Cutaneous angiomyolipoma: report of two cases with emphasis on HMB-45 utility

Cutaneous Angiomyolipoma-A Distinct Entity That Should Be Separated From Classic Angiomyolipoma: Complete Review of Existing Cases and Defining Fundamental Features

Cutaneous angiomyolipoma is a rare mesenchymal tumor that is demographically, clinically, and immunohistochemically distinct from its renal and extrarenal counterparts. We present a case of cutaneous angiomyolipoma in the right retroauricular area of a 35-year-old male patient and provide a broad systematic review of the literature and the largest compilation of cutaneous angiomyolipomas reported to date. According to the findings presented in this review, we conclude that cutaneous angiomyolipoma should be completely separated from renal and extrarenal angiomyolipomas and therefore be considered a distinct entity in the classification of skin tumors.

Cutaneous Angiomyolipoma of the Ear: A Rare Diagnostic Challenge

Cutaneous angiomyolipoma is an extremally rare mesenchymal tumor, distinct from its renal counterpart. We describe two patients with cutaneous angiomyolipoma of the earlobe, all of which were clinically misdiagnosed and mistreated as epidermoid cysts, to highlight the need to consider a broad spectrum of differential diagnoses when evaluating any nodular or cystic tumor of the ear. We also provide a comprehensive literature review about this cutaneous entity.

Cutaneous Angiomyolipoma of the Ear: A Case Report and Literature Review

Cutaneous angiomyolipoma is a rare mesenchymal tumor, distinct from its renal counterpart. Only few cases have been reported in English language literature to date. Here, we report a case in a 36-year-old man who presented with a painless swelling on his right ear. Microscopy revealed a well-circumscribed tumor, composed of an admixture of mature adipocytes, blood vessels, and bundles of smooth muscles. The tumor cells were positive for desmin and calponin but negative for HMB45, melan-A, SOX10, tyrosinase, and CD10. We present the case to emphasize the uniqueness of cutaneous angiomyolipoma from its renal counterpart. We also review the relevant literature on this topic.

Radiologic misunderstanding of cutaneous angiomyolipoma in the alar base

In this article, we will examine a case of cutaneous angiomyolipoma in the right nasal alar base area of a 36-year-old man. Generally, angiomyolipoma occurs in the kidney and, histologically, has features that are similar to cutaneous angiomyolipoma: smooth muscle cells, mature adipose cells, and a convoluted thick-walled blood vessel. Clinically, renal angiomyolipoma is related to tuberous sclerosis, but cutaneous angiomyolipomas occur very rarely, with a total of only 23 cases documented in the literature, with 39% (9/23) of those cases occurring in the ear or surrounding areas. In particular, the abundance of blood vessels inside a cutaneous angiomyolipoma produces good enhancement on computed tomographic image, making it easy for the tumor to be mistaken for a vascular tumor. In this particular case, we will report about a previously unheard case of cutaneous angiomyolipoma occurring in the nasal alar base that was mistaken for a vascular tumor.

Angiomyolipoma of the thoracic wall: an extremely rare diagnostic challenge

Extrarenal angiomyolipoma (AML) is an extremely uncommon lesion, accounting for less than 9% of all angiomyolipomas. We present a previously unreported case of a rarely located gigantic extrarenal angiomyolipoma at the posterolateral chest wall of a 35-year-old woman. Clinically, the lesion had all the characteristics of a benign tumor, being soft in palpation, painless, and growing in size in a slow rate. Histologically, the lesion consisted of convoluted thick-walled blood vessels without an elastic layer, interlacing fascicles of smooth muscle, and mature adipose tissue, features consistent with an angiomyolipoma. The mass was surgically removed, without any postoperative complications, and the patient has an uneventful postoperative course. Signs of local recurrence have not been observed. The purpose of this brief report is to point out the necessity of including angiomyolipoma in the differential diagnosis of adipose layer lesions.

