Diagnostic Pitfalls of Hepatic Sclerosed Hemangiomas: A Case Report

An 81-year-old man was found to have a liver mass on an annual medical checkup. Enhanced CT of the mass, 3.8 cm in size, showed weak enhancement with a small non-enhanced oval area near the mass borders. Ultrasound showed an oval mass with internal iso-echoes. Magnetic resonance imaging (MRI) showed that the mass had low and slightly high signal intensities on T1- and T2-weighted images, respectively. MRI of the small non-enhanced area on CT showed high signal intensity both on T1- and T2-weighted images, suggesting focal subacute bleeding. In addition to these image findings, elevated serum α-fetoprotein (AFP) and lectin-reactive fraction of AFP levels made us resect the liver mass without performing a biopsy to the tumor under the tentative diagnosis of possible hepatic malignancy. A postoperative pathological study showed that the mass had massive scar tissue with hemorrhage, lymphocytes, hemosiderin-laden macrophages, and multiple vascular structures, leading to the diagnosis of a hepatic sclerosed hemangioma (HSH). Why this case showed high tumor marker levels remains uncertain. The patient showed normal tumor marker levels shortly after surgery and has been well for 40 months without any problems. Diagnostic physicians should note that HSHs can present very similar image findings to those of intra-hepatic cholangiocarcinomas.