Case Report: A giant cavernous hemangioma detected in the remnant left liver 33 months after laparoscopic liver resection

A giant hepatic hemangioma detected after resection raises questions about lesion continuity and resection completeness. A 50-year-old man underwent laparoscopic resection in January 2022 for a symptomatic 10.0 × 7.8 cm cavernous hemangioma. The procedure was recorded as left lateral sectionectomy, but its exact segmental extent could not be independently verified. Thirty-three months later, a giant lesion measuring 9.3 × 8.6 cm on ultrasonography was detected in the remnant left liver and resected. Retrospective comparison of four multiphasic CT examinations, with radiologist-reviewed three-dimensional reconstructions, supported regional correspondence between medial enhancing tissue adjacent to the original mass in 2021, enhancing tissue in the retained liver in October 2022, and the 2024 lesion. The 2022 examination was obtained approximately nine months after surgery and did not establish an immediate postoperative residual lesion. Both specimens showed cavernous hemangioma without cytological atypia, tumor necrosis, or identified mitoses. Satellite nodules around the first lesion could not be mapped to the transection margin. Enlargement of residual tissue remained plausible, but lesion transection, histological continuity, and a residual-lesion growth rate were not established. The patient remained clinically well at approximately 17 months after the second operation. This case emphasizes correlation of multiphasic imaging and three-dimensional anatomy with the actual transection plane and oriented pathological margins.