Differential diagnosis of hepatic angiomyolipoma and hepatocellular carcinoma: a challenging case

Abstract

In a 40-year-old woman with no history of liver disease or alcohol consumption, contrast-enhanced abdominal computed tomography of a hepatic lesion demonstrated homogeneous dark staining in the arterial phase and washout in the portal venous phase, causing suspicion about hepatocellular carcinoma (HCC). The contrast-enhanced abdominal magnetic resonance imaging revealed that the lesion was slightly enhanced compared to the liver parenchyma in the early phase, washed out in the late phase, hypointense compared to the liver parenchyma in the 15-minute hepatocyte phase, and hyperintense in the diffusion-weighted imaging phase, lending support for the diagnosis of HCC. However, contrast-enhanced ultrasonography did not show any defects in the postvascular phase, which were not typical HCC findings. Given the challenging diagnosis, ultrasound-guided tumor biopsy was performed, leading to the diagnosis of hepatic angiomyolipoma.