RESUMO
Malignant angiomyolipoma (AML) of the liver is rare. We report a case of AML with malignant transformation and metastases. A 30-year-old man had developed giant hepatic masses. Microscopically, the periphery of the tumor showed components of classic hepatic AML, but the central region contained atypical epithelioid components with extremely pleomorphic and hyperchromatic nuclei with frequent mitotic figures. Immunohistochemical analysis revealed that the epithelioid cells were positive for HMB-45 and smooth muscle actin. Furthermore, the atypical epithelioid cells displayed P53 immunoreactivity and mutation at exon 7 for p53. The tumor showed a typical monoclonal pattern but no loss of heterozygosity or microsatellite instability. Markedly atypical epithelioid cells with vascular invasion, distant metastasis, and fatal outcome were interpreted as malignant characteristics of hepatic AML. It is suggested that large tumor size, pleomorphic nuclei with high proliferation activity, and P53 immunoreactivity may predict the existence of malignant transformation of hepatic AML.
Assuntos
Angiomiolipoma/genética , Angiomiolipoma/patologia , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/patologia , Actinas/metabolismo , Adulto , Antígenos de Neoplasias/metabolismo , Sequência de Bases , Transformação Celular Neoplásica , Análise Mutacional de DNA , Células Epitelioides/patologia , Humanos , Imuno-Histoquímica , Masculino , Antígenos Específicos de Melanoma , Dados de Sequência Molecular , Mutação , Proteínas de Neoplasias/metabolismo , Reação em Cadeia da Polimerase , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismoRESUMO
OBJECTIVE: To establish a new method of early cut-off skin flap by ligating to stegnosis pedicle and assess its feasibility and clinical application. METHODS: Twenty New Zealand rabbits were used to make skin flaps with the size of 8.0 cm x 4.0 cm on both sides of the back respectively. And one side was experimental group with the pedicles of skin flaps horizontally oversewn by several pairs of silk thread, the other side was control group. Two pairs of silk thread in the two sides of the pedicle of skin flap of experimental group were ligated on the 3rd day. On the 5th day the pedicle was wholly ligated. All pedicles were divided on the 6th day and the survival area of skin flaps were measured after 3 days. The tissue samples from the skin flaps were collected for histology test on the 4th and 6th day respectively. The pedicles of 78 random flaps from 48 patients were cut off after narrowing them by ligating. RESULTS: The mean flap survival rate of the experimental group was statistically higher than the control group. Histological examination results showed the density and diameter of blood vessel were increased in the skin flaps of the experimental group. The mean time for removal pedicles was shortened to 10 days, and no necrosis was found after resecting. CONCLUSIONS: This method is secure and convenient and the time of pedicle division can be shortened.