Coexisting Hepatic Hemangioma Treated Incidentally with Percutaneous Ethanol Injection and Transarterial Chemoembolization in a case of Hepatocellular Carcinoma

Reprint requests to: Dr. Jiunn-Ming Lii Department of Radiology, Taipei City Hospital. No. 10, Sec. 4, Ren Ai Road, Taipei 106, Taiwan, R.O.C. Hepatic hemangiomas are not routinely treated except for large symptomatic lesions. Transarterial chemo-embolization (TACE) and percutaneous ethanol injection (PEI) are often used to treat hepatocellular carcinoma (HCC). We report a patient with underlying HCC and a coexisting small hemangioma that was inadvertently treated with both PEI and TACE because of misdiagnosis as an additional HCC. The hemangioma persisted with no visible imaging changes, nor complications. It is important to identify hemangiomas in HCC patients to avoid unnecessary treatment. Hemangioma is the most common benign tumor affecting the liver. They rarely cause any symptoms unless progressive growth causes pressure effect or rupture. Symptomatic lesions are generally treated successfully by surgical resection [1], and some also claim satisfactory result with embolization [2]. However, Chen et al. also reported incidental transarterial chemoembolization (TACE) of six cases of hemangiomas with concurrent hepatocellular carcinoma (HCC), which appeared to have no effect on the hemangiomas [3]. The other treatment option for the hepatic hemangioma includes radiofrequency ablation [4, 5]. To the best of our knowledge, the combined PEI and TACE for a hepatic hemangioma were not reported previously. We hereby present a rare case of HCC coexist ing with an undiagnosed small hemangioma, which was inadvertently treated with one course of percutaneous ethanol injection therapy (PEI) and three sessions of TACE. The hemangioma persisted despite these therapies, and its radiographic features appear to be unaltered.