Hepatic venous malformations versus “hemangiomas”: a clinical, radiologic, and pathologic analysis

Background Hepatic venous malformations (VMs) are adult-onset vascular anomalies that continue to be inaccurately labeled as “hepatic hemangiomas.” Despite the widespread adoption of the International Society for the Study of Vascular Anomalies (ISSVA) classification, which distinguishes VMs from vascular tumors, outdated terminology persists. This misclassification may hinder diagnostic accuracy and limit the application of appropriate management strategies, including sclerotherapy. Purpose To analyze the clinical, radiographic, and histopathologic characteristics of hepatic VMs in adults and assess the accuracy of the existing diagnoses. Material and Methods This is a retrospective review of a large tertiary referral center with a statewide catchment area, analyzing adult patients with pathology-proven hepatic VMs referred between January 2000 and July 2021. The original diagnosis and data on clinical, radiographic, pathological, and treatment methods of pathology-proven lesions were collected and analyzed. Results A total of 24 adult patients (13 women; mean age = 53.5 years) met the inclusion criteria. In 20 (83.3%) cases, imaging labeled the lesion as “hemangioma” before pathology confirmed the same diagnosis; in 4 (16.7%) cases, imaging initially suggested metastases, but pathology labeled them as “hemangioma.” Most lesions were solitary (71%) and asymptomatic (67%). Symptomatic lesions had a larger mean diameter (9.3 cm) compared with the overall cohort (4.42 cm). Careful re-review of imaging and histopathology confirmed all lesions to be VMs. Conclusion Hepatic VMs are frequently misdiagnosed as hemangiomas. Accurate classification is essential for improving clinical understanding, guiding treatment, and aligning terminology with current vascular anomaly standards.