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Wang F, Numata K, Nihonmatsu H, Chuma M, Ideno N, Nozaki A, Ogushi K, Tanab M, Okada M, Luo W, Nakano M, Otani M, Inayama Y, Maeda S. Added Value of Ultrasound-Based Multimodal Imaging to Diagnose Hepatic Sclerosed Hemangioma before Biopsy and Resection. Diagnostics (Basel) 2022; 12:diagnostics12112818. [PMID: 36428878 PMCID: PMC9689571 DOI: 10.3390/diagnostics12112818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Imaging methods have the overwhelming advantage of being non-invasive in the diagnosis of hepatic lesions and, thanks to technical developments in the field of ultrasound (US), radiation exposure can also be avoided in many clinical situations. In particular, contrast-enhanced US (CEUS) outperforms other radiological methods in regard to real-time images, repeatability, and prompt reporting and demonstrates relatively few contraindications and adverse reactions. In this study, we reported in detail a rare benign tumor: hepatic sclerosed hemangioma (HSH). We described US-based multimodal imaging (B-flow imaging, US elastography, and Sonazoid CEUS) features of this HSH case. Furthermore, by summarizing the recently published literature on the imaging diagnosis of HSH, we offered readers comprehensive knowledge of conventional imaging methods (CT, MRI) and CEUS in the diagnosis of HSH and preliminarily discussed their mechanism of pathology-based diagnosis. Our multimodal imaging approach may provide a diagnostic strategy for HSH, thus avoiding unnecessary biopsy or resection.
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Affiliation(s)
- Feiqian Wang
- Ultrasound Department, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an 710061, China
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Kazushi Numata
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
- Correspondence: ; Tel.: +81-45-261-5656 or +81-45-261-9492
| | - Hiromi Nihonmatsu
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Makoto Chuma
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Naomi Ideno
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Akito Nozaki
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Katsuaki Ogushi
- Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Mikiko Tanab
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchi Kami-cho, Itabashi-ku, Tokyo 173-8610, Japan
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Military Medical University, No. 127 Changle West Road, Xi’an 710032, China
| | - Masayuki Nakano
- Tokyo Central Pathology Laboratory, 838-1, Utsukimachi, Hachioji 192-0024, Japan
| | - Masako Otani
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Yoshiaki Inayama
- Division of Diagnostic Pathology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Shin Maeda
- Division of Gastroenterology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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VEGF Pathway Gene Expression Profile of Proliferating versus Involuting Infantile Hemangiomas: Preliminary Evidence and Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060908. [PMID: 35740845 PMCID: PMC9221806 DOI: 10.3390/children9060908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/11/2022] [Accepted: 06/15/2022] [Indexed: 01/23/2023]
Abstract
Background. Infantile hemangiomas may have unexpected behavior. Initial regression (spontaneously or drug-induced) may be followed by unexplained recurrences. At this moment, there are no well-established criteria to predict infantile hemangioma reccurrences. Methods. We compared the VEGF pathway gene expression profile for one case of involuting infantile hemangioma versus one case of recurrent proliferative infantile hemangioma using TaqMan Array. Results. We found ten genes upregulated for both involuting and recurrent proliferative hemangiomas: ACTB, KRAS, MAP2K1, HRAS, NOS3, BAD, HSPB1, HPRT1, GUSB, and CASP9. Thirteen genes were downregulated for both involuting and proliferative hemangiomas: FIGF, ACTG1, GRB2, MAPKAPK2, ACTG2, MAP2K2, MAPK3, HSP90AA1, MAP2K6, NRAS, ACTA1, KDR, and MAPK1. Three genes showed divergent expression between proliferating and involuting hemangiomas. Proliferating hemangioma had MAPK14 and AKT1 gene upregulation and ACTA2 downregulation. Involuting infantile hemangioma was characterized by ACTA2 upregulation and AKT1 and MAPK14 downregulation. Conclusions. Three genes, AKT1, p38/MAPK14, and ACTA2, were found to have divergent expression in proliferating and involuting infantile hemangiomas. Excepting AKT1, which was mentioned in the last ISSVA classification (strictly related to Proteus Syndrome), none of the other genes were reported. An accurate gene expression profile mapping of infantile hemangiomas together with a gene expression-based hemangioma classification is stringently needed.
