Computed Tomography of Neoplasms of Small Vessels of the Liver in the Differential Diagnosis of Hypervascular Tumors (Clinical Case)

Purpose: To describe the semiotics of neoplasms of small vessels of the liver according to computed tomography, to present a possible differential diagnosis

Material and methods: Patient S., 52 years old, underwent computed tomography (CT) of the abdominal cavity with intravenous contrast due to a sharp increase in liver formation before the planned surgery. According to CT data, a large hypervascular formation measuring 198×146×247 mm was detected in the left lobe of the liver. The feeding extrahepatic arteries and draining hepatic veins are significantly dilated. Newly formed vessels and aneurysmally dilated arteriovenous shunts up to 29 mm in size were noted in the structure of the formation. A hemihepatectomy was performed. According to the results of morphological and immunohistochemical studies, a diagnosis of «Neoplasm of small vessels of the liver» was made.

Results: the disease «neoplasm of small vessels of the liver» (HSVN) became known in 2016 after the publication of an article by Ryan M. Gill et al. This is a vascular tumor that occupies an intermediate position between a hemangioma and an angiosarcoma. Currently, it is believed that the disease is benign. Several dozen confirmed cases are known. Due to hypervascularity, the tumor must be differentiated from angiosarcoma, hepa- and cholangiocellular cancer, hypervascular metastasis, as well as benign tumors such as hemangioma, focal nodular hyperplasia, and adenoma. In our case, the distinctive feature of the tumor was a significant expansion of the feeding extrahepatic arteries and draining main hepatic veins, aneurysmal expansion of arteriovenous shunts in the structure and the absence of signs of invasion of surrounding vessels and organs.

Conclusion: In the differential series of hypervascular liver tumors, in the presence of pronounced arterial blood supply, the presence of arteriovenous shunts in the structure and the absence of signs of infiltrative growth, neoplasm of small liver vessels should be considered.