Wang Ji-Ze, Chen Hao
Department of Surgical Oncology, Oncology Center, Lanzhou University Second Hospital, Lanzhou 730030, Gansu Province, China.
World J Clin Cases. 2025 Apr 16;13(11):101668. doi: 10.12998/wjcc.v13.i11.101668.
Hepatic hemangiomas can be challenging to diagnose, particularly when they present with atypical features that mimic other conditions, such as gastrointestinal stromal tumors (GISTs). This case highlights the diagnostic difficulties encountered when imaging subepithelial lesions, especially when conventional methods such as computed tomography (CT) and endoscopic ultrasound (EUS) are used.
A 44-year-old woman presented with intermittent abdominal distension and heartburn for three months. Her medical history included iron deficiency anemia, menorrhagia, and previous cholecystectomy. One week prior to admission, an endoscopy suggested a bulging gastric fundus, which was likely a GIST, along with chronic nonatrophic gastritis and bile reflux. CT and EUS revealed nodules in the gastric fundus, which were initially considered benign tumors with a differential diagnosis of stromal tumor or leiomyoma. During surgery, unexpected lesions were found in the liver pressing against the gastric fundus, leading to laparoscopic liver resection. Postoperative pathology confirmed the diagnosis of hepatic cavernous hemangiomas. The patient recovered well and was discharged five days later, with normal follow-up results at three months.
This case underscores the challenges in the preoperative diagnosis of GISTs, particularly the limitations of the use of CT and EUS for the evaluation of subepithelial lesions. While CT is the primary tool for visualizing abdominal tumors, it is difficult to detect smaller lesions and assess the layers of the gastrointestinal wall on CT. EUS is recommended for the evaluation of nodules smaller than 2 cm and is useful for distinguishing GISTs from other lesions; however, its accuracy with regard to the differential diagnosis is relatively low. In this case, the gastric distension observed on imaging led to the compression of a liver tumor against the stomach, resulting in the misinterpretation of the tumor as a gastric wall lesion.
肝血管瘤的诊断可能具有挑战性，尤其是当它们表现出非典型特征并类似其他疾病时，如胃肠道间质瘤（GIST）。本病例突出了在对上皮下病变进行成像时遇到的诊断困难，特别是在使用计算机断层扫描（CT）和内镜超声（EUS）等传统方法时。
一名44岁女性出现间歇性腹胀和烧心3个月。她的病史包括缺铁性贫血、月经过多和既往胆囊切除术。入院前一周，内镜检查提示胃底隆起，可能是胃肠道间质瘤，同时伴有慢性非萎缩性胃炎和胆汁反流。CT和EUS显示胃底有结节，最初被认为是良性肿瘤，鉴别诊断为间质瘤或平滑肌瘤。手术过程中，发现肝脏有意外病变压迫胃底，遂行腹腔镜肝切除术。术后病理证实为肝海绵状血管瘤。患者恢复良好，5天后出院，3个月随访结果正常。
本病例强调了胃肠道间质瘤术前诊断的挑战，特别是CT和EUS在评估上皮下病变方面的局限性。虽然CT是可视化腹部肿瘤的主要工具，但难以检测较小的病变并评估胃肠道壁的层次。对于小于2 cm的结节，建议使用EUS进行评估，其有助于将胃肠道间质瘤与其他病变区分开来；然而，其鉴别诊断的准确性相对较低。在本病例中，成像观察到的胃扩张导致肝脏肿瘤压迫胃部，从而将肿瘤误诊为胃壁病变所致。