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Hepatic sclerosed hemangioma and sclerosing cavernous hemangioma: a radiological study. Jpn J Radiol 2021; 39:1059-1068. [PMID: 34041675 PMCID: PMC8568860 DOI: 10.1007/s11604-021-01139-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/17/2021] [Indexed: 12/24/2022]
Abstract
Purpose To investigate and compare the CT and MRI features of hepatic sclerosed hemangioma (HSH) and sclerosing cavernous hemangioma (SCH). Materials and methods Twelve HSH cases and 36 SCH cases were included, the imaging findings on CT (9 HSH and 34 SCH) and MRI (8 HSH and 10 SCH) were analyzed. Qualitative image analysis included the location, size, shape, capsular retraction, density, calcification, signal intensity on T1-weighted image (T1WI) and T2-weighted image (T2WI), presence of diffusion restriction, apparent diffusion coefficient (ADC) map, transient hepatic attenuation difference around the lesion, and the dynamic enhancement patterns. Results The presence of liver cirrhosis in patients with HSH (3/12) was higher than SCH (1/36) (P = 0.043). The morphology appearance before enhancement showed no significant difference between HSH and SCH. Moreover, SCH had a stronger trend of centripetal enhancement patterns of cavernous hemangiomas (83.3%) compared to HSH (25%) (P < 0.001). Due to more frequent atypical enhancement features, containing rim-like enhancement, no enhancement, and peripheral heterogeneous enhancement, the misdiagnosis rate of HSH (75%) was significantly higher than that of SCH (16.7%) (P < 0.001). Furthermore, the ADC values of HSH and SCH were both higher than that of the surrounding liver parenchyma (P = 0.009, P = 0.002); however, there was no significant difference in ADC values between themselves (P = 0.613). Conclusion SCH showed the same trend of centripetal enhancement characteristics as typical hemangioma, while HSH exhibited atypical enhancement features due to complete sclerosis. Higher ADC values might contribute to the identification of atypical HSH and SCH from malignancies.
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Kim YY, Kang TW, Cha DI, Min JH, Kim YK, Kim SH, Sinn DH, Won H, Kim S. Gadoxetic acid-enhanced MRI for differentiating hepatic sclerosing hemangioma from malignant tumor. Eur J Radiol 2020; 135:109474. [PMID: 33352374 DOI: 10.1016/j.ejrad.2020.109474] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND To investigate the imaging features of gadoxetic acid-enhanced magnetic resonance imaging (MRI) to differentiate hepatic sclerosing hemangioma from malignant tumors. METHODS This retrospective case-control study included 18 patients with sclerosing hemangioma and 54 patients with common hepatic malignant tumor, including hepatocellular carcinoma, metastatic adenocarcinoma, and cholangiocarcinoma, who were examined using gadoxetic acid-enhanced liver MRI from January 2008 to June 2019. Imaging features including signal intensity, tumor margins, enhancement pattern, and presence or absence of diffusion restriction were analyzed. Significant MRI features for predicting sclerosing hemangioma were identified using multivariable logistic regression analysis. Diagnostic performances of each imaging feature and combinations of significant imaging features were summarized. RESULTS In the multivariable analysis, irregular margins (odds ratio [OR], 10.12; 95 % confidence interval [CI], 1.27-80.94; p = 0.029), centripetal or internal nodular enhancement in the transitional phase (OR, 13.58; 95 % CI, 1.48-124.82; p = 0.021), and absence of diffusion restriction (OR, 39.20; 95 % CI, 4.82-318.49; p = 0.001) were significant imaging features for the diagnosis of sclerosing hemangioma. Presence of at least two significant imaging features had a sensitivity, specificity, and accuracy of 88.9 %, 96.3 %, and 94.4 %, respectively, for diagnosing sclerosing hemangioma. CONCLUSION Combinations of two or more of the significant imaging features (irregular margins, centripetal or internal nodular enhancement in the transitional phase, and absence of diffusion restriction) were effective for differentiating hepatic sclerosing hemangioma from malignant tumors using gadoxetic acid-enhanced MRI.
