Rapidly Progressive Multiple Hepatic Hemangiomas Mimicking Angiosarcoma: A Case Report With Surgical and Interventional Management

BACKGROUND/AIM: Hepatic hemangioma is the most common benign liver tumor and typically shows slow or no growth. Rapidly enlarging hemangiomas are rare and distinguishing them from hepatic angiosarcoma can be challenging. CASE REPORT: A 39-year-old woman presented with multiple hepatic hemangiomas that were absent 3 years earlier. The largest lesion in segment 3 measured 70 mm and demonstrated heterogeneous enhancement, raising concern for hepatic angiosarcoma. Laparoscopic hepatectomy revealed cavernous hemangioma with intravascular papillary endothelial hyperplasia (IPEH). during follow-up, a segment 7 lesion enlarged from 13 mm to 71 mm within 20 months (annual growth rate ~3.5 cm), and multiple new lesions appeared. Despite imaging features suggestive of hemangioma, irregular margins and rapid progression necessitated repeat hepatectomy of segments 5, 7/8, and 6. All lesions were confirmed as cavernous hemangiomas. subsequent rapid regrowth of residual tumors was controlled with transarterial chemoembolization (TACE) using epirubicin, achieving stable disease for 16 months. CONCLUSION: This case represents an extremely rare presentation of multiple hepatic hemangiomas with exceptionally rapid progression mimicking hepatic angiosarcoma. Repeated hepatectomy was required for definitive diagnosis, and TACE proved effective in stabilizing residual lesions.