Additionally, immunohistochemistry, qPCR, and ELISA were conducted to assess <i>CD34</i>, <i>PPARG</i>, and <i>PTEN</i> expression to explore biological mechanisms associated with rupture.<h4>Results</h4>Tuberous sclerosis complex (TSC), tumor size ≥4 cm, rich vascular supply, and exophytic growth pattern were identified as independent predictors of hemorrhagic rupture (all p<0.05). Here, PTEN is linked to tuberous sclerosis.