Biomedical subjects

King-Wah Chiu

Publications and source records attributed to King-Wah Chiu.

At least 19 recordsLinked to original sources

PubMed2006

Pseudoachalasia in a patient after truncal vagotomy surgery successfully treated by subsequent pneumatic dilations.

Pseudoachalasia is a difficult condition for the clinician to differentiate from idiopathic achalasia even by manometry, radiological studies or endoscopy. Its etiology is usually associated with tumors. In most cases, the diagnosis is made after surgical explorations. The proposed pathogenesis of the disease is considered as mechanical obstruction of the distal esophagus or infiltration of the malignancy that affects the inhibitory neurons of the meyenteric plexus in the majority of cases. Surgery has been reported as a cause of pseudoachalasia. We report a 70-year-old man who suffered from deglutination disorder caused by pseudo-achalasia after truncal vagotomy. The patient was symptom-free after a nine-year follow-up and complete recovery of esophageal motility status from pseudoachalasia after pneumatic dilations. We also reviewed the literature of pseudoachalasia.

Aged↗

PubMed2006

Expression and prognostic role of molecular markers in 99 KIT-positive gastric stromal tumors in Taiwanese.

AIM: To elucidate the prognostic role and relationship of three molecular markers such as tumor suppressor gene p53, proliferating cell nuclear antigen (PCNA) and Ki-67 in gastric stromal tumor. METHODS: A total of 108 surgically resected gastric smooth muscle tumor specimens were collected from January 1987 to December 1999. Immunohistochemical studies were performed on the paraffin sections of 99 of 108 CD117-positive tumors with antibodies of p53, PCNA, and Ki-67. Immunoreactivity of three molecular markers was recorded by labeling index (LI, %) and was analyzed for clinicopathologic and survival correlation. RESULTS: Of the 99 cases, immunostaining revealed that 52 patients (52.5%) had p53, and 37 patients (37.3%) had Ki-67 immunoreactivity (defined as >10% of LI). All patients (100%) had PCNA immunoreactivity ranging from 12% to 93% of LI, divided into high or low by median. Statistics revealed that LI of three markers positively correlate to each other (P<0.01) and to microscopic tumor mitotic counts (P<0.001). By combination, patients with >=2 markers (positive or high) in tumors had early tumor recurrence (P<0.001) and unfavorable outcome (P<0.001). Univariate analysis indicated that patients with tumor size >5 cm (P=0.003), tumor mitosis >5/50 HPF (P<0.001), p53 immunoreactivity (P=0.001), Ki-67 immunoreactivity (P=0.026), high PCNA LI (P=0.015) and male gender (P=0.036) were six predictors for early disease recurrence. Subsequent multivariate analysis revealed that mitotic counts, tumor size, and p53 immunoreactivity were three independent prognostic factors for both disease free and overall survival of patients. By combination of three independent prognostic factors for grouping, we found higher tumor recurrence rate (P<0.001) and shorter survival (P<0.001) existed in groups with increasing factors. CONCLUSION: We first provide the prognostic value and linkage of three molecular markers in GISTs. The combination of three factors (p53, tumor size, and tumor mitosis) provides a more powerful prediction of prognosis than any single factor does.

Adult↗

PubMed2006

Major hepatectomy in children: approaching blood transfusion-free.

INTRODUCTION: Major hepatectomy complicated with massive blood loss requires blood transfusion, which may result in increased morbidity and mortality. Intraoperative techniques and postoperative management that achieves blood transfusion-free major hepatectomy in children are described. METHODS: Fourteen children with a mean age of 3.1 years and mean body weight of 14 kg underwent major hepatectomy between May 1994 and September 2002. Demographic information, surgical techniques, and intraoperative management were analyzed. RESULTS: Hepatectomy included right trisegmentectomy in seven cases, extended right lobectomy in three, right lobectomy in two, and left lobectomy in two. Preoperative imaging, hemihepatic inflow control, intraoperative ultrasonography, and ultrasonic dissection were routinely applied. Fluid was restricted to target a low central venous pressure (5 cm H(2)O) during transection. Postoperative low hemoglobin (>6.3 g/dl) was tolerated in pediatric patients. There was no operative mortality or major complications and only two cases of pleural effusion. The mean blood loss was 68 ml (range 1.25-13.0 ml/kg), and no blood transfusions were required intraoperatively. Blood transfusion was given because of a liberal strategy for major operation in two patients and preoperative tumor bleeding in one. CONCLUSIONS: Despite being technically challenging, major hepatectomy can be performed with minimal blood loss and without blood transfusion in children to decrease postoperative complications.

