Takihara Hiroshi, Oura Shoji, Shintani Hiroshi, Tanaka Hiroto
Department of Gastroenterology, Uji Tokushukai Hospital, Uji, JPN.
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada, JPN.
Cureus. 2025 Mar 17;17(3):e80738. doi: 10.7759/cureus.80738. eCollection 2025 Mar.
An 81-year-old man was found to have a liver mass on an annual medical checkup. Enhanced CT of the mass, 3.8 cm in size, showed weak enhancement with a small non-enhanced oval area near the mass borders. Ultrasound showed an oval mass with internal iso-echoes. Magnetic resonance imaging (MRI) showed that the mass had low and slightly high signal intensities on T1- and T2-weighted images, respectively. MRI of the small non-enhanced area on CT showed high signal intensity both on T1- and T2-weighted images, suggesting focal subacute bleeding. In addition to these image findings, elevated serum α-fetoprotein (AFP) and lectin-reactive fraction of AFP levels made us resect the liver mass without performing a biopsy to the tumor under the tentative diagnosis of possible hepatic malignancy. A postoperative pathological study showed that the mass had massive scar tissue with hemorrhage, lymphocytes, hemosiderin-laden macrophages, and multiple vascular structures, leading to the diagnosis of a hepatic sclerosed hemangioma (HSH). Why this case showed high tumor marker levels remains uncertain. The patient showed normal tumor marker levels shortly after surgery and has been well for 40 months without any problems. Diagnostic physicians should note that HSHs can present very similar image findings to those of intra-hepatic cholangiocarcinomas.
一名81岁男性在年度体检中被发现肝脏有肿物。该肿物大小为3.8 cm，增强CT显示强化较弱，肿物边界附近有一小片无强化的椭圆形区域。超声显示为椭圆形肿物，内部回声均匀。磁共振成像（MRI）显示，该肿物在T1加权像上呈低信号，在T2加权像上呈稍高信号。CT上无强化的小区域的MRI在T1加权像和T2加权像上均显示高信号，提示局灶性亚急性出血。除了这些影像学表现外，血清甲胎蛋白（AFP）升高以及AFP的凝集素反应性部分水平升高，使我们在初步诊断为可能的肝脏恶性肿瘤的情况下，未对肿瘤进行活检就切除了肝脏肿物。术后病理研究显示，肿物有大量瘢痕组织，伴有出血、淋巴细胞、含铁血黄素巨噬细胞和多个血管结构，诊断为肝脏硬化性血管瘤（HSH）。该病例为何出现肿瘤标志物水平升高仍不确定。患者术后不久肿瘤标志物水平恢复正常，40个月来情况良好，无任何问题。诊断医生应注意，HSH的影像学表现可能与肝内胆管癌非常相似。
