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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

Immunostaining for caveolin-1 in normal liver areas (a-c) and the lesion (d-f). For the lesion, immunostaining was performed on serial sections continuous with those used in Figure 4. a-c: normal liver areas a: Abundant caveolin-1 reactivities are seen in both the endothelial cells as well as smooth muscle cells in normal areas. P denotes portal tract. C denotes central vein. Bar denotes 154μm. b: Caveolin-1 reactivities are noted on the hepatic artery, capillary venules, and portal vein in the portal tract in normal control liver areas. Arrow heads denote hepatic artery, capillary venules, and portal vein. Bar denotes 32μm. c: Caveolin-1 reactivities are detected in the hepatic sinusoidal lining cells around pericentral zone 3 in normal control liver areas. Arrowheads denotes liver sinusoidal lining cell. Bar denotes 32μm. d-f: lesion. d: Caveolin-1 reactivities are reduced or absent in the hyalinized lesions of sclerosed hemangioma. In residual hemangioma, high expression of caveolin 1 is found in endothelial cells. Caveolin-1 reactivity is almost absent in fibroblasts. Asterisks denote sclerosed portion. Bar denotes 153μm. e: Lesion of liver cavernous hemangioma lesion. Arrowhead denotes endothelial cells. Bar denotes 32μm. f: Lesion of sclerosed hepatic hemangioma. Arrowhead denotes endothelial cell. Bar denotes 32μm. Red rectangles denote the regions seen in 6b or 6c and 6e or 6f, respectively.
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Figure 6: Immunostaining for caveolin-1 in normal liver areas (a-c) and the lesion (d-f). For the lesion, immunostaining was performed on serial sections continuous with those used in Figure 4. a-c: normal liver areas a: Abundant caveolin-1 reactivities are seen in both the endothelial cells as well as smooth muscle cells in normal areas. P denotes portal tract. C denotes central vein. Bar denotes 154μm. b: Caveolin-1 reactivities are noted on the hepatic artery, capillary venules, and portal vein in the portal tract in normal control liver areas. Arrow heads denote hepatic artery, capillary venules, and portal vein. Bar denotes 32μm. c: Caveolin-1 reactivities are detected in the hepatic sinusoidal lining cells around pericentral zone 3 in normal control liver areas. Arrowheads denotes liver sinusoidal lining cell. Bar denotes 32μm. d-f: lesion. d: Caveolin-1 reactivities are reduced or absent in the hyalinized lesions of sclerosed hemangioma. In residual hemangioma, high expression of caveolin 1 is found in endothelial cells. Caveolin-1 reactivity is almost absent in fibroblasts. Asterisks denote sclerosed portion. Bar denotes 153μm. e: Lesion of liver cavernous hemangioma lesion. Arrowhead denotes endothelial cells. Bar denotes 32μm. f: Lesion of sclerosed hepatic hemangioma. Arrowhead denotes endothelial cell. Bar denotes 32μm. Red rectangles denote the regions seen in 6b or 6c and 6e or 6f, respectively.

Mentions: Furthermore, we also observed the tumor by electron microscopy and investigated the expression of caveolin-1 by immunohistochemistry (Additional file 1). On electron micrograph, the tumor appeared to be hyalinized. Cells resembling mast cells or histiocytes, fibroblast-like cells, and remnant endothelial cells were observed (Figure 5a). Remnant endothelial cells contained a few micropinocytic vesicles and caveolae, but numerous cytoplasmic filaments (Figure 5b). We also found residual LCH composed of numerous caverns in various shapes and sizes. The caverns formed a labyrinth, communicating with each other. They were lined by spindle-shaped endothelial cells (Figure 5c). The endothelial cells also contained numerous cytoplasmic filaments (Figure 5d). Moreover, caveolae and multiple micropinocytic vesicles were observed along the luminal and basal cell surfaces. Slender intraluminal processes were also found, sometimes overlapping with the cytoplasmic extensions from other cells (Figure 5c and d). Immunohistochemistry revealed caveolin-1 expression on the hepatic artery, capillary venules, portal vein in the portal tract, and in the hepatic sinusoidal lining cells around pericentral zone 3 in normal control liver areas (Figure 6a-c). Caveolin-1 remained overexpressed in the endothelial cells of the capillary tufts at the edge of the residual LCH but was reduced in the sclerosed hyaluronic lesion (Figure 6d-f). High expression of caveolin-1 was observed in the endothelial cells of the hemangioma (Figure 6e). Caveolin-1 immunostaining was nearly absent in fibroblasts (Figure 6f).


