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Case Reports
. 2025 Mar 17;17(3):e80738.
doi: 10.7759/cureus.80738. eCollection 2025 Mar.

Diagnostic Pitfalls of Hepatic Sclerosed Hemangiomas: A Case Report

Hiroshi Takihara  1   2 , Shoji Oura  3 , Hiroshi Shintani  3 , Hiroto Tanaka  2
Affiliations
Case Reports

Diagnostic Pitfalls of Hepatic Sclerosed Hemangiomas: A Case Report

Hiroshi Takihara et al. Cureus. .

Abstract

An 81-year-old man was found to have a liver mass on an annual medical checkup. Enhanced CT of the mass, 3.8 cm in size, showed weak enhancement with a small non-enhanced oval area near the mass borders. Ultrasound showed an oval mass with internal iso-echoes. Magnetic resonance imaging (MRI) showed that the mass had low and slightly high signal intensities on T1- and T2-weighted images, respectively. MRI of the small non-enhanced area on CT showed high signal intensity both on T1- and T2-weighted images, suggesting focal subacute bleeding. In addition to these image findings, elevated serum α-fetoprotein (AFP) and lectin-reactive fraction of AFP levels made us resect the liver mass without performing a biopsy to the tumor under the tentative diagnosis of possible hepatic malignancy. A postoperative pathological study showed that the mass had massive scar tissue with hemorrhage, lymphocytes, hemosiderin-laden macrophages, and multiple vascular structures, leading to the diagnosis of a hepatic sclerosed hemangioma (HSH). Why this case showed high tumor marker levels remains uncertain. The patient showed normal tumor marker levels shortly after surgery and has been well for 40 months without any problems. Diagnostic physicians should note that HSHs can present very similar image findings to those of intra-hepatic cholangiocarcinomas.

Keywords: hepatic sclerosed hematoma; pet; sclerosing cavernous hemangioma; subacute bleeding; tumor marker elevation.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Computed tomography (CT) findings
A. CT showed an oval mass (arrow) with a slightly lower CT Hounsfield Unit value compared to that of the surrounding liver parenchyma. B. CT showed a weak enhancement predominantly in the mass margins (arrows) and a small part with no enhancement (arrowhead) on the early arterial phase. C. CT showed a washout pattern (arrows) and a clearly demarcated non-enhancement small area (arrowhead) on the late arterial phase. D. CT showed a retained slight rim enhancement (arrows) and a non-enhancement area (arrowhead) on the portal phase.
Figure 2
Figure 2. Ultrasound findings
Ultrasound showed a round mass with enhanced posterior echoes (A, arrows), blood flow around the mass, and no blood inflow to the mass (B).
Figure 3
Figure 3. Magnetic resonance image (MRI) findings
A. T1-weighted images showed that the mass showed low signal intensity (arrowheads) and had a small high-signal intensity area (arrow) in the mass borders. B. T2-weighted images showed that the mass showed slightly high signal intensity (arrowheads) and had a small high-signal intensity area encircled by a very low signal intensity ring (dashed arrow). C. T1-weighted images 31 seconds after the contrast medium injection showed a weak rim enhancement (arrowheads) and contrast effect directing toward the inside of the tumor (dashed arrow). D. T1-weighted images 120 seconds after the contrast medium injection still showed a weak rim enhancement (arrowheads) and a slight intra-tumoral enhancement (dashed arrow).
Figure 4
Figure 4. Pathological findings
A. Low-magnification view showed an oval scar tissue (arrowheads) and bleeding (arrow) in the scar. B. Magnified view showed bleeding (asterisk) in the scar. C. Magnified view showed multiple hemosiderin-laden macrophages (brownish cells) and lymphocytes. D. Small vessels (arrows) were observed in the scar tissue.
See this image and copyright information in PMC

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