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A hepatic sclerosed hemangioma with significant morphological change over a period of 10 years: a case report.

Shimada Y, Takahashi Y, Iguchi H, Yamazaki H, Tsunoda H, Watanabe M, Oda M, Yokomori H - J Med Case Rep (2013)

Bottom Line: Tumor markers carcinoembryonic antigen, alpha-fetoprotein, and CA19-9 levels in the peripheral blood were not elevated at any time.Segmental hepatectomy was performed.Immunochemically, the tumor cells were positive for CD34 and alpha smooth muscle actin.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Liver cavernous hemangioma is the most common noncystic hepatic lesion, and a hemangioma that undergoes degeneration and fibrous replacement is called a hepatic sclerosed hemangioma.

Case presentation: A 63-year-old Japanese man was admitted for detailed investigation of a liver tumor. Tumor markers carcinoembryonic antigen, alpha-fetoprotein, and CA19-9 levels in the peripheral blood were not elevated at any time. Plain computed tomography showed an approximately 1.5 cm low density mass in the periphery of segment 8, which was marginally enhanced on contrast-enhanced dynamic computed tomography. On magnetic resonance imaging, the tumor was hypointense on T1-weighted image and hyperintense on T2-weighted image. The tumor was suspected to be an atypical hemangioma, metastatic, hepatocellular carcinoma, or cholangiocellular carcinoma. Segmental hepatectomy was performed. Histological examination of the resected tumor specimen revealed a sclerosed hemangioma with marked hyalinization and sparse stromal fibrosis. Immunochemically, the tumor cells were positive for CD34 and alpha smooth muscle actin. Electron microscopically, the residual hemangioma consisted of numerous caveolae and vesicles in endothelial cells in irregular shapes and sizes. Immunostaining for caveolin-1 showed decreased or no caveolin-1 reactivity in the hyalinized lesions of the sclerosed hemangioma, but abundant caveolin-1 reactivity in the residual cavernous hemangioma. Of interest, computed tomography images of the tumor obtained 10 years earlier at our hospital depicted a 3 cm typical cavernous hemangioma.

Conclusions: Hepatic sclerosed hemangioma is a rare condition. Comparison of radiological findings of the lesion over a period of 10 years was valuable in providing insight for the evolutional process from liver cavernous hemangioma to hepatic sclerosed hemangioma.

No MeSH data available.


Related in: MedlinePlus

Abdominal contrast-enhanced dynamic computed tomography (CT) findings. a: Plain CT shows an approximately 1.5cm low-density mass in the periphery of segment 8 (arrow). b: Early arterial phase image (40sec) of enhanced CT shows that the tumor is marginally enhanced. Small satellite-like lesions (arrow) are found close to the main tumor. c: Portal venous phase image of enhanced CT shows the tumor in segment 8 (arrow). d: Delayed-phase image (180 seconds) of enhanced CT shows faint enhancement of a small portion of the tumor. Arrow denotes hepatic mass lesion.
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Figure 1: Abdominal contrast-enhanced dynamic computed tomography (CT) findings. a: Plain CT shows an approximately 1.5cm low-density mass in the periphery of segment 8 (arrow). b: Early arterial phase image (40sec) of enhanced CT shows that the tumor is marginally enhanced. Small satellite-like lesions (arrow) are found close to the main tumor. c: Portal venous phase image of enhanced CT shows the tumor in segment 8 (arrow). d: Delayed-phase image (180 seconds) of enhanced CT shows faint enhancement of a small portion of the tumor. Arrow denotes hepatic mass lesion.

Mentions: A 63-year-old Japanese man was transferred to our hospital for detailed investigation of a liver tumor. At admission to our hospital, the hematologic and blood chemistry data were as follows: white blood cell count 3,800/μL, hemoglobin 15.9g/dL, platelet count 146,000/μL, blood urea nitrogen 17.9mg/dL, creatinine 0.82mg/dL, albumin 4.3g/dL, aspartate aminotransferase 26IU/L, alanine aminotransferase 33IU/L, and total bilirubin 0.9mg/dL. Serum hepatitis B (HB) surface antigen, anti-HBe antibody, and anti-hepatitis C virus antibody were negative. Alpha-fetoprotein, carcinoembryonic antigen, and cancer antigen 19–9 levels were within the normal ranges. Dynamic CT depicted a mass measuring 1.5 × 1.4cm with a bulging contour in segment 8 of the liver, which was enhanced in the arterial phase and showed subtle low density with focal capsular enhancement in the delayed phase (Figure 1). A magnetic resonance image (MRI) demonstrated low signal intensity on T1-weighted image, and slightly high signal intensity on T2-weighted and diffusion-weighted images (Figure 2a–c). Dynamic contrast (gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid)-enhanced MRI of the tumor showed subtle marginal enhancement in the delayed phase and well-demarcated low intensity in the hepatobiliary phase (Figure 2d-h). Gastroscopy revealed atrophic gastritis and colonoscopy showed normal findings.


