Hepatic angiomyolipoma. A report of four cases with immunohistochemical and DNA-flow cytometric studies. Arch Pathol Lab Med. 1996;120:68-72.  [PubMed]  [DOI]  [Cited in This Article: ]
36.  Hirasaki S, Koide N, Ogawa H, Ujike K, Shinji T, Tsuji T. Tuberous sclerosis associated with multiple hepatic lipomatous tumors and hemorrhagic renal angiomyolipoma. Intern Med. 1999;38:345-348.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 19]  [Cited by in F6Publishing: 21]  [Article Influence: 0.8]  [Reference Citation Analysis (0)]
37.  Martignoni G, Pea M, Bonetti F, Zamboni G, Carbonara C, Longa L, Zancanaro C, Maran M, Brisigotti M, Mariuzzi GM. Carcinomalike monotypic epithelioid angiomyolipoma in patients without evidence of tuberous sclerosis: a clinicopathologic and genetic study. Am J Surg Pathol. 1998;22:663-672.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 138]  [Cited by in F6Publishing: 144]  [Article Influence: 5.5]  [Reference Citation Analysis (0)]
38.  Henske EP, Neumann HP, Scheithauer BW, Herbst EW, Short MP, Kwiatkowski DJ. Loss of heterozygosity in the tuberous sclerosis (TSC2) region of chromosome band 16p13 occurs in sporadic as well as TSC-associated renal angiomyolipomas. Genes Chromosomes Cancer. 1995;13:295-298.  [PubMed]  [DOI]  [Cited in This Article: ]
39.  Dal Cin P, Sciot R, Van Poppel H, Baert L, Van Damme B, Van den Berghe H. Chromosome analysis in angiomyolipoma. Cancer Genet Cytogenet. 1997;99:132-134.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 16]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
40.  Tawfik O, Austenfeld M, Persons D. Multicentric renal angiomyolipoma associated with pulmonary lymphangioleiomyomatosis: case report, with histologic, immunohistochemical, and DNA content analyses. Urology. 1996;48:476-480.  [PubMed]  [DOI]  [Cited in This Article: ]  [Cited by in Crossref: 14]  [Cited by in F6Publishing: 16]  [Article Influence: 0.5]  [Reference Citation Analysis (0)]
41.  Arnoletti JP, Brodsky J. Surgical treatment of benign hepatic mass lesions. Am Surg. 1999;65:431-433.  [PubMed]  [DOI]  [Cited in This Article: ]