Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review

Abstract

Background: Hepatic lymphangioma, a malformation of the liver lymphatic system, is a rare benign neoplasm and usually coexists with other visceral lymphangiomas. Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy.

Case summary: A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with, including Schistosome japonicum infection and jaundice, and also together with imaging results, which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase. The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation. Finally, the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation. The pathological examination indicated the mass as hepatic lymphangioma. The patient has been followed up for 30 mo without recurrence. To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future, we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms, imaging presentation, operative techniques, histology features and prognosis.

Conclusion: Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult. Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.

Keywords: Adult; Case report; Hepatic lymphangioma; Hepatocellular carcinoma; Laparoscopic hepatectomy; Trans-arterial chemoembolization.

Figure 1

Contrast-enhanced computed tomography scan of the patient before receiving transarterial chemoembolization. A: The mass was enhanced immediately during the arterial phase; B: The enhancement faded away quickly into equal density in the portal venous phase; C: The mass showed hypodensity in the delayed phase. The three phases of the computed tomography scan also showed multiple gallstones and splenomegaly.

Figure 2

Contrast-enhanced computed tomography scan of the patient after first transarterial chemoembolization. A: Iodized oil deposition in the tumor was observed in the arterial phase; B: Portal venous phase; C: Delayed phase.

Figure 3

The specimen was examined under microscopy (40 ×). A: The mass was made of dilated-cystic lymphatic lumens lined by endothelium; B: Filled with acidophilic lymph.