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.