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Open Access Case report

Giant pedunculated hepatocellular carcinoma with hemangioma mimicking intestinal obstruction

Theodore Karatzas1*, Anastasios Smirnis1, Dimitrios Dimitroulis1, Dimitrios Patsouras1, Kostantinos Evaggelou2, Stylianos Kykalos1 and Gregory Kouraklis1

Author Affiliations

1 2nd Propedeutic Department of Surgery, "Laiko" General Hospital, 17 Ag. Thoma str, 11527 Goudi, University of Athens, Medical School, Athens, Greece

2 Department of Pathology, University of Athens, Medical School, Mikras Asias 75, 11527, Goudi Athens, Greece

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BMC Gastroenterology 2011, 11:99  doi:10.1186/1471-230X-11-99

Published: 22 September 2011

Abstract

Background

Pedunculated hepatocellular carcinoma (P-HCC) has rarely been reported and is characteristically large and encapsulated. Only sporadic cases have been published, in which P-HCC was combined with other liver tumors (mostly benign), making the diagnosis difficult.

Case presentation

We report a patient who was admitted to our hospital with clinical features of intestinal obstruction and a palpable mass in the right iliac fossa. Ultrasound, computed tomography and magnetic resonance imaging demonstrated an encapsulated mass of unclear origin and characteristics of liver hemangioma. Laboratory tests revealed elevated α-fetoprotein (> 800 ng/ml) and cancer antigen 125 (> 51.2 U/ml). With a possible diagnosis of giant liver hemangioma, we proceeded to surgery. During surgery, a giant pedunculated tumor was discovered on the inferior surface of the right lobe of the liver, hanging free in the right abdominal cavity towards the right iliac fossa. The macroscopic appearance of the tumor was compatible with liver hemangioma. Tumor resection was performed at a safe distance, including the pedicle. The rest of the liver appeared normal. Histopathological examination revealed grade II and III HCC (according to Edmondson-Steiner's classification) with nodular configuration, central necrosis, and infiltration of the capsule. Underneath the tumor capsule, residual tissue of a cavernous hemangioma was recognized. The resection margins were free of neoplastic tissue.

Conclusion

This rare presentation of a giant P-HCC combined with a hemangioma with features of intestinal obstruction confirmed the diagnostic difficulties of similar cases, and required prompt surgical treatment. Therefore, patients benefit from surgical resection because both the capsule and the pedicle prevent vascular invasion, therefore improving prognosis.