Multiple hepatic sclerosing hemangiomas mimicking malignant lesions, a diagnostic dilemma: case report and literature review.

Abstract

Objectives: Hepatic sclerosing hemangioma (SH) is a rare benign liver lesion that poses a significant diagnostic challenge due to its ability to mimic malignant hepatic tumors on imaging.

Case presentation: We report the case of a 67-year-old woman with diabetes, hypertension, and chronic kidney disease who presented with incidental liver lesions discovered during the workup of elevated alkaline phosphatase. Cross-sectional imaging, including MRI and PET-FDG, revealed multiple atypical hypodense hepatic lesions with perihilar biliary obstruction, initially raising concern for cholangiocarcinoma. Multiple tissue biopsies including Spyglass-guided and percutaneous attempts were non-diagnostic, and the clinical suspicion of malignancy persisted. Diagnostic laparoscopy and targeted incisional biopsy ultimately confirmed the diagnosis of sclerosing hemangioma. The patient underwent laparoscopic wedge resection and has remained well on follow-up for more than two years.

Conclusions: This case highlights the importance of maintaining a broad differential diagnosis in the evaluation of atypical hepatic lesions, the limitations of radiological findings, and the value of a stepwise multidisciplinary approach in avoiding unnecessary major resections. A focused review of the literature supports the rarity of this entity and emphasizes the need for tissue diagnosis in ambiguous cases.