412 The Korean Journal of Hepatology Vol. 16. No. 4, December 2010 A B Figure 3. Macroscopic finding of the giant hemangioma. An externally bulging, huge, blue-red mass is noted (A). The cut section shows a discrete dark red, sponge-like nodule, measuring 10 cm at its greatest dimension, in the noncirrhotic liver (B). A B Figure 4. Microscopic finding of the giant hemangioma. (A) Low-power view disclosing proliferation of the cavernous vascular structures. (B) Each vascular space is lined by flat endothelial cells and filled with fresh red blood cells. (A: H-E, ×12.5; B: H-E, ×100). was discolored and sunken by an underlying whitish, firm nodule (Fig. 1A). Sectioning revealed a relatively homogenous, well-circumscribed gray-white solid nodule with several d ark-red, pin-point spots measuring 2.1×1.6 cm (Fig. 1B). Microscopic evaluation revealed that most areas comprised scle- rotic hyalinized collagenous tissue with scattered tiny-to-small, thin-walled vascular spaces (Fig. 2A and 2B). The vascular spaces were frequently collapsed and lined by flat endothelial cells. These cells were positive on immunohistochemistry for an endothelial marker (Fig. 2C). There was a focal marginal zone of identifiable vascular spaces. Some vascular channels were sur- rounded by a loose myxoid matrix and a concentric cuff of stel- late cells. A special stain highlighted the sclerotic condition of the mass (Fig. 2D), and the surrounding nonneoplastic liver showed periportal fibrosis. Areas of stromal calcification were focally present. DISCUSSION Cavernous hemangiomas of the liver can be found in- cidentally and may be readily diagnosed due to their character- istic homogeneous hyperechogenicity and posterior acoustic en- hancement on ultrasound examination. They can sometimes present different stages of involution. In these cases, radiological findings show atypical features,2 occasionally mimicking malig- nant lesions.3 The giant size of the tumor and specific symptoms in- cluding Kasabach-Merritt syndrome make the diagnosis difficult. In such cases, pathologic confirmation is needed to accurately characterize the lesion. The giant cavernous hemangioma shown in Figure 3 and 4 was resected from a 36-year-old woman due to progressive en- largement and multiplicity. Macroscopically, cavernous he- mangioma presents as a subcapsular blue-red flat mass (Fig. 3A), with cut sections showing a homogeneous spongiform surface