A hepatic sclerosing hemangioma emerged in the postoperative course of multiple gastric carcinoid tumors masquerading as metachronous liver metastasis

Ryota Koyama; Nozomi Minagawa; Yoshiaki Maeda; Toshiki Shinohara; Tomonori Hamada

doi:10.1016/j.ijscr.2019.03.018

A hepatic sclerosing hemangioma emerged in the postoperative course of multiple gastric carcinoid tumors masquerading as metachronous liver metastasis

Int J Surg Case Rep. 2019:58:1-5. doi: 10.1016/j.ijscr.2019.03.018. Epub 2019 Apr 4.

Authors

Ryota Koyama¹, Nozomi Minagawa², Yoshiaki Maeda², Toshiki Shinohara², Tomonori Hamada²

Affiliations

¹ Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan. Electronic address: ryout_koyam@sap-cc.go.jp.
² Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.

Abstract

Introduction: Hepatic sclerosing hemangiomas are rare tumors whose appearance on imaging is similar to that of malignant tumors. The resulting difficulties in preoperative diagnosis frequently lead to surgical resection in order to accurately identify the tumor.

Case presentation: A 68-year-old man was diagnosed with multiple gastric carcinoid tumors (T1N1M0, pStage IIIB) after total gastrectomy with D2 lymph node dissection. Enhanced computed tomography of the abdomen 2 years after the initial surgery revealed a novel solid lesion with ring enhancement measuring 22 × 15 mm at S5 of the liver. Metachronous liver metastasis from multiple gastric carcinoid tumors was suspected, and partial hepatectomy of S5 was successfully performed. Histopathological diagnosis was sclerosing hemangioma with no malignant findings.

Discussion: Ours is the first reported case of a newly appearing sclerosing hemangioma excised and diagnosed histopathologically. Hepatic sclerosing hemangiomas are rarely observed, but they are often resected under a preoperative diagnosis of malignant lesion due to the similarity on imaging studies.

Conclusion: Surgeons must consider that a hepatic tumor may be a sclerosing hemangioma, particularly when the lesion appears to be ring enhanced.

Keywords: Gastric carcinoid; Hepatic sclerosing hemangioma; Metachronous liver metastasis.