Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):527-534. 10.14701/ahbps.24-033.

Robotic management of huge hepatic angiomyolipoma: A case report and literature review

• Park A
• Savsani K
• Alfonso A
• Jo E
• Hatfield B
• Imai D
• Khan A
• Sharma A
• Saeed I
• Kumaran V
• Cotterell A
• Bruno D
• Sambommatsu Y
• Lee S

• KMID: 2561587
• DOI: http://doi.org/10.14701/ahbps.24-033

Abstract

Hepatic angiomyolipoma (HAML) is a rare, benign mesenchymal liver tumor encountered in Asia, primarily in females, and can be found within the right hepatic lobe, but also in other areas of the liver. Immunohistochemically, HAMLs are characteristically positive for human melanoma black-45 antigen (HMB-45) and can histochemically vary in the composition of angiomatous, lipomatous, and myomatous tissue, together with the presence of epithelioid cells. In this case report, we discuss a previously healthy patient presenting with bloating and previously documented concern of liver lesions, found to have HAML confirmed by surgical pathology. Surgery was decided, as HAMLs greater than 10 cm are at risk of rupture. This is one of the first documented cases of HAML resected through robot-assisted bisegmentectomy and cholecystectomy, and therefore, intraoperative images have been included to assist in the planning of future robotic cases.

Keyword

Robotics; Angiomyolipoma; Liver neoplasms

Figure

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  Fig. 1 (A) Axial view of (B) coronal view of magnetic resonance imaging showing large 14.9 cm exophytic mass arising from the inferior right hepatic lobe with non-enhancing hyperintensity.

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  Fig. 2 (A) Achieving access to the right inferior hepatic tumor off of segments 5 and 6. (B) Robot-assisted intraoperative ultrasound of tumor for the delineation of tumor perimeter. (C, D) Sealing the parenchymal transection with robotic scissors.

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  Fig. 3 (A) Juxtaposition of the myoid and vascular components of the tumor on the left with the normal liver on the right (H&E, ×20). (B) Intermixed epithelioid to spindled myoid cells and adipocytes (H&E, ×40). The myoid cells are positive for human melanoma black-45 antigen ×40 (C) and MelanA ×40 (D).

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  Fig. 4 Computed tomography scan with contrast image showing decrease in postoperative fluid collection along the inferior margin of the right hepatic lobe, 5-months postoperatively.

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