Multiple hepatic sclerosing hemangiomas mimicking malignant lesions, a diagnostic dilemma: case report and literature review
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Dana M. Al Baali
Abstract
Objectives
Hepatic sclerosing hemangioma (SH) is a rare benign liver lesion that poses a significant diagnostic challenge due to its ability to mimic malignant hepatic tumors on imaging.
Case presentation
We report the case of a 67-year-old woman with diabetes, hypertension, and chronic kidney disease who presented with incidental liver lesions discovered during the workup of elevated alkaline phosphatase. Cross-sectional imaging, including MRI and PET-FDG, revealed multiple atypical hypodense hepatic lesions with perihilar biliary obstruction, initially raising concern for cholangiocarcinoma. Multiple tissue biopsies including Spyglass-guided and percutaneous attempts were non-diagnostic, and the clinical suspicion of malignancy persisted. Diagnostic laparoscopy and targeted incisional biopsy ultimately confirmed the diagnosis of sclerosing hemangioma. The patient underwent laparoscopic wedge resection and has remained well on follow-up for more than two years.
Conclusions
This case highlights the importance of maintaining a broad differential diagnosis in the evaluation of atypical hepatic lesions, the limitations of radiological findings, and the value of a stepwise multidisciplinary approach in avoiding unnecessary major resections. A focused review of the literature supports the rarity of this entity and emphasizes the need for tissue diagnosis in ambiguous cases.
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Research ethics: Ethical approval for this case report and literature review was obtained from the Institutional Review Board of Sultan Qaboos Comprehensive Cancer Care & Research Center.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Author contributions: Conceptualization: Abdullah Al Farai and Fabrizio Panaro. Case Management and Clinical Investigation: Dana Al Baali, Mahmoud Ajoub, Abdullah Al Rawahi, and Abdullah Al Farai. Radiological Assessment: Issa Al Qarshoubi and Abdullah Al Rawahi. Pathological Evaluation: Babikir Ahmed. Data Curation and Literature Review: Dana Al Baali, Mahmoud Ajoub and Abdulateef Al Sulaimani. Writing – Original Draft Preparation: Dana Al Baali and Mahmoud Ajoub. Writing – Review and Editing: Abdullah Al Farai, Fabrizio Panaro, and Abdulateef Al Sulaimani. Supervision and Project Administration: Abdullah Al Farai. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Use of Large Language Models, AI and Machine Learning Tools: None declared.
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Conflict of interest: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
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