Giant Masses in a Non-Cirrhotic Liver: All That Look Epithelial Are Not Carcinoma

Angiomyolipoma (AML) is an uncommon mesenchymal neoplasm with myomelanocytic differentiation. Hepatic AML (HAML) is an uncommon tumor that often mimics a primary hepatic epithelial malignancy and is a challenging diagnosis for clinicians and pathologists. This article discusses the clinical, radiological, histopathological, and immunohistochemical details of two cases of HAML and their differential diagnoses. A 46-year-old woman and a 38-year-old man presented with pain, weakness, and weight loss. Radiology revealed large, well-defined, heterogeneous, enhancing masses in the non-cirrhotic liver. Histopathology showed a variable combination of epithelioid cells, spindle cells, adipocytes, and thick-walled blood vessels with smooth muscle actin (SMA) and HMB45 immunopositivity. The diagnosis of HAML depends on classical histopathology. However, a wide array of differential diagnoses should be considered depending on the proportionate representation of each component. A detailed histological evaluation, judicious use of immunohistochemistry to document myo-melanocytic differentiation, and awareness of the entity are useful for the correct diagnosis.