Blood Loss, Surgical↗

PubMed2006

Salmonellosis with liver abscess mimicking hepatocellular carcinoma in a diabetic and cirrhotic patient: a case report and review of the literature.

Salmonellosis with liver abscess in a cirrhotic liver is extremely rare. We report the first case of Salmonellosis with septic shock and liver abscess in a diabetic and cirrhotic patient. The image studies of liver initially favored hepatocellular carcinoma. But no definite focus of sepsis was found. After close follow-up of the liver space-occupied lesion, ultrasound examination revealed the features of liver abscesses at space-occupied lesion later. Ultrasound-guided liver aspiration proved abscess. The clinical and radiological responses were good after antibiotics treatment.

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PubMed2005

Upper gastrointestinal carcinoid tumors incidentally found by endoscopic examinations.

AIM: This study shares Asian clinical experiences of carcinoid tumors that originated in the upper gastrointestinal tract. METHODS: From May 1987 to June 2002, we had found only 13 cases of histologically confirmed carcinoid tumors in the upper gastrointestinal tract by endoscopic examinations. There were eight males and five females. The mean age was 53.16+/-20.51 years that ranged from 26 to 82 years. Each of their clinical presentations, locations, tumor morphology, and size and the treatment outcome were analyzed and discussed. RESULTS: One patient had a polypoid lesion at the lower esophagus, nine were stomach lesions and three located at the duodenum. All patients with polypoid and submucosal tumor types were of small size (<1.7 cm) and all patients survived after simple excision or polypectomy. Four of the five patients in tumor mass forms died and the tumors were more than 2.0 cm in size. CONCLUSION: Carcinoid tumors rarely originated from the upper gastrointestinal tract and are usually found accidentally after endoscopic study. Bigger size (more than 2 cm) tumor masses may indicate a more severe disease and poor prognosis.

Adult↗

PubMed2005

Effect of autologous blood donation on the central venous pressure, blood loss and blood transfusion during living donor left hepatectomy.

AIM: Autologous blood donation (ABD) is mainly used to reduce the use of banked blood. In fact, ABD can be regarded as acute blood loss. Would ABD 2-3 d before operation affect the CVP level and subsequently result in less blood loss during liver resection was to be determined. METHODS: Eighty-four patients undergoing living donor left hepatectomy were retrospectively divided as group I (GI) and group II (GII) according to have donated 250-300 mL blood 2-3 d before living donor hepatectomy or not. The changes of the intraoperative CVP, surgical blood loss, blood products used and the changes of perioperative hemoglobin (Hb) between groups were analyzed and compared by using Mann-Whitney U test. RESULTS: The results show that the intraoperative CVP changes between GI (n = 35) and GII (n = 49) up to graft procurement were the same, subsequently the blood loss, but ABD resulted in significantly lower perioperative Hb levels in GI. CONCLUSION: Since none of the patients required any blood products perioperatively, all the predonated bloods were discarded after the patients were discharged from the hospital. It indicates that ABD in current series had no any beneficial effects, in term of cost, lowering the CVP, blood loss and reduce the use of banked blood products, but resulted in significant lower Hb in perioperative period.

Adult↗

PubMed2005

Is there any difference in anesthetic management of biliary atresia and glycogen storage disease patients undergoing liver transplantation?

BACKGROUND: The purpose of the study was to compare the intraoperative blood glucose changes and the dosage of glucose infused between biliary atresia and glycogen storage disease (GSD) patients undergoing living donor liver transplantation (LDLT). PATIENTS AND METHODS: The anesthesia records of biliary atresia and GSD patients undergoing LDLT were reviewed retrospectively. The levels of intraoperative blood glucose before operation, after induction of anesthesia, in the dissection, anhepatic, 10 min after reperfusion, and at the end of operation, as well as the dosage glucose infused, were compared between groups. The Mann-Whitney U test was used for statistical analysis; P < 0.05 was regarded as significant. RESULTS: Seventy-two biliary atresia patients were grouped into group I (GI) and 8 GSD patients into group II (GII). The blood glucose levels of both groups increased after operation and remained hyperglycemic, around 100-300 mg/dl, until the end of the operation. The mean glucose amounts infused were 2.7 +/- 1.9 and 2.5 +/- 1.15 mg/kg/min for GI and GII, respectively. CONCLUSION: No significant difference was found in the anesthetic management between groups. The only difference was that the GSD patients required continuous glucose supply the night before the operation, while biliary atresia patients did not.

