Hepatic small vessel neoplasm case report: A surveillance conundrum

Incidental Vascular Lesion in Explanted Liver: A Rare Case Report and Review of the Literature

Hepatic small vessel neoplasm (HSVN) is a rare vascular hepatic lesion that is usually an asymptomatic incidental finding. Here we present a case of a 66-year-old male with HSVN who was discovered to have a lesion presenting as a small nodule in an explanted liver. HSVN is a recently described hepatic vascular lesion that has been previously underdiagnosed. It has an uncertain long-term malignant potential, so close follow-up is recommended.

Hepatic Small Vessel Neoplasm: A Case Report and Review of the Literature

Hepatic small vessel neoplasm (HSVN) is a recently described vascular neoplasm of the liver. It demonstrates an infiltrative growth pattern and lacks cytologic atypia and mitotic activity. So far, no cases of metastasis or disease recurrence after excision have been reported in the literature. In this report, we present the case of a 31-year-old woman with a lesion in segments VII-VIII of the liver who was referred to our surgical department due to right lumbar pain. She underwent an atypical wedge hepatectomy (segments VII, VIII) and cholecystectomy. The histopathology of the resected specimen confirmed a 40mm HSVN. The patient did not receive any adjuvant therapy and is scheduled for follow-up with serial magnetic resonance imaging (MRI) scans over the next five years due to the unknown malignant potential of the tumor.

Multifocal hepatic small vessel neoplasm with spleen dissemination

Among liver vascular tumours, hepatic small vessel neoplasm (HSVN) has been recently identified as a rare infiltrative vascular neoplasm whose malignant potential is yet to be fully ascertained. About 30 cases of HSVN have been described so far. The most common clinical presentation is an asymptomatic solitary liver lesion. Multifocal disease has been described in literature; however, to date, there are no reports of disease dissemination to other organs. Here we report a case of multifocal HSVN with synchronous spleen secondary lesions.

Hepatic small vessel neoplasm - A systematic review

Background

Hepatic small vessel neoplasm (HSVN) is a recently described vascular neoplasm of the liver that can mimic hepatic angiosarcoma (AS) because of its infiltrative nature but is considered biologically less aggressive. We carried out a systematic review of the literature after previously coming across a case of HSVN [1] to guide our surveillance.

Methods

We conducted a systematic review for all cases using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, case report journals and Google Scholar according to the PRISMA guidelines using the terms “hepatic small vessel neoplasm” or “hepatic small vessel neoplasia” with no language restrictions. The review was registered with Research Registry (UIN: reviewregistry1127) [2].

Results

We identified 69 articles, of which 6 articles were eligible after screening. A total of 23 cases were identified. Median age was 58 (range 24–83 years) with a male preponderance (17 M:6F). Mean tumour size was 2.8 cm (range 0.2–15.9 cm). Mean follow-up was 7 months (range 1–24 months) with no reported evidence of recurrence in both patient groups with no residual disease or with positive margins after resection.

Discussion

HSVN appears to demonstrate a benign clinical course with no reported recurrences or metastatic disease. Long-term follow-up data will further supplement our understanding of these tumours and guide future management.

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HSVN is a recently described neoplasm with uncertain long-term malignant potential.

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23 cases have been identified, mean follow-up was 7 months (range 1–24 months).

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There is no reported evidence of recurrence in patients with no residual disease.

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There is no reported evidence of recurrence in patients with residual disease.

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Follow-up is limited in reported cases.