PMC9524384_01
Radiology and gross images of the lesion(s). A - The CECT showing the largest hypodense lesion involving the left lobe along with its medial extension; B - The CECT showing a large heterogeneous and hypodense lesion in the right lobe with irregular margins; C - The intraoperative figure showing the large lesion in the left lobe of the liver (black arrow); D - The gross picture of the largest lesion highlighting a seemingly well-encapsulated mass with tan-brown color and a spongy honeycombed cut surface.
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The largest lesion measuring 11x8x11.3 cm was located in the left lobe with medial extension in the gastrohepatic region abutting the gastric lesser curvature laterally, the antropyloric region inferiorly, and the body and the tail of the pancreas posteriorly (Figure 1A). Another large lesion sizing 10x7.5x8.2 cm was identified in the right hepatic lobe extending downwards to the pararenal space with irregular margins (Figure 1B). During surgical enucleation of the vascular masses, dense adhesions of the liver with both the anterior abdominal wall and transverse colon were noted (Figure 1C). These masses showed a firm to a spongy cut surface with a few perilesional cherry-colored honeycomb foci (Figure 1D).
Photomicrographs of the giant cavernous hemangioma. A - Scanner view of the largest cavernous hemangioma that was well-encapsulated (H&E; 20x); B - Focal insinuation of the margin into the native hepatic parenchyma (H&E; 40x); C - highlighted in Masson trichrome stain (C; 40x); D - the higher magnification revealing multiple cystically dilated vascular spaces lined by flattened single layer of endothelium containing erythrocytes (H&E; 200x).
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Microscopically, all lesions were relatively well-circumscribed (Figure 2A) and partly encapsulated, although there was the microscopic insinuation of the margins into the native hepatic parenchyma (Figure 2B). The irregularity of the margin was highlighted by Masson trichrome stain (Figure 2C). These lesions were vascular and contained numerous, variable-sized, thin-walled, non-anastomosing vascular spaces in a spongiform configuration (Figure 2D). These vascular spaces were lined by a single layer of flat endothelial cells and contained numerous erythrocytes (Figure 2D).
Photomicrographs of the native liver parenchyma. A - Variable sized micro-angiomatous lesions characterized by irregular-shaped dilated vascular channels arranged throughout the native liver parenchyma (black arrows) along with sinusoidal dilatation (black arrowhead) (H&E; 20x); B and C - The locations of the microangiomatous lesions being portal tracts and central veins as highlighted by Masson trichrome stain (B; 20x) (C; 100x); D - The retention of the interlobular bile ducts without any ductopenia in CK7 immunostain while the vascular lesions were unstained by CK7 (peroxidase; 200x).
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These portal tracts and central veins showed irregular shapes due to micro-angioma formation (Figure 3A). These microangiomatous changes were highlighted by Masson trichrome stain (Figures 3B and 3C). CK7 immunostain did not highlight any associated ductopenia (Figure 3D).