Necrotic Hepatic Hemangioma Mimicking Liver Metastasis at

73-year-old male was a victim of sigmoid colon cancer. He received a sigmoid-colectomy 10 years ago. He suffered from watery diarrhea about 3 times per day for 2-3 months recently. Magnetic resonance imaging (MRI) showed a heterogeneously enhanced mass in the transverse colon and a 9x8.2 cm well-marginated mass in the left lobe of the liver. The hepatic tumor showed mixed signal intensity on T1-weighted imaging (T1WI ), low signal intensity with small spotted high signals on T2-weighted imaging (T2WI). Recurrent colon cancer with liver metastasis was impressed. The patient received transverse and descending-colectomy and left hepatectomy. Histopathological examination showed solitary hepatic mass virtually filled with yellowish white necrotic material. A dark-red, blood clot-like substance at the periphery was noted in gross. In microscopic examination, the liver tumor was composed entirely of fibrin clot and blood clot at center with closely aggregated, ectactic and congested thinwalled vessels at small focal area at the periphery of the tumor. Hepatic hemangioma coexisting with a transverse colon mucinous adenocarcinoma was diagnosed by the pathologist. The MRI findings did not showed the characteristics of hepatic hemangioma. The atypical appearance was due to marked hemorrhagic necrosis of the tumor. We report this unusual case, and suggest to consider the possibility of atypical hemangioma in liver masses with similar imaging patterns.