Hyperplastic hepatocellular nodule with localized hemangiomatosis: A hither-to unrecognized type of hypervascular...

The differential diagnosis of hypervascular hepatocellular nodular lesion includes hepatocellular carcinoma and it is sometimes difficult to image. We report herein two patients with hyperplastic hepatocellular nodule associated with localized hemangiomatosis.

A hypervascular hepatic nodule approximately 10 mm in diameter was incidentally detected in a 79-year-old woman and a 58-year-old man. Hepatocellular carcinoma was suspected and partial hepatectomy was performed.

Hepatitis viral markers and tumor markers were negative in both patients. On histology, the nodular lesions had an ill-defined border and included hemangioma-like vessels and sinusoidal dilatation showing immunoreactivity for CD34. There were no abnormal unpaired arteries or a central stellate scar suggesting focal nodular hyperplasia. Hepatic columns in the lesion were thickened to two to three cell layers and cellular density was mildly more increased than the background liver. Cellular atypia and diminished reticulin fibers around the hepatic column were not observed. A survey of the background livers of 13 patients with cavernous hemangioma disclosed similar hemangioma-like vessels in hepatic parenchyma in six patients (46%), but similar nodular lesions were not detected in any patients.

Taken together, the hepatic lesions in these two patients may be hither-to unrecognized types of hyperplastic hepatocellular lesion associated with localized hemangiomatous lesion that may cause irregular blood flow.