Background: Hepatic angiomyolipoma is a rare benign mesenchymal tumor. We report an unusual case of a\npatient with multiple hepatic angiomyolipomas exhibiting high 18 F-fluorodeoxyglucose (FDG) uptake.\nCase presentation: A 29-year-old man with a medical history of tuberous sclerosis was admitted to our hospital for\nfever, vomiting, and weight loss. Abdominal dynamic computed tomography revealed faint hypervascular hepatic\ntumors in segments 5 (67 mm) and 6 (10 mm), with rapid washout and clear borders; however, the tumors exhibited\nno definite fatty density. Abdominal magnetic resonance imaging revealed that the hepatic lesions were slightly\nhypointense on T1-weighted imaging, slightly hyperintense on T2-weighted imaging, and hyperintense with no\napparent fat component on diffusion-weighted imaging. FDG-positron emission tomography (PET) imaging revealed\nhigh maximum standardized uptake values (SUVmax) of 6.27 (Segment 5) and 3.22 (Segment 6) in the hepatic\ntumors. A right hepatic lobectomy was performed, and part of the middle hepatic vein was also excised. Histological\nexamination revealed that these tumors were characterized by the background infiltration of numerous inflammatory\ncells, including spindle-shaped cells, and a resemblance to an inflammatory pseudotumor. Immunohistochemical\nevaluation revealed that the tumor stained positively for human melanoma black-45. The tumor was therefore considered\nan inflammatory pseudotumor-like angiomyolipoma. Although several case reports of hepatic angiomyolipoma\nhave been described or reviewed in the literature, only 3 have exhibited high 18 F-FDG uptake on PET imaging\nwith SUVmax ranging from 3.3ââ?¬â??4.0. In this case, increased 18 F-FDG uptake is more likely to appear, particularly if\nthe inflammation is predominant.\nConclusion: Although literature regarding the role of 18 F-FDG-PET in hepatic angiomyolipoma diagnosis is limited\nand the diagnostic value of 18 F-FDG-PET has not yet been clearly defined, the possibility that hepatic angiomyolipoma\nmight exhibit high 18 F-FDG uptake should be considered.
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