Clinical Case Summary

The hemangiomas represent the most common benign mesenchymal tumor of the liver. Most often they occur solitary. We distinguish several variants, and one of the rarest forms is so-called pedunculated hemangioma, which represents an exophytically growing lesion. Pedunculated hemangiomas can be asymptomatic, but due to the size and extrahepatic localization, they can compress the bile ducts, surrounding abdominal organs or vascular structures. Another potential manifestation is so-called Kasabach-Merritt syndrome, which presents with hemolytic anemia, thrombocytopenia, hypofibrinogenemia or prolonged prothrombin time. Most often, this syndrome manifests in childhood, it is very rare in adults. We presented a case of 65-year-old female patient was hospitalized at the internal department for severe pancytopenia in June 2022. On admission, the patient reported weight loss of 10 kg over the course of 6 months. She suffered from anemia, trombocytopenia and hypofibrinogenemia. During hospitalization, CT scan of the abdomen was made and showed a liver lesion in the S2/S3 segment a peripheral lesion (43x30 mm) and lobular tumor extending into the left subphrenic (120x94mm) compressing the spleen. Post-contrast, the lesion was nodularly filled at the periphery of the lesion, with gradual filling in the delayed phase - like a hemangioma.
The patient underwent a hematological examination with a conclusion of severe thrombocytopenia due to consumption coagulopathy, thrombocytopenia due to giant liver hemangioma. The patient was subsequently presented at a multidisciplinary seminar and partial resection of the hemangioma together with its extrahepatic part was indicated due to the risk of torsion. A left-sided bisegmentectomy of the liver was performed. The resection was subsequently sent for histological examination, which verifies a giant cavernous hemangioma. The postoperative course was without complications, some laboratory parameters gradually improved at discharge.

Disclosure

Fig. 1 A pedunculated hemangioma on an axial CT section of the abdomen p
using a contrast material - clear compression of the spleen to the spine
(archive of the University Hospital in Martin)