Adolescent↗

PubMed2005

Dextrose in the banked blood products does not seem to affect the blood glucose levels in patients undergoing liver transplantation.

AIM: Hyperglycemia commonly seen in liver transplantation (LT) has often been attributed to the dextrose in the storage solution of blood transfusion products. The purpose of the study is to compare the changes of the blood glucose levels in transfused and non-transfused patients during LT. METHODS: A retrospective study on 60 biliary pediatric patients and 16 adult patients undergoing LT was carried out. Transfused pediatric patients were included in Group I (GI), those not transfused in Group II (GII). Twelve adult patients were not given transfusion and assigned to Group III (GIII); whereas, four adult patients who received massive transfusion were assigned to Group IV (GIV). The blood glucose levels, volume of blood transfused, and the volume of crystalloid infused were recorded, compared and analyzed. RESULTS: Results showed that the changes in blood glucose levels during LT for both non-transfused and minimally transfused pediatric groups and non-transfused and massively-transfused adult groups were almost the same. CONCLUSION: We conclude that blood transfusion does not cause significant changes in the blood glucose levels in this study.

Adult↗

PubMed2005

Impact of pre-operative transarterial embolization on the treatment of hepatocellular carcinoma with liver transplantation.

AIM: To determine the effectiveness of pre-liver transplant (LT) transarterial embolization (TAE) in treating hepatocellular carcinoma (HCC) and the patient categories, which are likely to have a good outcome after LT. METHODS: Twenty-nine patients with hepatitis-related cirrhosis and unresectable HCC after LT were studied over a 7-year period. The patients were divided into two groups: group A patients (19/29) received pre-LT TAE, whereas group B (10/29) underwent LT without prior TAE. According to Milan criteria, group A patients were further subdivided into: group A1 (12/19) who met the criteria, and group A2 (7/19) who did not. Patient survivals were compared. RESULTS: In the explanted liver, CT images correlated well with pathological specimens showing that TAE induced massive tumor necrosis (>85%) in 63.1% of patients in group A and all 7 patients in group A2 exhibited tumor downgrading that met Milan criteria. The overall 5-year actuarial survival rate was 80.6%. The TAE group had a better survival (84% at 5 years) than the non-TAE (75% at 4 years). The 3-year survival of group A2 (83%) was also higher than that of group A1 (79%). Tumor necrosis >85% was associated with excellent survival of 100% at 3 years, which was significantly better than the others who showed <85% tumor necrosis (57.1% at 3 years) or who did not have TAE (75% at 3 years). CONCLUSION: TAE is an effective treatment for HCC before LT. Excellent long-term survival was achieved in patients that did not fit Milan criteria. Our results broadened and redefined the selection policy for LT among patients with HCC. Meticulous pre-LT TAE helps in further reducing the rate of dropout from waiting lists and should be considered for patients with advanced HCC.

Carcinoma, Hepatocellular↗

PubMed2005

The effects of anti-histone H1 antibody on immune cells responsible for rejection reaction.

We previously demonstrated the immunosuppressive activity of anti-histone H1 autoreactive antibodies (Ab) transiently induced in serum of a rat tolerogenic orthotopic liver transplantation (OLT) model. In the present study, we investigated the effects of anti-histone H1 Ab on dendritic cells (DCs), T-cells, lymphokine-activated killer (LAK) cells, and human natural killer (NK) cells. The effects of anti-histone H1 Ab on Concanavalin A (ConA) blast, on rat DC cytokine profiles and phenotypes, and on T-cells, LAK cells, and human NK cells were examined by flow cytometry and RT-PCR. The cytotoxicity of LAK and NK cells pretreated with anti-histone H1 Ab was assayed. The addition of anti-histone H1 Ab to ConA blast inhibited the proliferation of 5-(6)-carboxy-fluorescein succinimidyl ester (CFSE)-labeled lymphocytes without toxicity but increased the population of CD4+CD25+ T-cells. DCs treated with anti-histone H1 Ab expressed lower levels of CD80/CD86, IL-1beta, and IL-6. The addition of anti-histone H1 Ab to LAK culture decreased the percentages of NKR-P1 populations and down-regulated levels of inducible nitric oxide synthase (iNOS), IL-2, and INF-gamma in RT-PCR. The cytotoxicity of LAK and NK cells was lower when pretreated with anti-histone H1 Ab than when pretreated with control IgG. We found that the blockade of histone H1 modulated DCs toward tolerogenic status, decreased the cytotoxicity of LAK and NK cells, and induced CD4+CD25+ T-cells. These results suggest that the use of anti-histone H1 Abs might be a useful strategy for the development of a form of immunosuppression.

