Sclerosing Hepatic Hemangioma Can Be Difficult to Differentiate from Liver Metastasis of Rectal Cancer: A Case Report.

Abstract

Introduction: Sclerosing hepatic hemangiomas are a rare form of cavernous hemangioma, reported in 0.2% of autopsy cases. Preoperative diagnosis is difficult because of the variety of imaging findings. Herein, we report a case of hepatic sclerosing hemangioma that was difficult to differentiate from a liver metastasis of rectal cancer.

Case presentation: A 67-year-old man visited our hospital with a chief complaint of bleeding during defecation, and a colonoscopy revealed advanced rectal cancer. A dynamic contrast-enhanced magnetic resonance imaging (MRI) showed a 15 mm-sized tumor in S7 of the liver. In the arterial phase, the tumor interior showed low signal intensity, and the tumor margins were enhanced. The tumor interior was gradually stained from portal to equilibrium phases. Partial S7 resection was performed for liver metastasis from rectal cancer. Hematoxylin and Eosin staining revealed flattened endothelial cells with poor atypia that formed a lumen. Immunohistochemical staining was positive for CD31 and CD34, and the final diagnosis was sclerosing hemangioma.

Conclusion: Although a rare tumor, hepatic sclerosing hemangioma should always be considered as a differential diagnosis for liver tumors. If the diagnosis is difficult to make and malignancy cannot be ruled out, resection may be indicated as a diagnostic treatment.