Yamashita Y, Shimada M, Taguchi K, Gion T, Hasegawa H, Utsunomiya T, Hamatsu T, Matsumata T, Sugimachi K
Second Department of Surgery, Kyushu University School of Medicine, Fukuoka, Japan.
Surg Today. 2000;30(9):849-52. doi: 10.1007/s005950070072.
We present herein the case of a sclerosing hemangioma of the liver which was extremely difficult to differentiate from liver metastasis of rectal cancer, in a 67-year-old woman. All the radiological findings were compatible with liver metastasis; however, marginal pooling of the tumor revealed by computed tomographic angiography and magnetic resonance imaging scans was inconsistent with a diagnosis of liver metastasis. At laparotomy, the tumor was macroscopically unusual in that it was yellowish elastic-hard with a very clear margin, and thus, it did not have the appearance of a metastatic tumor. Mile's operation and a partial hepatectomy were performed, followed by an uneventful postoperative course and no signs of recurrence. The carcinoembryonic antigen (CEA) level in the peripheral blood was not elevated at any time. The postoperative pathological diagnosis was a rare hepatic tumor, namely, a "sclerosing hemangioma," based on the findings of cellular fibrous stroma containing vascular channels with flattened endothelial cells. Preoperatively differentiating between sclerosing hemangioma and a metastatic liver tumor from colorectal cancer may be very difficult; however, this case demonstrated some interesting characteristics, namely, the serum CEA level was not elevated, marginal pooling of the tumor was found in the enhanced radiological findings, and the tumor was macroscopically unusual. Therefore, the possibility of sclerosing hemangioma should be borne in mind when considering the differential diagnosis of patients suspected of having colorectal liver metastasis. A preoperative biopsy should be carried out and when a laparotomy is performed under the misdiagnosis of colorectal liver metastasis, it is advisable that either an intraoperative needle biopsy or a frozen histological analysis be undertaken to avoid unnecessary extended hepatic resection of this rare benign hepatic tumor.
本文报告了一例67岁女性肝脏硬化性血管瘤病例，该病例极难与直肠癌肝转移相鉴别。所有影像学检查结果均与肝转移相符；然而，计算机断层血管造影和磁共振成像扫描显示肿瘤边缘有造影剂充盈，这与肝转移的诊断不符。剖腹手术时，肿瘤在肉眼下表现异常，呈淡黄色，质地硬且有弹性，边界非常清晰，因此不具有转移瘤的外观。患者接受了Miles手术和部分肝切除术，术后恢复顺利，无复发迹象。外周血癌胚抗原（CEA）水平在任何时候均未升高。术后病理诊断为一种罕见的肝脏肿瘤，即“硬化性血管瘤”，其依据是在含有血管腔隙且内皮细胞扁平的细胞性纤维间质中发现的病变。术前鉴别硬化性血管瘤和结直肠癌肝转移瘤可能非常困难；然而，该病例呈现出一些有趣的特征，即血清CEA水平未升高，增强影像学检查发现肿瘤边缘有造影剂充盈，且肿瘤在肉眼下表现异常。因此，在考虑疑似结直肠癌肝转移患者的鉴别诊断时，应考虑到硬化性血管瘤的可能性。术前应进行活检，当在结直肠癌肝转移误诊的情况下进行剖腹手术时，建议进行术中针吸活检或冷冻组织学分析，以避免对这种罕见的肝脏良性肿瘤进行不必要的扩大肝切除术。
