Spontaneous regression of a giant hepatic hemangioma on serial MRI: A case report with 3-year follow-up

Hepatic hemangiomas are the most common benign mesenchymal tumors of the liver and usually demonstrate stable imaging characteristics over time, whereas spontaneous regression in adults remains uncommon and poorly documented in literature. We report the case of a 53-year-old woman with a giant hepatic hemangioma incidentally detected on magnetic resonance imaging (MRI) during evaluation of chronic nonspecific abdominal discomfort. Serial MRI examinations performed in February 2022, August 2023, and January 2025 demonstrated classic imaging findings of cavernous hemangioma, including marked T2 hyperintensity and peripheral nodular discontinuous enhancement with progressive centripetal fill-in, followed by substantial spontaneous regression without medical, surgical, or interventional treatment. Lesion dimensions changed from 14.1 × 9.4 × 9.5 cm to 15.9 × 10.0 × 9.5 cm, followed by regression to 8.0 × 5.4 × 4.7 cm, corresponding to an estimated volumetric reduction exceeding 80%. The patient remained clinically stable throughout follow-up, with no evidence of malignant transformation or clinically significant laboratory abnormalities. This case highlights that giant hepatic hemangiomas with characteristic MRI features may demonstrate substantial spontaneous regression during long-term follow-up and supports conservative management in clinically stable patients with typical imaging findings.