Animals↗

PubMed2005

Mucin-producing cholangiocarcinoma: clinical experience of 24 cases in 16 years.

OBJECTIVE: Mucin-producing cholangiocarcinoma (MPCC) is an uncommon biliary tract malignancy. This retrospective study was designed to investigate the clinical presentations, associated diseases, the value of tumor markers, and treatment and prognosis of MPCC. MATERIAL AND METHODS: The study included 24 MPCC cases (7 M, 17 F) from 132 histopathology-proven cholangiocarcinoma patients seen between 1988 and 2003. MPCC and non-mucin-producing cholangiocarcinoma (non-MPCC) were compared. RESULTS: Common clinical symptoms and signs included epigastric or right upper quadrant pain, fever and chills, jaundice, and anemia. Seventeen patients had mucobilia in surgical, cholangiographic, or CT findings. Biliary stones were found in 71% of MPCC patients. In detecting MPCC, a serum CA-19-9 level > 120 U/ml had 73% sensitivity, 41% specificity, 25% positive predictive value, 85% negative predictive value, and 48% accuracy in the 132 cholangiocarcinoma patients. The 1-, 2-, 3-, 4-, and 5-year survival rates were 44.3%, 33.8%, 28.1%, 21.1%, and 21.1%, respectively. Univariate analysis showed that tumor type (MPCC) was the only significant factor predicting survival when compared with non-MPCC patients in 5-year cumulative survival rates (21.1% versus 5.4%). MPCC patients receiving surgical resection had a prolonged median survival time (13 months versus 6 months) than those without resection. CONCLUSIONS: MPCC clinical presentations were similar to non-MPCC in Taiwan except for more jaundice, fever and chills. The major factor predisposing to MPCC was biliary stones. Using serum CA19-9 levels greater than 120 U/ml was a diagnostic aid to detecting MPCC patients. MPCC patients had a better prognosis than non-MPCC patients. The recommended treatment for MPCC is surgical resection.

Adult↗

PubMed2005

Maintenance of normothermia at operation room temperature of 24 degrees C in adult and pediatric patients undergoing liver transplantation.

Hypothermia is common during surgery in regular operating room (OR) temperature. The effect of increasing the OR temperature to 24 degrees C coupled with simple warming measures to maintain normothermia in both pediatric and adult patients during living donor liver transplantation (LDLT) was evaluated. One hundred patients undergoing LDLT were separated into pediatric (GI) and adult (GII) groups. Nasopharyngeal temperature (NT) at each hour for the first 6 h, at the time of anhepatic phase, 5 and 30 min after reperfusion, and each hour for the last 2 h of the operation was recorded, compared and analyzed. A significant difference in core temperature variation was noted between the two groups. GI tended to be hyperthermic, while GII remained mildly hypothermic throughout the procedure. A sudden decrease of NT was observed in both groups during the anhepatic and reperfusion phases. Correlation between liver graft weight over recipient body weight ratio rather than the graft weight itself was found in GI, but no such correlation was found in GII. OR temperature of 24 degrees C, together with simple active and passive warming measures are more effective in maintaining normothermia during liver transplantation in pediatric patients than in adults.

Adult↗

PubMed2005

Endoscopic findings and management of dengue patients with upper gastrointestinal bleeding.