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Affiliation(s)
- Yeun-Yoon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong Ik Cha
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Young Kon Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Seong Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Hojeong Won
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea.
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Akahoshi S, Yamamura K, Sato N, Oda E, Kinoshita K, Yuki H, Motohara T, Deguchi A, Komohara Y, Beppu T. A hepatic sclerosed hemangioma with drastic changes in contrast-enhanced ultrasonography. Clin J Gastroenterol 2020; 13:1252-1257. [PMID: 32705537 DOI: 10.1007/s12328-020-01194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/12/2020] [Indexed: 10/23/2022]
Abstract
Hepatic sclerosed hemangioma is a rare benign liver tumor that originated from hepatic cavernous hemangioma; however, the process of its formation has been unclear. We herein present the patient of a histologically proven hepatic sclerosed hemangioma that showed drastic changes in diagnostic images in a short period. A 56-year-old man was referred to our hospital for the treatment of suspicious hepatocellular carcinoma with hepatitis C, approximately 2 cm in diameter in liver segment 8. Initially, the tumor manifested as early entire enhancement with mildly delayed washout in contrast-enhanced ultrasonography; however, it manifested as continuous peripheral enhancement with the central non-enhanced area after 1 month in various diagnostic images. He completely quit drinking and smoking 1 month preoperatively. No special symptoms and signs were found to suggest tumor ischemia. Anatomical resection of segment 8 was completed. Histological examination confirmed the final diagnosis of common type hepatic sclerosed hemangioma, derived from atypically enhancing cavernous hemangioma. No signs of impaired blood flow were observed in both diagnostic images and histological examination. Sclerosing changes in hepatic cavernous hemangioma may be completed in a relatively short time with no apparent reason.
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Affiliation(s)
- Shinichi Akahoshi
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan.
| | - Kensuke Yamamura
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Nobutaka Sato
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Eri Oda
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Koichi Kinoshita
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Hideaki Yuki
- Department of Radiology, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Toshihiko Motohara
- Department of Gastroenterology, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
| | - Akihiro Deguchi
- Department of Internal Medicine, Kagawa Rosai Hospital, 3-3-1 Jyoto, Marugame, Kagawa, 763‑8502, Japan
| | - Yoshihiro Komohara
- Department of Cell Pathology, Graduate School of Life Sciences, Kumamoto University, 1-1-1, honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Toru Beppu
- Department of Surgery, Yamaga City Medical Center, 511 Yamaga, Kumamoto, 861-0593, Japan
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Xu L, Yang X, Ke S, Ding XM, Wang SH, Gao J, Sun WB. Resection as first-line therapy for large hepatic sclerosing hemangioma: a case report. Onco Targets Ther 2019; 12:6839-6842. [PMID: 31692527 PMCID: PMC6710544 DOI: 10.2147/ott.s217528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
Abstract
Hepatic sclerosing hemangioma is a rare benign disease that occurs in association with hepatic cavernous hemangioma degeneration and sclerosis. Recent studies have shown that radiofrequency (RF) ablation is an alternative treatment for hepatic cavernous hemangiomas, even for large hemangiomas (≥10 cm). However, RF ablation might not be suitable to treat large sclerosing hemangiomas. We herein report the successful surgical removal of a large hepatic sclerosing hemangioma after RF ablation treatment failure in a 65-year-old man. In conclusion, we suggest that resection should be chosen as a first-line therapy for the disease.
