PMC6193354_01
Abdominal computed tomography during hepatic angiography and magnetic resonance imaging. Arterial phase CT scan shows a geographic lesion in the right lobe of the liver with a rim and nodular enhancement (a), and the delayed phase of CT reveals heterogeneous enhancement in the peripheral area of the mass with a gradual centripetal enhancement pattern (b). The tumor shows low signal intensity on T1-weighted images (c) and some high-signal intensity nodules on T2-weighted images (d). EOB-MRI shows no uptake in the corresponding area (e).
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Abdominal computed tomography (CT) during hepatic arteriography (CTHA) revealed early ring enhancement in the peripheral area in the arterial phase and slight internal heterogeneous enhancement in the delayed phase (Figures 1(a) and 1(b)). Gadolinium ethoxybenzyl (Gd-EOB) MRI revealed no uptake in the corresponding area (Figures 1(c), 1(d), and 1(e)).
Abdominal angiography. (a) Common hepatic angiography image. (b) Three-dimensional image obtained by common hepatic angiography. Hepatic angiography shows a large avascular region in the liver corresponding to the tumor.
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Abdominal angiography demonstrated a large avascular region in the liver corresponding to the tumor, although no typical features of cavernous hemangioma were evident (Figure 2). 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) revealed no abnormal FDG uptake.
Intraoperative findings and macroscopic findings of the resected tumor. Exploration of the abdominal cavity showed a relatively soft, dark red tumor (a). The cut surface demonstrated a white solid and cystic mass (170x100x80 mm in size) that was elastic, soft, and homogeneous with multiple hemorrhagic foci (b).
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fig3
Intraoperative examination revealed a relatively soft dark red tumor (Figure 3(a)); the resected specimen weighed 1.1 kg and measured as 170x100x80 mm. The cut surface of the tumor revealed a white, solid, and cystic mass that was elastic, soft, and homogeneous with a yellowish area considered to be myxoid degeneration (Figure 3(b)).
Histological appearances of sclerosing hemangioma. (a) Sclerotic area is manly present and cavernous hemangioma area (indicated by H) is partly observed. (Loupe image, HE stain). (b) Sclerotic area presents diffuse fibrosis. (HE stain, x40). (c) Histology of cavernous hemangioma. Note increase and dilation of medium sized veins with cavernous form in b (HE stain, x40). (d) The increased and dilated veins show positivity of CD31 immunostaining being a marker of endothelium in (c) (x40).
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Histological examination showed that the tumor mostly consisted of sclerotic area and cavernous hemangioma area is partly observed (Figure 4(a)). Sclerotic area presents diffuse fibrosis (Figure 4(b)) and the typical histology of cavernous hemangioma was confirmed in some parts. In addition, marked increase and dilation of medium sized veins with cavernous form were frequently noted in the surrounding areas of tumor (Figure 4(c)). The increased and dilated veins show positivity of CD31 immunostaining being a marker of endothelium (Figure 4(d)).