There are 100 million cases of dengue infection, 500,000 cases of dengue hemorrhagic fever, and 25,000 deaths annually due to dengue worldwide. Gastrointestinal bleeding is the most common type of severe hemorrhage in dengue fever. However, there are no reports about the clinical applications of endoscopic therapy for upper gastrointestinal bleeding (UGI) in dengue patients. From June 17, 2002 to January 30, 2003, 1,156 patients with confirmed dengue virus infection were treated at Kaohsiung Chang Gung Memorial Hospital in Taiwan. We analyzed those patients who had received endoscopic therapy for UGI. The characteristic endoscopic findings, therapeutic courses, and amount of blood component transfused were collected from their charts for statistical analysis. Among the 1,156 dengue patients, 97 (8.4%) had complications of UGI bleeding during hospitalization. The endoscopic findings included hemorrhagic (and/or erosive) gastritis in 67% of the patients, gastric ulcer in 57.7%, duodenal ulcer in 26.8%, and esophageal ulcer in 3.1%. Of the 73 patients with peptic ulcer, 42 (57.5%) met the endoscopic criteria (recent hemorrhage) for endoscopic hemostasis therapy. Peptic ulcer patients with recent hemorrhage required more transfusions with packed red blood cells (P = 0.002) and fresh frozen plasma (P = 0.05) than those without recent hemorrhage. Among these 42 patients with recent hemorrhage, endoscopic injection therapy was conducted in 15 patients (group A). The other 27 patients (group B) did not receive endoscopic therapy. After endoscopy, patients in group A required more transfusions with packed red blood cells (P = 0.03) and fresh frozen plasma (P = 0.014) than did patients in group B. There were no significant differences between groups A and B in duration of hospital stay and amounts of transfused platelet concentrate after endoscopy. Medical treatment with blood transfusion is the mainstay of management of UGI bleeding in dengue patients. Patients having peptic ulcer with recent hemorrhage require more transfusions with packed red blood cells and fresh frozen plasma for management of UGI bleeding than those without recent hemorrhage. However, when peptic ulcer with recent hemorrhage is encountered during the endoscopic procedure, endoscopic injection therapy is not an effective adjuvant treatment of hemostasis in dengue patients with UGI bleeding.

Adult↗

PubMed2005

Short report: Abnormal liver function in scrub typhus.

Scrub typhus is one kind of rickettsial disease and may cause fever, cough, and skin rashes in infected humans. Regarding liver involvement, it was uncommon to be reported in previous medical literature from Western countries. This study observes the relationship between scrub typhus and liver function. From January 1998 to August 2003 in Kaohsiung Chang Gung Memorial Hospital in Taiwan, we observed 30 patients with scrub typhus, and 29 of them had liver function abnormality. In these patients, we found 89.3% with elevated aspartate aminotransferase (AST) levels, 91.7% with elevated alanine aminotransferase (ALT) levels, 84.2% with elevated alkaline phosphatase (ALP) levels, and 38.5% with elevated total bilirubin levels. In our study, there is a close relationship between scrub typhus and impaired liver function tests. Therefore, if patients are found with fever of unknown origin and abnormal liver function, we should take scrub typhus into consideration.

Female↗

PubMed2005

Gastrointestinal tract cytomegalovirus disease in southwestern Taiwan: a clinical study of 1950 endoscopic biopsies.

BACKGROUND: Gastrointestinal (GI) cytomegalovirus (CMV) disease occurs in adult patients with immune suppression. This study reviews and discusses the clinical settings, endoscopic features, and locations of GI CMV lesions. METHODS: In total, 1950 endoscopic biopsy reports for all GI tract lesions in Chang Gung Memorial Hospital, Kaohsiung were retrospectively reviewed for CMV disease from 1999 to 2002. Only those patients found to be positive for viral inclusion bodies in tissue specimens, with further confirmation by special immunohistochemical staining, were enrolled in this study. RESULTS: Our series showed that all 5 patients were immunosuppressed when attacked by the virus. The esophagus (n = 2) and colon (n = 2) were infected in 4 patients, while stomach was involved in one patient. Those patients with lesions of the esophagus and stomach followed a more-benign clinical course. Endoscopic examination showed 1 or more prominent ulcers in the distal esophagus and at the antrum of the stomach. Rare endoscopic findings of diffuse esophageal CMV disease and severe and extensive colitis were presented. The overall mortality rate was 20%, and all but 1 patient responded well to ganciclovir treatment. CONCLUSIONS: We emphasize that GI CMV disease is still rare in Taiwan. A high degree of suspicion for CMV disease is important when diagnosing immunosuppressed patients suffering from GI symptoms.

Adult↗

PubMed2005

Clinicopathological characteristics and prognosis of patients with small intestinal stromal tumors.