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Affiliation(s)
- Li Xu
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
| | - Xu Yang
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
| | - Shan Ke
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
| | - Xue-Mei Ding
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
| | - Shao-Hong Wang
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
| | - Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
| | - Wen-Bing Sun
- Department of Hepatobiliary Surgery, Beijing Chao-yang Hospital Affiliated with Capital Medical University, Beijing 100043, People's Republic of China
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Differentiation of Hepatic Sclerosed Hemangiomas From Cavernous Hemangiomas Based on Gadoxetic Acid-Enhanced Magnetic Resonance Imaging Features. J Comput Assist Tomogr 2019; 43:762-769. [PMID: 31356526 DOI: 10.1097/rct.0000000000000905] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the imaging features of a hepatic sclerosed hemangioma by comparing them with those of a cavernous hemangioma using magnetic resonance imaging with gadoxetic acid enhancement. METHODS Nine patients with hepatic sclerosed hemangiomas and 36 patients with cavernous hemangiomas (control group) who underwent gadoxetic acid-enhanced magnetic resonance imaging were included. Qualitative values (imaging findings and enhancement pattern [typical vs atypical enhancement]) and quantitative values (apparent diffusion coefficient) were evaluated. RESULTS Patients with sclerosed hemangiomas showed significantly more irregular tumor margin on hepatobiliary phase images, peritumoral arterial enhancement, and a lower proportion of hyperintensity on heavily T2-weighted images compared with controls (all P values <0.05). In addition, the sclerosed hemangioma group had significantly more frequent atypical enhancement patterns than did the control group (88.9% vs 33.3%; P = 0.006). However, the mean apparent diffusion coefficient value of hemangiomas was not significantly different between the 2 groups (P = 0.639). CONCLUSIONS Gadoxetic acid-enhanced magnetic resonance images can help in differentiating between hepatic sclerosed hemangiomas and cavernous hemangiomas.
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Hepatic Sclerosing Hemangioma with Predominance of the Sclerosed Area Mimicking a Biliary Cystadenocarcinoma. Case Reports Hepatol 2018; 2018:7353170. [PMID: 30402303 PMCID: PMC6193354 DOI: 10.1155/2018/7353170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/22/2018] [Accepted: 09/20/2018] [Indexed: 11/18/2022] Open
Abstract
We report here an extremely rare case of hepatic sclerosing hemangioma mimicking a biliary cystadenocarcinoma. A previously healthy 39-year-old woman was referred to our hospital because of a large tumor in the liver. Abdominal computed tomography revealed early peripheral ring enhancement in the arterial phase and slight internal heterogeneous enhancement in the delayed phase. Magnetic resonance imaging revealed a tumor with low intensity in the T1-weighted image and very high intensity in the fat-saturated T2-weighted image. The patient underwent hepatectomy for a possible malignant liver tumor. Grossly, the tumor appeared as a white, solid, and cystic mass (weighted 1.1 kg and measured 170×100×80 mm) that was elastic, soft, and homogeneous with a yellowish area. Histological examination showed that the tumor mostly consisted of fibrotic areas with hyalinization. The typical histology of cavernous hemangioma was confirmed in part, and the tumor was diagnosed as a sclerosing hemangioma with predominancy of the sclerosed area. A review of 20 cases reported previously revealed that only 2 (10%) patients were diagnosed as having sclerosing hemangioma preoperatively.
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Utility of contrast-enhanced ultrasonography with perflubutane in evaluating indications for diagnostic percutaneous tumor biopsy in a case of hepatic sclerosed hemangioma. Clin J Gastroenterol 2018; 11:514-520. [DOI: 10.1007/s12328-018-0880-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 12/14/2022]
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Nunes LMAO, de Mello-Amoedo CD, Yamauchi FI, Baroni RH. Atypical hepatic hemangioma: imaging features of hyalinized hemangioma. EINSTEIN-SAO PAULO 2018; 16:eAI4256. [PMID: 29898024 PMCID: PMC5995546 DOI: 10.1590/s1679-45082018ai4256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/06/2018] [Indexed: 11/22/2022] Open
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Ozaki K, Yoshikawa J, Yamamoto T, Maeda K, Kaizaki Y. Preoperative diagnosis of the sclerosed hemangioma of the liver using multimodality imaging findings: A case report. Radiol Case Rep 2018; 13:1025-1029. [PMID: 30228837 PMCID: PMC6137339 DOI: 10.1016/j.radcr.2018.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/01/2018] [Indexed: 11/13/2022] Open
Abstract
A sclerosed hemangioma of the liver is a rare benign lesion characterized by fibrosis and hyalinization of a hepatic cavernous hemangioma as a result of degeneration. This condition has been difficult to correctly diagnose with imaging. Our patient was a 57-year-old man whose computed tomography (CT) scan showed a mass of 45 mm in diameter in the lateral segment. On dynamic contrast-enhanced CT, the lesion was found to comprise peripheral, gradual, and heterogeneous enhanced areas with a central nonenhanced area; malignancy was suspected. On magnetic resonance imaging, the peripheral area showed slight hperintensity on T2-weighted image, and showed a similar intensity on T1- and diffusion-weighted images as compared to the background liver and gradual enhancement, and the presence of abundant fibrous tissue was suspected. Conversely, the central area showed remarkable hyperintensity on T2-weighted images and no enhancement, and degeneration or hyalinization was suspected. The mass showed no uptake of fluorine-18 fludeoxyglucose (FDG). Some imaging findings suspected a benign tumor, and sclerosed hemangioma with abundant fibrosis and hyalinization was pathologically confirmed. Herein, we report a case of sclerosed hemangioma focusing on possible preoperative diagnosis using a combination of multimodality imaging findings—diffusion-weighted imaging and FDG-positron emission tomography imaging.
