PMC4861836_01
60-year-old woman presented with an acute onset of bright red blood in her stool and an incidental liver mass. Axial CT of the abdomen in the portal-venous phase shows a hypodense peripherally enhancing mass with subtle intrahepatic biliary ductal dilatation in the left lobe.
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The enhancement pattern on CT was nonspecific, and the mass was hypodense (Fig. 1).
60-year-old woman presented with an acute onset of bright red blood in her stool and an incidental liver mass. (A) Axial Single Shot Fast Spin echo (SSFSE) and (B) axial T2-weighted fat-suppressed image show a T2 hyperintense mass (arrow) in segment 4 without areas of internal fat. Subtle intrahepatic biliary ductal dilatation is evident in the left lobe of the liver. (C) Diffusion-weighted image shows an area of diffusion restriction. Early (D), late-arterial phase (E), portal venous (F), and delayed phase (G) images show peripheral, somewhat nodular enhancement with continued filling in on the delayed images. A classic hemangioma is present in segment 7.
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A classic hemangioma was seen in segment 8 with peripheral nodular enhancement on the arterial phase and filling-in on the portal venous and delayed phases (Fig. 2).
60-year-old woman presented with an acute onset of bright red blood in her stool and an incidental liver mass. (A) The partial hepatectomy specimen shows a 4.2cm, well-circumscribed, somewhat soft, white, and focally hemorrhagic mass. (B) Microscopy revealed well-demarcated, thin-walled, variably cavernous and compressed vascular channels lined by endothelial cells without cytologic atypia or mitoses. No bile duct proliferation or carcinoma was present, which was confirmed by a negative CK7 stain (not shown). Extensive zones of sclerosis were present within the hemangioma, more prominent at the periphery. The background liver had mild steatosis. (C) CD31 stain confirmed the vascular nature of the neoplasm.
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On pathology, the tumor was diagnosed as a sclerosing hemangioma (Fig. 3).