BACKGROUND AND PURPOSE: Gastrointestinal stromal tumors (GISTs) involving the small intestine are less common than those involving the stomach, and data on small intestinal stromal tumors (SISTs) are more limited. This study investigated the clinicopathological characteristics and prognostic factors of SISTs and compared them with those of gastric stromal tumors (GSTs). METHODS: A total of 82 surgically resected and pathologically diagnosed smooth muscle tumors of small bowel in patients treated from January 1986 to December 2000 were included. Immunohistochemical studies were performed on these tumors with antibodies of CD117, CD34, smooth muscle actin (SMA), desmin and S-100. The results were analyzed and compared with 74 cases of GSTs diagnosed and treated from January 1986 to December 1997. RESULTS: Among the 82 small intestine tumors, 71 were CD117-positive (86.6%) and were classified as SISTs. Of the 71 SISTs, 70.4% were immunoreactive to CD34, 88.7% to SMA, 46.5% to S-100, but none to desmin. Survival analysis demonstrated that tumor size < 5 cm (p = 0.021), mitosis number < 5/50 high-power field (p < 0.001), SMA-positive (p = 0.027), non-epithelioid cell type (p = 0.005) and tumor with skeinoid fibers (p = 0.010) predicted longer disease-free survival after operation. Multivariate analysis revealed that mitotic number (p = 0.001), cell morphology (p = 0.031) and tumor size (p = 0.004) were independent prognostic factors. In comparison to GSTs, SISTs exhibited significantly lower rates of CD34, but significantly higher rates of SMA and S-100 immunoreactivity. CONCLUSIONS: SISTs exhibited a different immunophenotype from GSTs. SMA reactivity is a predictor of benign clinical behavior in SISTs. Tumor mitotic numbers, tumor size, and cell type were independent prognostic factors for patients with SISTs after operation.

Female↗

PubMed2004

Perioperative normovolemic anemia is safe in pediatric living-donor liver transplantation.

BACKGROUND: Perioperative normovolemic anemia was applied in pediatric living-donor liver transplant (LDLT) recipients with the aim of reducing the use of blood products and decreasing transfusion-related risk. METHODS: The anemic state was allowed to occur by replacing intraoperative blood and transudate loss with colloid solutions and a discriminate use of packed red blood cells. When blood transfusion was required, the amount of blood replacement was calculated to target a hemoglobin level not higher than 8 to 9 g/dL. RESULTS: Forty-eight pediatric patients underwent LDLT. Their mean hemoglobin and hematocrit levels were maintained below 9 g/dL and 27%, respectively, at the end of the operation, at the time of extubation, postoperative days 3, 10, and 20, and at the time of discharge. The mean ventilatory support time was 15.7 hr, and no patient required reintubation. Graft function normalized within the first week posttransplant in all patients, and there was no documented case of acute hepatic artery thrombosis. All the patients were discharged with acceptable liver function, and 98% of them remain alive to date. CONCLUSION: Routine application of perioperative normovolemic anemia in pediatric LDLT has allowed the sparing use of blood products. Approximately half of our patients (42%) did not require intraoperative blood transfusion; 31% of the patients went home without receiving any blood products except 5% albumin. There were no adverse effects with this maneuver, and graft function was good in all patients.

Adolescent↗

PubMed2004

Hepatic angiomyolipoma: report of two cases with emphasis on smear cytomorphology and the use of cell block with immunohistochemical stains.

Angiomyolipoma is a benign mesenchymal lesion that occurs most commonly in the kidney. Its occurrence in the liver is relatively rare. We report two cases of hepatic angiomyolipoma diagnosed by ultrasound-guided, needle aspiration biopsy. One of the patients was a previously healthy 62-yr-old woman who presented with a hepatic mass incidentally during a healthy examination. The other patient was a 67-yr-old man, a victim of chronic hepatitis C, who was found to have a hepatic tumor in the right lobe during regular follow-up. Cytologic preparations of the two hepatic masses showed some mature adipocytes admixed with clusters of variable-sized mesenchyme-like cells with fibrillar cytoplasm and indistinct cytoplasmic borders. Some of the cells were round to oval and others were spindle shaped with oval, cigar-shaped or elongated nuclei. The nuclear chromatin was fine and some cells showed round nucleoli. No thick-walled blood vessels were noted in the cytological smears. In the cell block preparations, a mixture of thick-walled blood vessels, mature adipose tissue, and bundles of variable-sized smooth muscle cells were noted. The spindle or epithelioid smooth muscle cells were positive for vimentin, alpha-smooth muscle actin, and human melanoma black (HMB)-45 but negative for desmin and S100 protein in immunohistochemical stains. The purpose of the current study is to describe cytological features of this lesion with differential diagnosis because pathologists may be called on to render a diagnosis on needle aspiration. HMB-45 has been proved to be a sensitive marker for the smooth muscle component of angiomyolipoma. Cell block preparations assisted with immunohistochemical staining should be emphasized for definite diagnosis. Although a surgical procedure may still be necessary once a diagnosis of angiomyolipoma is made, treatment may be tailored for a less aggressive procedure than for malignant hepatic nodules.

Aged↗