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Affiliation(s)
- Kumi Ozaki
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Jun Yoshikawa
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Toru Yamamoto
- Department of Radiology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Kazuya Maeda
- Department of Surgery, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
| | - Yasuharu Kaizaki
- Department of Pathology, Fukui Prefectural Hospital, 2-8-1 Yotsui, Fukui 910-8526, Japan
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Peritumoral Hyperplasia in Hepatic Sclerosed Hemangioma. ACG Case Rep J 2017; 4:e61. [PMID: 28462238 PMCID: PMC5407361 DOI: 10.14309/crj.2017.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 03/15/2017] [Indexed: 11/17/2022] Open
Abstract
Peritumoral hyperplasia (PTH) is a hyperplastic lesion located around hypervascular tumors. Hepatic sclerosed hemangioma is a very rare form of hemangioma with sclerotic changes and is distinct from sclerosing hemangioma. We present a patient with non-alcoholic steatohepatitis-induced cirrhosis who presented with a hypervascular tumor. The tumor showed atypical findings of hemangioma and was treated with surgical resection because hepatic malignancy could not be ruled out. Histopathologic examination revealed the tumor was a sclerosed hemangioma with PTH. Lesions with carcinogenic potential were found in the PTH lesion. Sclerosed hemangioma should be observed and managed carefully.
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Yuki M, Emoto Y, Kinoshita Y, Yoshizawa K, Yuri T, Tsubura A. Sclerosed Hemangioma Accompanied by Multiple Cavernous Hemangiomas of the Liver. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:401-5. [PMID: 26116763 PMCID: PMC4485642 DOI: 10.12659/ajcr.893934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND A sclerosed hemangioma of the liver, an extremely rare type of benign hepatic tumor, was found at autopsy. CASE REPORT An 81-year-old Japanese man was admitted to our hospital for surgical resection of squamous cell carcinoma of the skin in his left forearm. At admission, serological tests for hepatitis B surface antigen and hepatitis C antibody were negative with no evidence of cirrhosis. At 2, 3, and 5 months after the removal of the forearm tumor, skin grafting was performed because of unhealed skin ulceration. Although anti-bacterial drugs were prescribed, the patient died after the 3rd skin graft (5 months after the surgery) because of pneumonia. During the treatment course, the patient was diagnosed as having multiple liver masses suspected to be cysts of the liver based on non-contrasted computed tomography results. Autopsy revealed a sclerosed hemangioma occupying the entire left lobe accompanied by multiple small cavernous hemangiomas in the right lobe of the liver. CONCLUSIONS Sclerosed hemangioma, a rare benign disease, occurred in association with degeneration and sclerosis of cavernous hemangiomas of the liver. The VEGF pathway may be involved in the genesis of cavernous and sclerosed hemangioma of the liver.
