Hepatic angiomyolipoma (HAML) is a rare mesenchymal tumor of the liver composed of varying proportions of adipose tissue, smooth muscle cells, and blood vessels. Its heterogenous composition results in diverse features that may closely mimic hepatocellular carcinoma (HCC) on imaging. Here, we report a 56-year-old woman was referred after an incidental 1.8 cm hepatic mass on computed tomography. Magnetic resonance imaging demonstrated arterial phase hyperenhancement, portal venous washout, hepatobiliary phase hypointensity, and diffusion restriction, strongly mimicking the imaging appearance of HCC. However, the absence of chronic liver disease or viral hepatitis limited a confident noninvasive diagnosis. To establish a definitive diagnosis, percutaneous tumor biopsy was performed. Histologically, the lesion consisted showed a characteristic admixture of smooth muscle cells, adipose tissue, and blood vessels, and immunohistochemistry demonstrated diffuse positivity for HMB-45, confirming the diagnosis of HAML.
