J Yeungnam Med Sci.  2022 Jan;39(1):53-57. 10.12701/yujm.2021.00969.

Multilocular cystic hemangioma of the liver mimicking mucinous cystic neoplasm: a case report

• Lee NK
• Kim S
• Hong SB
• Lee SJ
• Seo HI

• KMID: 2525028
• DOI: http://doi.org/10.12701/yujm.2021.00969

Abstract

Hepatic hemangiomas infrequently exhibit atypical imaging features, which may cause diagnostic confusion with hepatic malignancies and lead to unnecessary surgery. We report a rare case of multilocular cystic hemangioma of the liver mimicking a mucinous cystic neoplasm of the liver in a 48-year-old female, focusing on computed tomography and magnetic resonance imaging features and their differential diagnosis.

Keyword

Cavernous hemangioma; Liver; Liver neoplasms; Magnetic resonance imaging; Multidetector computed tomography

Figure

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  Fig. 1. Computed tomography (CT) findings of a multilocular cystic hemangioma of the liver in a 48-year-old female. Contrast-enhanced dynamic-phase abdominal CT scans show a huge septated cystic mass in the right lobe of the liver. (A) Nonenhanced, (B) arterial phase, (C) portal venous phase, and (D) delayed phase. Enhancement of the septa within the mass (arrows) is noted.

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  Fig. 2. Magnetic resonance imaging findings of a multilocular cystic hemangioma of the liver in a 48-year-old female. (A) T1-weighted and (B) T2-weighted images show a multiseptated cystic mass containing variable signal intensity. Most locules present as T1-hypointensity and T2-hyperintensity, identical to signal intensity of fluid. Some T1 hyperintense locules present as T2-hypointensity, suggesting subacute hemorrhage (arrowheads). (C) Contrast-enhanced fat-suppressed T1-weighted image shows septal enhancement (arrow).

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  Fig. 3. Histopathologic findings of a multilocular cystic hemangioma of the liver in a 48-year-old female. (A) The cut section of the gross specimen shows multiple cystic loculi separated by multiple septa. (B) Low-power magnification shows a multilocular cystic mass composed of medium to small-sized cystic space (hematoxylin and eosin [H&E] stain, ×40). (C) High-power magnification shows the cystic wall lined by flattened or cuboidal endothelial cells without cytologic atypia and supported by fibrotic stroma (H&E stain, ×200). On immunohistochemical staining, the endothelial cells are positive for vascular endothelial cell markers such as (D) ETS-related gene (ERG), (E) CD34, and (F) factor VIII (immunohistochemical stain, ×200 [D-F]), but negative for biliary epithelial cell markers such as cytokeratin 7 (CK 7) and CK 19 (not shown).

Reference

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