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Affiliation(s)
- Michiko Yuki
- Department of Pathology II, Kansai Medical University, hirakata, Osaka, Japan
| | - Yuko Emoto
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yuichi Kinoshita
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Katsuhiko Yoshizawa
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takashi Yuri
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
| | - Airo Tsubura
- Department of Pathology II, Kansai Medical University, Hirakata, Osaka, Japan
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Miyamoto S, Oshita A, Daimaru Y, Sasaki M, Ohdan H, Nakamitsu A. Hepatic Sclerosed Hemangioma: a case report and review of the literature. BMC Surg 2015; 15:45. [PMID: 25927893 PMCID: PMC4428228 DOI: 10.1186/s12893-015-0029-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 03/28/2015] [Indexed: 12/02/2022] Open
Abstract
Background Although cavernous hemangioma is one of the most frequently encountered benign hepatic neoplasms, hepatic sclerosed hemangioma is very rare. We report a case of hepatic sclerosed hemangioma that was difficult to distinguish from an intrahepatic cholangiocarcinoma by imaging studies. Case presentation A 76-year-old male patient with right hypochondralgia was referred to our hospital. Abdominal ultrasonography revealed a heterogeneously hyperechoic tumor that was 59 mm in diameter in segment 7 of the liver. Dynamic computed tomography showed a low-density tumor with delayed ring enhancement. Gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) demonstrated a low-signal intensity mass with ring enhancement on T1-weighted images. The mass had several high-signal intensity lesions on T2-weighted images. EOB-MRI revealed a hypointense nodule on the hepatobiliary phase. From these imaging studies, the tumor was diagnosed as intrahepatic cholangiocarcinoma, and we performed laparoscopy-assisted posterior sectionectomy of the liver with lymph node dissection in the hepatoduodenal ligament. Histopathological examination revealed a hepatic sclerosed hemangioma with hyalinized tissue and collagen fibers. Conclusion Hepatic sclerosed hemangioma is difficult to diagnose preoperatively because of its various imaging findings. We report a case of hepatic sclerosed hemangioma and review the literatures, especially those concerning imaging findings.
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Affiliation(s)
- Shunsuke Miyamoto
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3, Jigozen, 738-8503,, Hatsukaichi, Japan
| | - Akihiko Oshita
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3, Jigozen, 738-8503,, Hatsukaichi, Japan. .,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Yutaka Daimaru
- Department of Pathology, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Masaru Sasaki
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3, Jigozen, 738-8503,, Hatsukaichi, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsushi Nakamitsu
- Department of Surgery, JA Hiroshima General Hospital, 1-3-3, Jigozen, 738-8503,, Hatsukaichi, Japan
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Wakasugi M, Ueshima S, Tei M, Tori M, Yoshida KI, Tsujimoto M, Akamatsu H. Multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor successfully treated by laparoscopic surgery: Report of a case. Int J Surg Case Rep 2015; 8C:137-40. [PMID: 25679307 PMCID: PMC4353964 DOI: 10.1016/j.ijscr.2015.01.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/20/2015] [Indexed: 01/08/2023] Open
Abstract
Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors. This report is the first to describe multiple hepatic sclerosing hemangiomas treated by laparoscopic surgery.
Introduction Hepatic sclerosing hemangioma is a very rare benign tumor, characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. We report here a rare case of multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor that was successfully treated using laparoscopic surgery. Presentation of case A 67-year-old woman with multiple liver tumors underwent single-incision laparoscopic sigmoidectomy under a diagnosis of advanced sigmoid cancer with multiple liver metastases. Examination of surgical specimens of sigmoid colon revealed moderately differentiated adenocarcinoma invading the serosa, and no lymph node metastases. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 remained within normal limits throughout the course. Two months after sigmoidectomy, the patient underwent laparoscopic partial hepatectomy of S1 and S6 of the liver and cholecystectomy. Histopathological examination showed that the tumors mainly comprised hyalinized tissue and collagen fibers with sporadic vascular spaces on hematoxylin and eosin-stained sections, yielding a diagnosis of multiple hepatic sclerosing hemangioma. No evidence of recurrence has been seen as of 21 months postoperatively. Discussion Differentiating multiple sclerosing hemangiomas from metastatic liver tumors was quite difficult because the radiological findings were closely compatible with liver metastases. Laroscopic hepatectomy provided less blood loss, a shorter duration of hospitalization, and good cosmetic results. Conclusion Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors.
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Affiliation(s)
| | | | - Mitsuyoshi Tei
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Masayuki Tori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
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