S2730 Hepatic Sclerosing Hemangioma: A Radiologically Deceptive Entity That Warrants Liver Biopsy for Accurate Diagnosis

Abstract

INTRODUCTION: Sclerosing hemangioma is an extremely rare and benign tumor. Due to its rarity and atypical radiologic findings, it can be indistinguishable from other lesions such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma and metastatic lesions, which constitutes a diagnostic dilemma. Here we highlight a case of hepatic sclerosing hemangioma mimics malignancy that requires biopsy for final diagnosis. CASE DESCRIPTION/METHODS: A 70-year-old Caucasian male who presented to clinic for an incidental hepatic mass (right lobe mass, 5.2 × 3.9 cm) found on ultrasonography. Past medical history included hypertension, hyperlipidemia and alcohol use disorder. He admitted to two wine spritzer three times per month as well as 1–2 drinks per day for the past 50 years. Review of systems revealed an unintentional weight loss of 14 pounds over the last 3 months. The physical exam was unremarkable with no stigmata of hepatic disease noted. Liver function tests were normal except a mildly elevated total bilirubin 1.7 mg/dL (normal range 0.1–1.1 mg/dL). Tumor markers were all unremarkable. HIV and hepatitis serologies are negative. Alpha-1 antitrypsin and ceruloplasmin levels were normal. Serum Iron saturation was low (19%) while serum ferritin was normal. Antinuclear and anti-smooth muscle antibodies were unrevealing. Colonoscopy was performed 8 months earlier and showed tubular adenoma. A triple phase contrast CT of the abdomen revealed a lobulated, poorly demarcated liver lesion (4.5 × 4.8 cm in diameter) in segment 5 with encasement of the left portal branch, without clear washout in portal venous phase [Figure A]. The overall radiologic impression was indeterminate, however there was a high suspicion for malignancy. CT guided biopsy of the liver lesion was performed and histopathological examination showed foci of prominent fibrosis and hyalinization with narrowed and obliterated vascular spaces consistent with a sclerosing hemangioma [Figure B]. No evidence of malignant neoplastic process was noted. The patient was discharged with no need for further surveillance. DISCUSSION: Sclerosing hemangioma of liver is caused by degenerative changes and typically discovered incidentally during abdominal imaging in patients between the age of 30 to 50 years old. It is extremely difficult to precisely diagnose hepatic sclerosing hemangiomas from imaging modalities. If the possibility of a malignancy cannot be ruled out based on radiologic findings, a targeted biopsy would be indicated for conclusive diagnosis.Figure 1Figure 2