Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case

Abstract

Introduction: Hepatic sclerosing hemangioma is a very rare benign tumor, characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. We report here a rare case of multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor that was successfully treated using laparoscopic surgery.

Presentation of case: A 67-year-old woman with multiple liver tumors underwent single-incision laparoscopic sigmoidectomy under a diagnosis of advanced sigmoid cancer with multiple liver metastases. Examination of surgical specimens of sigmoid colon revealed moderately differentiated adenocarcinoma invading the serosa, and no lymph node metastases. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 remained within normal limits throughout the course. Two months after sigmoidectomy, the patient underwent laparoscopic partial hepatectomy of S1 and S6 of the liver and cholecystectomy. Histopathological examination showed that the tumors mainly comprised hyalinized tissue and collagen fibers with sporadic vascular spaces on hematoxylin and eosin-stained sections, yielding a diagnosis of multiple hepatic sclerosing hemangioma. No evidence of recurrence has been seen as of 21 months postoperatively.

Discussion: Differentiating multiple sclerosing hemangiomas from metastatic liver tumors was quite difficult because the radiological findings were closely compatible with liver metastases. Laroscopic hepatectomy provided less blood loss, a shorter duration of hospitalization, and good cosmetic results.

Conclusion: Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors.

Keywords: Hepatic sclerosing hemangioma; Laparoscopic liver resection; Metastatic liver tumor.

Fig. 1

Imaging results. (a) Computed tomography shows a ring-enhancing 28-mm exophytic lesion (arrowhead) arising from S6 of the liver. GB, gallbladder. (b) Contrast-enhanced magnetic resonance imaging shows a signal-hypointense mass in S6. A similar small nodule (arrow) is apparent in S1.

Fig. 2

Port site for laparoscopic surgery.

Fig. 3

Intraoperative laparoscopic observation. Two well-demarcated, white tumors are apparent on the surface of S6 (a) and S1 (b).

Fig. 4

Pathological examination. The tumors mainly comprise hyalinized tissue and collagen fibers with sporadic vascular spaces on sections stained with hematoxylin and eosin.