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)

Immunostaining for caveolin-1 in normal liver areas (a-c) and the lesion (d-f). For the lesion, immunostaining was performed on serial sections continuous with those used in Figure 4. a-c: normal liver areas a: Abundant caveolin-1 reactivities are seen in both the endothelial cells as well as smooth muscle cells in normal areas. P denotes portal tract. C denotes central vein. Bar denotes 154μm. b: Caveolin-1 reactivities are noted on the hepatic artery, capillary venules, and portal vein in the portal tract in normal control liver areas. Arrow heads denote hepatic artery, capillary venules, and portal vein. Bar denotes 32μm. c: Caveolin-1 reactivities are detected in the hepatic sinusoidal lining cells around pericentral zone 3 in normal control liver areas. Arrowheads denotes liver sinusoidal lining cell. Bar denotes 32μm. d-f: lesion. d: Caveolin-1 reactivities are reduced or absent in the hyalinized lesions of sclerosed hemangioma. In residual hemangioma, high expression of caveolin 1 is found in endothelial cells. Caveolin-1 reactivity is almost absent in fibroblasts. Asterisks denote sclerosed portion. Bar denotes 153μm. e: Lesion of liver cavernous hemangioma lesion. Arrowhead denotes endothelial cells. Bar denotes 32μm. f: Lesion of sclerosed hepatic hemangioma. Arrowhead denotes endothelial cell. Bar denotes 32μm. Red rectangles denote the regions seen in 6b or 6c and 6e or 6f, respectively.
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Figure 6: Immunostaining for caveolin-1 in normal liver areas (a-c) and the lesion (d-f). For the lesion, immunostaining was performed on serial sections continuous with those used in Figure 4. a-c: normal liver areas a: Abundant caveolin-1 reactivities are seen in both the endothelial cells as well as smooth muscle cells in normal areas. P denotes portal tract. C denotes central vein. Bar denotes 154μm. b: Caveolin-1 reactivities are noted on the hepatic artery, capillary venules, and portal vein in the portal tract in normal control liver areas. Arrow heads denote hepatic artery, capillary venules, and portal vein. Bar denotes 32μm. c: Caveolin-1 reactivities are detected in the hepatic sinusoidal lining cells around pericentral zone 3 in normal control liver areas. Arrowheads denotes liver sinusoidal lining cell. Bar denotes 32μm. d-f: lesion. d: Caveolin-1 reactivities are reduced or absent in the hyalinized lesions of sclerosed hemangioma. In residual hemangioma, high expression of caveolin 1 is found in endothelial cells. Caveolin-1 reactivity is almost absent in fibroblasts. Asterisks denote sclerosed portion. Bar denotes 153μm. e: Lesion of liver cavernous hemangioma lesion. Arrowhead denotes endothelial cells. Bar denotes 32μm. f: Lesion of sclerosed hepatic hemangioma. Arrowhead denotes endothelial cell. Bar denotes 32μm. Red rectangles denote the regions seen in 6b or 6c and 6e or 6f, respectively.
Mentions: Furthermore, we also observed the tumor by electron microscopy and investigated the expression of caveolin-1 by immunohistochemistry (Additional file 1). On electron micrograph, the tumor appeared to be hyalinized. Cells resembling mast cells or histiocytes, fibroblast-like cells, and remnant endothelial cells were observed (Figure 5a). Remnant endothelial cells contained a few micropinocytic vesicles and caveolae, but numerous cytoplasmic filaments (Figure 5b). We also found residual LCH composed of numerous caverns in various shapes and sizes. The caverns formed a labyrinth, communicating with each other. They were lined by spindle-shaped endothelial cells (Figure 5c). The endothelial cells also contained numerous cytoplasmic filaments (Figure 5d). Moreover, caveolae and multiple micropinocytic vesicles were observed along the luminal and basal cell surfaces. Slender intraluminal processes were also found, sometimes overlapping with the cytoplasmic extensions from other cells (Figure 5c and d). Immunohistochemistry revealed caveolin-1 expression on the hepatic artery, capillary venules, portal vein in the portal tract, and in the hepatic sinusoidal lining cells around pericentral zone 3 in normal control liver areas (Figure 6a-c). Caveolin-1 remained overexpressed in the endothelial cells of the capillary tufts at the edge of the residual LCH but was reduced in the sclerosed hyaluronic lesion (Figure 6d-f). High expression of caveolin-1 was observed in the endothelial cells of the hemangioma (Figure 6e). Caveolin-1 immunostaining was nearly absent in fibroblasts (Figure 6f).

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