Sclerosis of hepatic cavernous hemangioma: CT findings and pathologic correlation

Abstract

We report a case of hepatic cavernous hemangioma with computed tomographic findings of well demarcated nodular lesser attenuation foci within the main low attenuation mass on precontrast scans and non-enhancement of the foci even on the delayed contrast scans. These have been described as one of the atypical findings of cavernous hemangioma earlier in the literature. Surgery proved that sclerosis accounted for the hypodense nodular densities within the hepatic cavernous hemangioma.

Sclerosing hemangioma in the liver

“…In another report, consistent low attenuation on unenhanced and dynamic CT scans and bright high signal intensity on T2 weighted MR images, was pathologically composed of a hyalinized portion 5. It is particularly important that CT appearances of sclerotic nodule in hepatic hemangioma might be confused with other malignant tumors with necrosis 4. However, in our case, there was unenhanced area on delayed phase scan, but it did not present more hypoattenuated area on unenhanced scan nor higher signal intensity areas on T2 weighted MR images, so it was postulated as sclerosing mesenchyma with very slow contrast enhancement, not hyalinized area.…”

“…It has been postulated that central non-opaicified areas might be related to slow blood flow in the central sinusoids, necrosis, fibrosis, central thrombosis, or hemorrhage 4. In another report, consistent low attenuation on unenhanced and dynamic CT scans and bright high signal intensity on T2 weighted MR images, was pathologically composed of a hyalinized portion 5.…”

“…With the typical hemangiomas, imaging modalities are highly reliable for diagnosis, especially MRI, which has a sensitivity and specificity of >90%. However, only about 50% of all hemangiomas show these typical radiological findings 4. The diagnosis of some atypical hemangiomas remains uncertain with an MRI study owing to the presence of intralesional thrombosis or calcified, hyalinized, or cystic components that result in the loss of its characteristic appearance of markedly high signal intensity on heavy T2-weighted imaging and present with atypical enhancement patterns on postenhanced study 5.…”

Sclerosed hemangioma of the liver

“…They can sometimes present different stages of involution. In these cases, radiological findings show atypical features,2 occasionally mimicking malignant lesions 3. The giant size of the tumor and specific symptoms including Kasabach-Merritt syndrome make the diagnosis difficult.…”

Sclerosed hemangioma of the liver: Report of a case and review of the literature

“…A hepatic sclerosed hemangioma is an extremely rare benign disorder, characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma 1 . Because its radiological features resemble those of hepatic malignancies such as cholangiocarcinoma, metastatic liver cancer or fibrolamellar hepatocellular carcinoma, definite preoperative diagnosis is difficult, often resulting in surgical resection 2–9 . We report here a resected case of such a rare hepatic tumor, sclerosed hemangioma, and review the relevant literature.…”