Hepatic Sclerosing Hemangioma Mimicking Malignancy: A Case and Literature Review

Tian Li¹, Miriam M. Klar¹, Mouyed Alawad², Rishard Abdul¹, Ayesha Zahiruddin³, Moro O. Salifu¹ and Isabel M. McFarlane^1,

¹Department of Medicine, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203

²Department of Pathology, State University of New York Downstate Health Sciences University, Brooklyn, NY 11203

³Department of Gastroenterology and Hepatology, VA NY Harbor Health Care System- Brooklyn Campus

Cite this paper:
Tian Li, Miriam M. Klar, Mouyed Alawad, Rishard Abdul, Ayesha Zahiruddin, Moro O. Salifu and Isabel M. McFarlane. Hepatic Sclerosing Hemangioma Mimicking Malignancy: A Case and Literature Review. American Journal of Medical Case Reports. 2021; 9(3):144-146. doi: 10.12691/ajmcr-9-3-2

Abstract

Background: Sclerosing hemangiomas of the liver are rare, benign tumors with degenerative changes. These degenerative changes, however, often obscure the true, benign nature of the tumor and give them features indistinguishable from other malignant processes, thus making the diagnosis difficult. Case presentation: A 70-year-old male without any previously diagnosed liver disease or malignant process presented with incidental right hepatic mass in ultrasonography and weight loss. Physical exam was unremarkable. The labs were significant for mild pancytopenia, elevated total bilirubin and slightly decreased transferrin. Follow-up triple phase-contrast CT scan of the abdomen revealed a lobulated, poorly demarcated lesion measuring 4.8 x 4.5 cm, located in segment V of the liver with encasement of the left portal branch. The overall picture was indeterminate but highly suspicious for malignancy. A decision was made to perform a CT-guided biopsy which revealed sclerosing hemangioma of the liver. Conclusion: It is challenging to differentiate sclerosing hepatic hemangioma from atypical hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic tumors utilizing only imaging modalities. The diagnostic workup should include biopsy of the atypical liver lesion which unveils the final diagnosis and avoid subjecting the patient to an extensive, and invasive surgical resection.

Keywords:
hemangioma sclerosing liver imaging features

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Dietrich CF, Mertens JC, Braden B, Schuessler G, Ott M, Ignee A: Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007, 45(5):1139-1145.
[2]	Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K: Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case. Surg Today 2000, 30(9):849-852.
[3]	Caseiro-Alves F, Brito J, Araujo AE, Belo-Soares P, Rodrigues H, Cipriano A, Sousa D, Mathieu D: Liver haemangioma: common and uncommon findings and how to improve the differential diagnosis. Eur Radiol 2007, 17(6):1544-1554.
[4]	Song JS, Kim YN, Moon WS: A sclerosing hemangioma of the liver. Clin Mol Hepatol 2013, 19(4):426-430.
[5]	Goodman ZD: Neoplasms of the liver. Modern Pathology 2007, 20(1):S49-S60.
[6]	Cheng HC, Tsai SH, Chiang JH, Chang CY: Hyalinized liver hemangioma mimicking malignant tumor at MR imaging. American Journal of Roentgenology 1995, 165(4):1016-1017.
[7]	Makhlouf HR, Ishak KG: Sclerosed hemangioma and sclerosing cavernous hemangioma of the liver: a comparative clinicopathologic and immunohistochemical study with emphasis on the role of mast cells in their histogenesis. Liver 2002, 22(1): 70-78.
[8]	Shepherd NA, Lee G: Solitary necrotic nodules of the liver simulating hepatic metastases. J Clin Pathol 1983, 36(10): 1181-1183.
[9]	Doyle DJ, Khalili K, Guindi M, Atri M: Imaging Features of Sclerosed Hemangioma. American Journal of Roentgenology 2007, 189(1): 67-72.
[10]	Behbahani S, Hoffmann J, Stonebridge R, Mahboob S: Clinical case report: Sclerosing hemangioma of the liver, a rare but great mimicker. Radiology Case Reports 2016, 11:58-61.
[11]	Miyamoto S, Oshita A, Daimaru Y, Sasaki M, Ohdan H, Nakamitsu A: Hepatic Sclerosed Hemangioma: a case report and review of the literature. BMC Surg 2015, 15: 45-45.
[12]	Andeen NK, Bhargava P, Park JO, Moshiri M, Westerhoff M: Cavernous hemangioma with extensive sclerosis masquerading as intrahepatic cholangiocarcinoma ¡ª A pathologist's perspective. Radiology Case Reports 2014, 9(2): 937.
[13]	Wakasugi M, Ueshima S, Tei M, Tori M, Yoshida K-I, Tsujimoto M, Akamatsu H: Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case. Int J Surg Case Rep 2015, 8C: 137-140.