Anastomosing hemangioma of liver

Abstract

Anastomosing hemangiomas are a rare subtype of benign vascular hemangioma which most commonly arise in the genitourinary tract and retroperitoneum. In only a small number of reports has this entity been shown originating within the liver parenchyma. Despite their benign behavior, on contrast-enhanced computer tomography and magnetic resonance imaging studies anastomosing hemangiomas can demonstrate enhancement characteristics similar to primary and metastatic liver lesions. This case report highlights the imaging features of this entity and provides a brief review of the limited literature that exists on this rare hepatic lesion.

Keywords: Anastomosing hemangioma; CT; Hepatic small vessel neoplasm; Liver; MRI; US.

Figure 1

56 year-old man with hepatic anastomosing hemangioma on noncontrast CT. Findings: Axial (1A) and Coronal (1B) noncontrast CT images of a homogenously hypoattenuating lesion (white arrows) with somewhat ill-defined margins within hepatic segment VII. No additional lesions were seen within the liver. Technique: Toshiba Aquilion PRIME, Scan mode - Helical, Slice thickness - 5mm, mA - 110, kVp - 120, Pitch - 0.81.

Figure 2

56 year-old man with hepatic anastomosing hemangioma on ultrasound. Findings: Transverse (2A) ultrasound images of a centrally isoechoic peripherally hypoechoic lesion (white arrows) within hepatic segment VII. Doppler interrogation (2B) demonstrates a feeding vessel within the periphery of the lesion (arrowhead). Technique: Toshiba Aplio 500, Transducer - 6Cs1.

Figure 3

56 year-old man with hepatic anastomosing hemangioma on contrast-enhanced MRI. 3A: Findings: Axial T2-weighted image with fat-suppression shows a rounded well-circumscribed homogenously hyperintense mass in hepatic segment VII (white arrow). No additional liver lesions were identified. Technique: 3.0 Tesla MRI (Philips Medical Systems Achieva), TR - 1264, TE - 70, Slice thickness - 7.5 mm. 3B: Findings: Axial T1-weighted image without fat-suppression shows a rounded well-circumscribed homogenously hypointense mass in hepatic segment VII (white arrow). Technique: 3.0 Tesla MRI (Philips Medical Systems Achieva), TR - 10, TE - 2.3, Slice thickness - 7.5 mm. 3C–D: Findings: Coronal (3C) and Axial (3D) arterial phase post-contrast T1-weighted image with fat-suppression shows rounded well-circumscribed homogenous intense enhancement within the segment VII mass (white arrows). Technique: 3.0 Tesla MRI (Philips Medical Systems Achieva), TR - 2.69, TE - 1.34, Slice thickness - 3.5 mm, Contrast agent - ProHance (Gadoteridol) 0.2 mL/kg. 3E–F: Findings: Axial T1-weighted post-contrast images in the portal venous phase (3E) and 8-minute delayed phase (3F) demonstrate persistent intense homogenous enhancement without washout (white arrows). Technique: 3.0 Tesla MRI (Philips Medical Systems Achieva), TR - 2.69, TE - 1.34, Slice thickness - 3.5 mm, Contrast agent - ProHance (Gadoteridol) 0.2 mL/kg.

Figure 4

Histopathology findings of hepatic anastomosing hemangioma in a 56 year-old man. 4A: Findings: H&E sections (magnification: 200X) showed a circumscribed proliferation of small and thin-walled vascular spaces with hobnailed endothelial cells. No cytologic atypia or mitotic activity was seen. 4B: Findings: Immunohistochemistry (magnification: 200X) for CD34 shows strong, diffuse staining.