Wakasugi Masaki, Ueshima Shigeyuki, Tei Mitsuyoshi, Tori Masayuki, Yoshida Ken-Ichi, Tsujimoto Masahiko, Akamatsu Hiroki
Department of Surgery, Osaka Police Hospital, Osaka, Japan.
Department of Surgery, Osaka Police Hospital, Osaka, Japan.
Int J Surg Case Rep. 2015;8C:137-40. doi: 10.1016/j.ijscr.2015.01.032. Epub 2015 Jan 21.
Hepatic sclerosing hemangioma is a very rare benign tumor, characterized by fibrosis and hyalinization occurring in association with degeneration of a hepatic cavernous hemangioma. We report here a rare case of multiple hepatic sclerosing hemangioma mimicking metastatic liver tumor that was successfully treated using laparoscopic surgery.
A 67-year-old woman with multiple liver tumors underwent single-incision laparoscopic sigmoidectomy under a diagnosis of advanced sigmoid cancer with multiple liver metastases. Examination of surgical specimens of sigmoid colon revealed moderately differentiated adenocarcinoma invading the serosa, and no lymph node metastases. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 remained within normal limits throughout the course. Two months after sigmoidectomy, the patient underwent laparoscopic partial hepatectomy of S1 and S6 of the liver and cholecystectomy. Histopathological examination showed that the tumors mainly comprised hyalinized tissue and collagen fibers with sporadic vascular spaces on hematoxylin and eosin-stained sections, yielding a diagnosis of multiple hepatic sclerosing hemangioma. No evidence of recurrence has been seen as of 21 months postoperatively.
Differentiating multiple sclerosing hemangiomas from metastatic liver tumors was quite difficult because the radiological findings were closely compatible with liver metastases. Laroscopic hepatectomy provided less blood loss, a shorter duration of hospitalization, and good cosmetic results.
Sclerosing hemangioma should be included among the differential diagnoses of multiple liver tumors in patients with colorectal cancer. Laparoscopic hepatectomy is useful for diagnostic therapy for undiagnosed multiple liver tumors.
肝硬化性血管瘤是一种非常罕见的良性肿瘤，其特征是在肝海绵状血管瘤退变的同时伴有纤维化和玻璃样变。我们在此报告一例罕见的多发性肝硬化性血管瘤病例，该病例酷似转移性肝肿瘤，经腹腔镜手术成功治疗。
一名患有多发性肝肿瘤的67岁女性因诊断为晚期乙状结肠癌伴多发性肝转移而接受了单孔腹腔镜乙状结肠切除术。乙状结肠手术标本检查显示为中分化腺癌侵犯浆膜，无淋巴结转移。整个病程中癌胚抗原和糖类抗原19-9的血清水平均保持在正常范围内。乙状结肠切除术后两个月，患者接受了肝脏S1和S6段的腹腔镜部分肝切除术及胆囊切除术。组织病理学检查显示，苏木精-伊红染色切片上肿瘤主要由玻璃样变组织和胶原纤维组成，伴有散在的血管间隙，诊断为多发性肝硬化性血管瘤。术后21个月未见复发迹象。
将多发性硬化性血管瘤与转移性肝肿瘤区分开来相当困难，因为影像学表现与肝转移密切相符。腹腔镜肝切除术出血量少、住院时间短且美容效果好。
硬化性血管瘤应列入结直肠癌患者多发性肝肿瘤的鉴别诊断之中。腹腔镜肝切除术对未确诊的多发性肝肿瘤的诊断性治疗很有用。
