• Bleomycin
• Giant hemangioma
• Lipiodol
• Liver
• Long-term follow-up
• Transarterial chemoembolization

• Humans
• Chemoembolization, Therapeutic/methods
• Liver Neoplasms/therapy
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Male
• Female
• Ethiodized Oil/administration & dosage
• Retrospective Studies
• Bleomycin/administration & dosage
• Bleomycin/therapeutic use
• Middle Aged
• Adult
• Hemangioma/therapy
• Hemangioma/diagnostic imaging
• Treatment Outcome
• Antibiotics, Antineoplastic/administration & dosage
• Antibiotics, Antineoplastic/therapeutic use
• Aged
• Tomography, X-Ray Computed
• Emulsions
• Young Adult
• Magnetic Resonance Imaging

• Giant hemangioma
• Liver hemangioma
• TAE
• Transarterial embolization

• Humans
• Liver Neoplasms/therapy
• Liver Neoplasms/diagnostic imaging
• Hemangioma/therapy
• Hemangioma/diagnostic imaging
• Ethiodized Oil/administration & dosage
• Bleomycin/administration & dosage
• Bleomycin/therapeutic use
• Embolization, Therapeutic/methods
• Antibiotics, Antineoplastic/administration & dosage
• Antibiotics, Antineoplastic/therapeutic use
• Female
• Male
• Middle Aged
• Emulsions
• Chemoembolization, Therapeutic/methods

• interventional radiology
• liver
• minimally invasive surgical procedures
• multimodal imaging
• operating rooms

• Humans
• Operating Rooms
• Surgery, Computer-Assisted/methods
• Liver Neoplasms/surgery
• Biliary Tract Surgical Procedures/methods

• bleomycin–lipiodol emulsion
• giant hepatic hemangioma
• interventional radiology
• liver tumor treatment
• transcatheter arterial chemoembolization (TACE)

• bleomycin
• giant hepatic hemangiomas
• lipiodol
• transarterial bleomycin–lipiodol embolization
• transarterial chemoembolization (TACE)

• Humans
• Female
• Male
• Middle Aged
• Ethiodized Oil/therapeutic use
• Carcinoma, Hepatocellular/therapy
• Feasibility Studies
• Retrospective Studies
• Liver Neoplasms/therapy
• Chemoembolization, Therapeutic/adverse effects
• Aortic Dissection
• Bleomycin/adverse effects
• Hemangioma
• Syndrome

Infantile hemangiomas (IH) are the most common benign vascular tumors in childhood. Although they tend to have a benign nature, some hemangiomas may be complicated with astigmatism or deprivation amblyopia. We report a unique case of using an interventional radiological vascular embolization treatment modality for the early management of amblyogenic large right orbital and periorbital infantile capillary hemangiomas.

After the confirmation of the diagnosis using a magnetic resonance imaging (MRI) of the brain and orbit, and an initial trial of systemic propranolol, an early interventional radiological vascular embolization was done. This was combined with the use of a tapering systemic corticosteroid. The functional and cosmetic outcomes were satisfactory.

The use of arterial embolization is a promising modality of treatment as a possible alternative or adjunct to medical and surgical treatment cases of IH. To the authors’ knowledge, this is one of the rare cases reported in the ophthalmic literature addressing the use of this technique for early management of orbital and periorbital capillary hemangiomas.

• Capillary hemangioma
• Infantile hemangioma
• Prematurity
• Vascular embolization

Background: Transcatheter arterial embolization (TAE) is regarded as an effective treatment for patients with symptomatic hepatic hemangioma. However, few studies have evaluated the efficacy of TAE alone for treating hepatic hemangioma. The aim of this study was to identify the factors that influence the response to TAE and formulate a quantitative nomogram to optimize the individualized management of hepatic hemangioma.

Methods: We retrospectively studied 276 patients treated with TAE for hepatic hemangioma at our center from January 2011 to December 2019. The full cohort was randomly divided into training and validation cohorts. After assessing the potential predictive factors for the efficacy of TAE in the training cohort, a nomogram model was established and evaluated by discrimination and calibration.

Results: During follow-up, the symptom relief rate was 100%. The tumor blood supply (p < 0.001), tumor number (p = 0.004), and tumor size (p = 0.006) were identified as significant predictors of the failure of tumor shrinkage in response to TAE. The nomogram model showed favorable discrimination and calibration, with a C-index of 0.775 (95% CI, 0.705–0.845) in the training cohort, which was further confirmed in the validation cohort (C-index 0.768; 95% CI, 0.680–0.856). The side effects of TAE were relatively minor and included mainly abdominal pain, nausea, vomiting, fever, and the presence of elevated hepatic transaminases.

Conclusion: TAE is a safe and effective treatment for symptomatic hepatic hemangioma. The established nomogram performed well for the estimation of the effect of TAE in patients with hepatic hemangioma and can facilitate the selection of patients who would benefit most from the treatment.

• efficacy
• nomogram
• symptomatic hepatic hemangioma
• therapeutic response
• transcatheter arterial embolization

Hepatic hemangiomas are the most typical benign mesenchymal lesions of the liver. Most of these lesions are asymptomatic. Giant hepatic hemangiomas (GHH) (>10 cm) are often symptomatic and require surgical intervention. This study aimed to describe the clinical findings, risk factors, diagnostic approach and management of GHH.

We performed a retrospective analysis of patients with GHH treated at our hospital from January 2008 to December 2018. The medical records of each patient were reviewed to obtain the clinical and surgical data.

Twelve patients with GHH were treated during the study period. 9 were female and 3 were male. The mean age of diagnosis was 48,2 years. The most common presenting symptom was abdominal pain. Eight patients presented an abdominal mass. Indications for surgical resections were rupture (n = 2), Kasabach-Merritt syndrome (n = 1) and abdominal pain (n = 9). Right hepatectomy was done in four patients, left lobectomy in four patients, and enucleation in four patients. Embolization was performed in 4 patients, but due to the persistence of symptoms or bleeding, surgery was indicated. The mean operative time was 3.5 h, and median blood loss was 870 ml. The median hospital stay was 5.3 days. For four patients, we registered postoperative complications causing death in one case. All alive patients were asymptomatic at a median follow-up of 55 months.

Despite limitations and alternative modalities, surgery remains the only effective curative treatment for GHH.

•

Hepatic hemangiomas are the most common benign tumors of the liver with the incidence of 0.4–20%.

• Giant hepatic hemangioma
• Liver resection /surgery

• