Hepatic Venous Hemangioma Mimics Acetate-Positive Hepatocellular Carcinoma

A 70-year-old man with prostate adenocarcinoma (Gleason score 4+3=7) and chronic hepatitis B underwent radical prostatectomy. A follow-up CT revealed a suspicious liver nodule in the left lobe nine months post-surgery. PSMA PET/CT scan revealed mild peripheral uptake in the liver lesion, atypical for metastatic prostate cancer. Further, 11 C-acetate PET/CT demonstrated significant uptake in the hepatic lesion, supporting a diagnosis of hepatocellular carcinoma. However, pathology after partial hepatectomy confirmed a hepatic venous hemangioma. This case highlights that benign hepatic vascular lesions can also exhibit PSMA and 11 C-acetate uptake, emphasizing careful differential diagnosis.