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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

Histologic features of the sclerosed hemangioma nodule. a: A hyalinized mass is distinguished from the surrounding normal liver tissue (hematoxylin and eosin staining). b:The mass is composed of collapsed vascular spaces on a rich paucicellular fibrous stroma. Sclerosis is highlighted by Masson’s trichrome stain. c: The vascular spaces are clearly identified by immunohistochemistry for the endothelial marker CD34. d: The vascular and cavernous hemangioma spaces are identified by immunohistochemistry for the vascular smooth muscle cell marker, alpha smooth muscle actin. Asterisks denote sclerosed portion.
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Figure 4: Histologic features of the sclerosed hemangioma nodule. a: A hyalinized mass is distinguished from the surrounding normal liver tissue (hematoxylin and eosin staining). b:The mass is composed of collapsed vascular spaces on a rich paucicellular fibrous stroma. Sclerosis is highlighted by Masson’s trichrome stain. c: The vascular spaces are clearly identified by immunohistochemistry for the endothelial marker CD34. d: The vascular and cavernous hemangioma spaces are identified by immunohistochemistry for the vascular smooth muscle cell marker, alpha smooth muscle actin. Asterisks denote sclerosed portion.

Mentions: Based on the radiologic findings, we suspected the tumor to be an atypical hemangioma, metastatic, hepatocellular carcinoma, or a cholangiocellular carcinoma. Due to a suspicion of carcinoma, a hepatic segmentectomy of segment 8 was performed. On pathological examination, the resected liver tumor measured 1.1cm × 1.1cm × 1.0cm. Sectioning revealed a relatively homogenous, well-circumscribed white solid nodule with several dark-red, pin-point spots (Figure 3). Histopathological evaluation revealed that most areas were composed of sclerotic hyalinized collagenous tissues with scattered tiny-to-small, thin-walled vascular spaces (Figure 4a and b). The vascular spaces were frequently collapsed and lined by flat endothelial cells. Immunohistochemical studies showed that the cells were positive for CD34, an endothelial marker (Figure 4c) and alpha smooth muscle actin, a marker of vascular smooth muscle (Figure 4d). Based on these pathological findings, the tumor was diagnosed as HSH.


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)

Histologic features of the sclerosed hemangioma nodule. a: A hyalinized mass is distinguished from the surrounding normal liver tissue (hematoxylin and eosin staining). b:The mass is composed of collapsed vascular spaces on a rich paucicellular fibrous stroma. Sclerosis is highlighted by Masson’s trichrome stain. c: The vascular spaces are clearly identified by immunohistochemistry for the endothelial marker CD34. d: The vascular and cavernous hemangioma spaces are identified by immunohistochemistry for the vascular smooth muscle cell marker, alpha smooth muscle actin. Asterisks denote sclerosed portion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Histologic features of the sclerosed hemangioma nodule. a: A hyalinized mass is distinguished from the surrounding normal liver tissue (hematoxylin and eosin staining). b:The mass is composed of collapsed vascular spaces on a rich paucicellular fibrous stroma. Sclerosis is highlighted by Masson’s trichrome stain. c: The vascular spaces are clearly identified by immunohistochemistry for the endothelial marker CD34. d: The vascular and cavernous hemangioma spaces are identified by immunohistochemistry for the vascular smooth muscle cell marker, alpha smooth muscle actin. Asterisks denote sclerosed portion.
Mentions: Based on the radiologic findings, we suspected the tumor to be an atypical hemangioma, metastatic, hepatocellular carcinoma, or a cholangiocellular carcinoma. Due to a suspicion of carcinoma, a hepatic segmentectomy of segment 8 was performed. On pathological examination, the resected liver tumor measured 1.1cm × 1.1cm × 1.0cm. Sectioning revealed a relatively homogenous, well-circumscribed white solid nodule with several dark-red, pin-point spots (Figure 3). Histopathological evaluation revealed that most areas were composed of sclerotic hyalinized collagenous tissues with scattered tiny-to-small, thin-walled vascular spaces (Figure 4a and b). The vascular spaces were frequently collapsed and lined by flat endothelial cells. Immunohistochemical studies showed that the cells were positive for CD34, an endothelial marker (Figure 4c) and alpha smooth muscle actin, a marker of vascular smooth muscle (Figure 4d). Based on these pathological findings, the tumor was diagnosed as HSH.

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