PEComas: a review with emphasis on cutaneous lesions

The connection between angiomyolipoma (AML) of the kidney, clear cell sugar tumor (CCST) of the lung, and pulmonary lymphangioleiomyoma (LAM), was progressively discovered because of the histologic and immunophenotypic similarities between the three tumors and their frequent association with tuberous sclerosis complex (TSC). Morphologically, analogous lesions found in other locations are composed of the unifying cell, the perivascular epithelioid cell (PEC). PEC tumors (or PEComas), other than AML, CCST, and LAM, are not associated with TSC and typically occur in middle-aged adult females. These neoplasms are composed of nests and fascicles of clear to granular epithelioid and/or spindled cells with a consistent arrangement around blood vessels. Characteristically, the cells express both melanocytic (usually HMB45) and myogenic (typically actin) markers. Although the most common sites are the gastrointestinal and genitourinary tracts, approximately 23 cases, to date, of PEComas arising in the skin have been reported. Primary cutaneous PEComas also have a predilection for adult females and most often present as a painless mass on the extremities. In contrast to other sites, the myogenic marker most commonly expressed in PEComas of the skin is desmin. Most reported cutaneous PEComas follow a benign course, however, a malignant case has been reported. Surgical excision is currently the mainstay of treatment.

A case of a cutaneous angiomyolipoma

A cutaneous angiomyolipoma, which is also known as a cutaneous angiolipoleiomyoma, is a rare benign mesenchymal tumor. Only 18 cases have been reported in the English literature. We describe a case of an angiomyolipoma presenting on the right ear helix of a 26-year-old female. The histopathologic examination revealed a typical form of an angiomyolipoma with a proliferation of mature adipocytes. As with all previously reported cases, our patient did not present with the stigmata of tuberous sclerosis. This is the 20th reported case of cutaneous angiomyolipoma and the 3rd reported case in Korea.

Cutaneous angiolipoleiomyoma

We describe a girl with cutaneous angiolipoleiomyoma on the buttock. The 16-year-old girl had a 2.5- x 1.5-cm subcutaneous tumor on the right buttock, which was slightly tender. The tumor appeared to be vascular and was, therefore, surgically excised. Histologically, the lesion was poorly circumscribed and was composed of differently sized blood vessels, smooth-muscle bundles, and mature adipose tissue. These histologic findings were consistent with those of angiomyolipoma, which commonly occurs in the kidney. Cutaneous angiomyolipoma, which is also known as cutaneous angiolipoleiomyoma, is a rare benign mesenchymal tumor. To our knowledge, only 16 cases have been reported in the English-language literature. In our report, we review the clinical features of 17 cases, including the current one. We point out the differences between the cutaneous and renal forms of angiomyolipoma, and conclude that the cutaneous lesion is distinct from a renal lesion in several aspects, including tuberous sclerosis complex association and immunoreactivity to both HMB-45 and MART-1.

Angiomyolipoma in the knee--a case report

Extrarenal angiomyolipoma is an uncommon disease and this may be the first report of angiomyolipoma in the knee, mimicking a malignant sarcoma. A 38-year-old man without tuberous sclerosis presented with a history of increased mass in the knee joint. Computerized tomography and magnetic resonance imaging demonstrated a CS x CS x CR cm subcutaneous tumor in the knee joint. The tumor was widely excised. Histologically, the tumor was, well circumscribed, and composed of smooth muscle, vascular spaces, connective tissue, and mature fat. There were no signs of recurrence at one year and eight months after surgery.

Epithelioid angiomyolipoma of the ovary: a case report and literature review

Angiomyolipoma (AML) is a benign mesenchymal neoplasm that mainly occurs in the kidney either sporadically or in patients with tuberous sclerosis complex (TSC). Extrarenal AML is uncommon. We describe a 39-year-old female with a history of TSC and bilateral multicentric renal AML who presented with a persistent cystic ovarian mass that fluctuated in size during 2 years of ultrasonographic observation before its removal by salpingo-oophorectomy. The 4.5-cm mass was solid and cystic and tan-yellow. Microscopic examination showed an admixture of epithelioid cells, smooth muscle bundles, large thick-walled blood vessels, and mature adipose tissue. The epithelioid cells had abundant eosinophilic cytoplasm and many had bizarre atypical nuclei including multinucleated forms. Mitoses were rare. Typical smooth muscle cells and the epithelioid cells were strongly immunoreactive for HMB-45. To our knowledge, this represents the first report of an AML arising in the ovary. The differential with other oxyphilic tumors of the ovary is discussed.