A unique intersection: Exploring an exophytic, pedunculated hepatic hemangioma with gastric connection in a case report

Abstract

Hepatic hemangiomas are commonly benign liver tumors, typically asymptomatic and predominantly located in the right lobe. This case report details an exceptional instance of a left-lobe hepatic hemangioma manifesting as an exophytic, pedunculated mass resembling a gastric tumor. A 77-year-old woman with a history of melanoma presented with a mass incidentally discovered during evaluations for chest pain. Advanced imaging techniques, including computed tomography (CT) and endoscopic ultrasound (EUS), identified this mass as a benign, pedunculated hemangioma extending from the left hepatic lobe toward the gastric fundus. Given the tumor's benign nature and the patient's lack of symptoms, a conservative management approach was adopted. This case emphasizes the importance of accurate imaging and diagnostic assessment in managing atypical hepatic hemangiomas, highlighting the need to carefully consider rare growth patterns and locations in differential diagnoses to avoid unnecessary interventions. Such cases reinforce the complexity of diagnosing and managing unusual presentations of common benign tumors.

Keywords: Conservative management; Diagnostic imaging; Endoscopic ultrasound; Exophytic growth; Hepatic hemangioma; Left hepatic lobe; Nuclear medicine; Pedunculated hemangioma; Submucosal gastric mass.

Fig. 1

CTA demonstrating mass (red arrow) between the liver and stomach.

Fig. 2

Black arrows demonstrating submucosal gastric mass seen on EGD.

Fig. 3

Red arrow demonstrating smooth, oval, homogenous, hypoechoic area in the gastric fundus during EUS.

Fig. 4

Axial nuclear medicine liver scan with vascular flow, white arrow demonstrating localization of the mass to the left hepatic lobe with vascular flow, strongly suggesting a hemangioma.

Fig. 5

Microphotographs of hematoxylin and eosin slides showing the proliferation of variably sized, dilated, thin-walled blood vessels lined by a single layer of flat endothelial cells. No cytologic atypia or mitosis is seen.

Fig. 6

ERG immunostaining (left) and CD31 immunostaining (right) highlighting the endothelial differentiation.