A Case of Sclerosed Hemangioma Mimicking Intrahepatic Cholangiocarcinoma / 대한소화기학회지

Hemangioma is one of the most frequently encountered benign hepatic neoplasm which can develop secondary degeneration. Sclerosed hemangioma is a rare disease histologically characterized by large amount of collagen and elastic fibril between sclerosed small vessels. Its differential diagnosis is very difficult. It should be included in the differential diagnosis of other hepatic lesions such as hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic hepatic tumor. A 77-year old male was admitted with upper abdominal discomfort. Abdominal ultrasonography revealed GB stone, dilated common bile duct with bile duct stone, and a 4.6 cm sized hyperechoic mass at segment 5 and 6 of the liver. Abdominal dynamic computed tomography demonstrated dilated intrahepatic bile ducts and a 5x5 cm sized mass which showed minimally delayed enhancement. Abdominal magnetic resonance imaging revealed the mass with low signal intensity in T1 weighted image, high signal intensity and focal low signal in T2 weighted image which showed minimal enhancement. We removed common bile duct stone with endoscopic retrograde cholangiopancreatography then decided to undergo right lower segmentectomy of liver due to possibility of cholangiocarcinoma. Histopathological examination of hepatic mass showed large amount of fibrous tissue with occasional residual vascular channels. We describe one case of sclerosed hemangioma mimicking cholangiocarcinoma.

Sclerosed Hemangioma of the Liver

Hepatic hemangioma is one of the most frequent benign neoplasm of the liver. Its radiologic findings are easily identified to peripheral strong contrast enhancement in the early phase of dynamic comupted tomography (CT) and progressive contrast fill-in on the delay phase. Nevertheless, sclerosed hemangioma is a very rare disease and a regressed form of cavernous hemangioma. Therefore, its differential diagnosis is very difficult. It should be included in the differential diagnosis of other hepatic lesions such as hepatocellular carcinoma, intrahepatic peripheral cholangiocarcinoma and metastatic hepatic tumor. The treatment of sclerosed hemangioma should be conservative management, if diagnostic confirmation was made preoperatively. In this report, we present a case of a 48-year-old male who was treated for hepatic resection. We were not able to identify the sclerosed hemangioma preoperatively.