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Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report

RATIONALE: Hemangioma of the liver is a benign hepatic tumor, more common in women than in men, which is typically asymptomatic, solitary, and incidentally discovered. Atypical hemangioma is a variant of hepatic hemangioma with atypical imaging finding features on CT and MRI that can be confused wit...

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Autores principales: Lin, Shengzhang, Zhang, Lele, Li, Mengxia, Cheng, Qiyang, Zhang, Liang, Zheng, Shusen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815745/
https://www.ncbi.nlm.nih.gov/pubmed/29390333
http://dx.doi.org/10.1097/MD.0000000000009192
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author Lin, Shengzhang
Zhang, Lele
Li, Mengxia
Cheng, Qiyang
Zhang, Liang
Zheng, Shusen
author_facet Lin, Shengzhang
Zhang, Lele
Li, Mengxia
Cheng, Qiyang
Zhang, Liang
Zheng, Shusen
author_sort Lin, Shengzhang
collection PubMed
description RATIONALE: Hemangioma of the liver is a benign hepatic tumor, more common in women than in men, which is typically asymptomatic, solitary, and incidentally discovered. Atypical hemangioma is a variant of hepatic hemangioma with atypical imaging finding features on CT and MRI that can be confused with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and mixed hepatocellular cholangiocarcinoma (HCC-CC). PATIENT CONCERNS: We report a case of atypical hepatic hemangioma mimicking HCC-CC: A 59-year-old man was referred to our hospital for a hepatic lesion that was 4.7×3.6 cm in size and located in segments 2 and 3 of the liver. Serum alpha-fetoprotein (AFP) level increased from 17.03 ng/mL to 374.9 ng/mL. The patient was positive for hepatitis B. DIAGNOSES: Atypical hepatic hemangioma. INTERVENTIONS: US, CT, MRI and Tc-99m RBC liver scans were performed. Dynamic contrast-enhanced MRI showed no uptake in the corresponding area during the arterial phase, peripheral nodular enhancement during the portal phase and delayed phase, and hypo-intensity in the central area. An initial diagnosis of HCC-CC was offered based on the history and imaging findings. Finally, percutaneous liver biopsy (PLB) was offered to the patient. Histopathologic examination of the liver lesions revealed nodular cirrhosis and atypical hyperplasia of liver cells with cavernous hemangioma, where numerous old Schistosoma japonicum eggs were found. OUTCOMES: Accurate diagnosis of the patient obviated the need for surgery. The patient's recovery after liver puncture was uneventful, and he was discharged on the seventh post-operative day. LESSONS: In some cases, accurate preoperative imaging of focal hepatic lesions is essential but insufficient for diagnosis. PLB and histopathological examination are important, especially in patients with suspected malignancy.
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spelling pubmed-58157452018-02-28 Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report Lin, Shengzhang Zhang, Lele Li, Mengxia Cheng, Qiyang Zhang, Liang Zheng, Shusen Medicine (Baltimore) 4500 RATIONALE: Hemangioma of the liver is a benign hepatic tumor, more common in women than in men, which is typically asymptomatic, solitary, and incidentally discovered. Atypical hemangioma is a variant of hepatic hemangioma with atypical imaging finding features on CT and MRI that can be confused with hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC) and mixed hepatocellular cholangiocarcinoma (HCC-CC). PATIENT CONCERNS: We report a case of atypical hepatic hemangioma mimicking HCC-CC: A 59-year-old man was referred to our hospital for a hepatic lesion that was 4.7×3.6 cm in size and located in segments 2 and 3 of the liver. Serum alpha-fetoprotein (AFP) level increased from 17.03 ng/mL to 374.9 ng/mL. The patient was positive for hepatitis B. DIAGNOSES: Atypical hepatic hemangioma. INTERVENTIONS: US, CT, MRI and Tc-99m RBC liver scans were performed. Dynamic contrast-enhanced MRI showed no uptake in the corresponding area during the arterial phase, peripheral nodular enhancement during the portal phase and delayed phase, and hypo-intensity in the central area. An initial diagnosis of HCC-CC was offered based on the history and imaging findings. Finally, percutaneous liver biopsy (PLB) was offered to the patient. Histopathologic examination of the liver lesions revealed nodular cirrhosis and atypical hyperplasia of liver cells with cavernous hemangioma, where numerous old Schistosoma japonicum eggs were found. OUTCOMES: Accurate diagnosis of the patient obviated the need for surgery. The patient's recovery after liver puncture was uneventful, and he was discharged on the seventh post-operative day. LESSONS: In some cases, accurate preoperative imaging of focal hepatic lesions is essential but insufficient for diagnosis. PLB and histopathological examination are important, especially in patients with suspected malignancy. Wolters Kluwer Health 2017-12-15 /pmc/articles/PMC5815745/ /pubmed/29390333 http://dx.doi.org/10.1097/MD.0000000000009192 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 4500
Lin, Shengzhang
Zhang, Lele
Li, Mengxia
Cheng, Qiyang
Zhang, Liang
Zheng, Shusen
Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report
title Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report
title_full Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report
title_fullStr Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report
title_full_unstemmed Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report
title_short Atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: Case report
title_sort atypical hemangioma mimicking mixed hepatocellular cholangiocarcinoma: case report
topic 4500
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815745/
https://www.ncbi.nlm.nih.gov/pubmed/29390333
http://dx.doi.org/10.1097/MD.0000000000009192
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