A hepatic sclerosed hemangioma with significant morphological change over a period of 10 years: a case report.

Shimada Y, Takahashi Y, Iguchi H, Yamazaki H, Tsunoda H, Watanabe M, Oda M, Yokomori H - J Med Case Rep (2013)

Abdominal contrast-enhanced dynamic computed tomography (CT) findings. a: Plain CT shows an approximately 1.5cm low-density mass in the periphery of segment 8 (arrow). b: Early arterial phase image (40sec) of enhanced CT shows that the tumor is marginally enhanced. Small satellite-like lesions (arrow) are found close to the main tumor. c: Portal venous phase image of enhanced CT shows the tumor in segment 8 (arrow). d: Delayed-phase image (180 seconds) of enhanced CT shows faint enhancement of a small portion of the tumor. Arrow denotes hepatic mass lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750244&req=5

Figure 1: Abdominal contrast-enhanced dynamic computed tomography (CT) findings. a: Plain CT shows an approximately 1.5cm low-density mass in the periphery of segment 8 (arrow). b: Early arterial phase image (40sec) of enhanced CT shows that the tumor is marginally enhanced. Small satellite-like lesions (arrow) are found close to the main tumor. c: Portal venous phase image of enhanced CT shows the tumor in segment 8 (arrow). d: Delayed-phase image (180 seconds) of enhanced CT shows faint enhancement of a small portion of the tumor. Arrow denotes hepatic mass lesion.
Mentions: A 63-year-old Japanese man was transferred to our hospital for detailed investigation of a liver tumor. At admission to our hospital, the hematologic and blood chemistry data were as follows: white blood cell count 3,800/μL, hemoglobin 15.9g/dL, platelet count 146,000/μL, blood urea nitrogen 17.9mg/dL, creatinine 0.82mg/dL, albumin 4.3g/dL, aspartate aminotransferase 26IU/L, alanine aminotransferase 33IU/L, and total bilirubin 0.9mg/dL. Serum hepatitis B (HB) surface antigen, anti-HBe antibody, and anti-hepatitis C virus antibody were negative. Alpha-fetoprotein, carcinoembryonic antigen, and cancer antigen 19–9 levels were within the normal ranges. Dynamic CT depicted a mass measuring 1.5 × 1.4cm with a bulging contour in segment 8 of the liver, which was enhanced in the arterial phase and showed subtle low density with focal capsular enhancement in the delayed phase (Figure 1). A magnetic resonance image (MRI) demonstrated low signal intensity on T1-weighted image, and slightly high signal intensity on T2-weighted and diffusion-weighted images (Figure 2a–c). Dynamic contrast (gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid)-enhanced MRI of the tumor showed subtle marginal enhancement in the delayed phase and well-demarcated low intensity in the hepatobiliary phase (Figure 2d-h). Gastroscopy revealed atrophic gastritis and colonoscopy showed normal findings.

Bottom Line: Tumor markers carcinoembryonic antigen, alpha-fetoprotein, and CA19-9 levels in the peripheral blood were not elevated at any time.Segmental hepatectomy was performed.Immunochemically, the tumor cells were positive for CD34 and alpha smooth muscle actin.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: Liver cavernous hemangioma is the most common noncystic hepatic lesion, and a hemangioma that undergoes degeneration and fibrous replacement is called a hepatic sclerosed hemangioma.

Case presentation: A 63-year-old Japanese man was admitted for detailed investigation of a liver tumor. Tumor markers carcinoembryonic antigen, alpha-fetoprotein, and CA19-9 levels in the peripheral blood were not elevated at any time. Plain computed tomography showed an approximately 1.5 cm low density mass in the periphery of segment 8, which was marginally enhanced on contrast-enhanced dynamic computed tomography. On magnetic resonance imaging, the tumor was hypointense on T1-weighted image and hyperintense on T2-weighted image. The tumor was suspected to be an atypical hemangioma, metastatic, hepatocellular carcinoma, or cholangiocellular carcinoma. Segmental hepatectomy was performed. Histological examination of the resected tumor specimen revealed a sclerosed hemangioma with marked hyalinization and sparse stromal fibrosis. Immunochemically, the tumor cells were positive for CD34 and alpha smooth muscle actin. Electron microscopically, the residual hemangioma consisted of numerous caveolae and vesicles in endothelial cells in irregular shapes and sizes. Immunostaining for caveolin-1 showed decreased or no caveolin-1 reactivity in the hyalinized lesions of the sclerosed hemangioma, but abundant caveolin-1 reactivity in the residual cavernous hemangioma. Of interest, computed tomography images of the tumor obtained 10 years earlier at our hospital depicted a 3 cm typical cavernous hemangioma.

Conclusions: Hepatic sclerosed hemangioma is a rare condition. Comparison of radiological findings of the lesion over a period of 10 years was valuable in providing insight for the evolutional process from liver cavernous hemangioma to hepatic sclerosed hemangioma.

No MeSH data available.


Related in: MedlinePlus