Do Clinical and Pathologic Differences Exist Between Hepatic Cavernous Hemangiomas Diagnosed Radiologically Versus Those Biopsied Due To Unclear Clinical Diagnosis?

Authors

Eleanor Dyer, Saumya Gurbani, Raul S Gonzalez

Published in

Human pathology. Pages 106300. Nov 07, 2026. Epub Nov 07, 2026.

Abstract

Hemangiomas are the most common benign vascular tumors of the liver, typically asymptomatic, and incidentally identified on imaging. Biopsies are contraindicated due to risk of hemorrhage and low diagnostic yield. However, clinical and radiologic suspicion for hemangioma remains low in some instances, often leading to biopsy. This study compared clinical and pathologic features between hemangiomas not suspected clinically versus those with high clinical confidence in a diagnosis of hemangioma. We searched our departmental archives for hepatic hemangiomas in biopsy and resection specimens, then performed chart review of radiology reports/clinical notes to determine whether the diagnosis of hemangioma was concordant (suspected hemangioma) or discordant (unsuspected hemangioma) with pathology results. Our final cohort of 121 cases included 47 unsuspected hemangiomas (usually biopsies) and 74 suspected hemangiomas (usually resections). Patients with unsuspected hemangiomas were older on average, had smaller tumors, and more commonly had a history of malignancy (all P<0.0001). By morphology, unsuspected hemangiomas were more likely to demonstrate sclerosis (P=0.001) and thick-walled blood vessels (P=0.008), while suspected hemangiomas were more likely to show cavernous architecture (P=0.001). While hepatic hemangiomas are common, they may be clinically unsuspected in older patients with smaller lesions (perhaps obscuring classic radiologic changes) and a clinical history of malignancy (likely skewing the differential toward metastatic disease). Samples from such unsuspected hemangiomas are more likely to show sclerosis and thick-walled vessels and less likely to show cavernous architecture compared to clinically diagnosed hemangiomas, which may be resected and more likely show classic histologic features.

PMID:
42998682
Bibliographic data and abstract were imported from PubMed on 08 Nov 2026.

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