Abstract
BackgroundHepatic sclerosing hemangiomas (HSH) are rare benign vascular tumors that mimic radiologically hepatic malignancies. HSH is characterized by extensive fibrosis and hyalinosis as a result of degeneration and thrombosis. Pre-operative diagnosis is very difficult and most of the cases undergo surgical resections.Case presentationA 65 years old, hepatitis C virus-infected female presented by an accidentally discovered hepatic focal lesion. Magnetic resonance imaging (MRI) showed a T2 hyperintense mass displaying peripheral enhancement in porto-venous phase. The patient had a simultaneous typical hepatic hemangioma and multiple vertebral bodies’ hemangiomata. Tissue-guided biopsy revealed a densely sclerotic stroma containing vascular spaces with occasional obliteration of the lumen. Immunohistochemical staining was performed for Pan CK, CD34, SMA, VEGF, and c-Kit which confirmed the vascular nature of neoplasm and the involuting phase of hemangioma development. The patient was reassured and recommended for a regular radiological follow-up to reassess the lesion size.ConclusionThe definitive preoperative diagnosis of HSH is still problematic. However, the awareness of surgeons by this entity, peripheral enhancement in porto-venous phase on dynamic MRI, the presence of simultaneous typical hepatic hemangioma in the absence of cancer history could raise suspicion for HSH. Liver biopsy is still the gold standard in approaching the accurate diagnosis.
Highlights
ConclusionThe definitive preoperative diagnosis of Hepatic sclerosing hemangiomas (HSH) is still problematic
Hepatic sclerosing hemangiomas (HSH) are rare benign vascular tumors that mimic radiologically hepatic malignancies
Case presentation A 65-year-old female presented to a medical physician when hepatic focal lesion during routine examination for hepatitis C virus (HCV) infection was accidentally discovered
Summary
Despite HSH are benign tumors that remain stable or even regressed over time, resection is necessary for large size lesions. The awareness of the imaging characteristics of HSH can alter patient management. Preoperative tissue biopsy or intraoperative frozen section should be considered to avoid unnecessary extended hepatic resection. If tumor malignancy cannot be ruled out or if the biopsy is hemorrhagic, hepatic resection should remain the choice for diagnostic surgery at present
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