Clinical Review
Diagnostic Dilemma of Hepatocellular Carcinoma Presenting as Hepatic Angiomyolipoma
Case in Point
Fed Pract. 2011 April;28(4):28
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Vincent P. Duron, MD; Adeel S. Khan, MD; Anne Marie L. Dunican, MD; Michael Klein, MD; and Michael P. Vezeridis, MD
Dr. Duron is a fourth-year general surgery resident, Dr. Dunican is an associate professor of surgery, and Dr. Vezeridis is a professor of surgery, all in the Brown Medical School Surgery Residency Program in Providence, Rhode Island. Dr. Khan is a hepatobiliary fellow at Washington University Medical Center in St. Louis, Missouri. Dr. Klein is a clinical assistant professor of pathology in the Department of Pathology and Laboratory Medicine at Brown Medical School. In addition, Dr. Dunican is the residency coordinator, Dr. Klein is a pathologist, and Dr. Vezeridis is the chief of surgery, all at the Providence VA Medical Center in Rhode Island.
Although this patient’s initial imaging and laboratory test results suggested hepatic angiomyolipoma, repeat pathologic analysis finally confirmed
a diagnosis of hepatocellular carcinoma.
Hepatocellular carcinoma (HCC) usually develops in patients who have a history of chronic liver disease. In fact, 77% of HCC cases are associated with chronic viral hepatitis, and 62% are associated with liver cirrhosis; only 7% of liver cancers are found to emanate from a normal liver bed.1 Clear-cell HCC is a rare type of liver cancer, accounting for 7% to 12% of all liver cancer cases.2 Although clear or fatty cellular changes may be seen frequently in early HCCs, they are relatively uncommon in larger cancers.3