Two hepatic cavernous hemangiomas mimicking colorectal liver metastasis: A rare case report

INTRODUCTION: Hepatic cavernous hemangioma (HCH) is a common benign lesion of the liver. The radiological features of HCH can resemble those of hepatic malignancies such as metastatic liver cancer, which make the preoperative definitive diagnosis difficult. PRESENTATION OF CASE: We report the case of a 77-year-old woman who presented with a 2-month history of abdominal pain and per rectum fresh bleeding. The initial diagnosis at the referral hospital, based on computed tomography (CT) scan of the chest, abdomen, and pelvis, was sigmoid colon cancer with liver metastasis. Further evaluation at our hospital, the patient underwent colonoscopy and biopsy. Histopathological examination of the biopsy revealed an invasive moderately differentiated adenocarcinoma. The patient underwent laparoscopic sigmoidectomy and left hepatectomy. The histopathological examination of the sigmoid colon mass revealed an invasive moderately to poorly differentiated adenocarcinoma. One out of twenty lymph nodes is positive for metastatic carcinoma. The pathological stage is pT3, pN1a, pM0. The histopathological examination of the left hepatic lobe revealed two hyalinized cavernous hemangiomas with no malignancy is seen. The postoperative recovery was uneventful, and the patient was discharged home with regular follow-up in our outpatient clinic. DISCUSSION: HCH is congenital vascular malformation and is the most common benign hepatic tumors. Fine-needle biopsy during diagnostic laparoscopy for undiagnosed multiple liver tumor can differentiate atypical HCH from colorectal metastasis but can potentially lead to rupture or seeding of cancer cells. CONCLUSION: Surgical resection is necessary to determine if the mass is malignant in some atypical HCH mimicking liver metastasis to confirm the diagnosis with histopathologic examination.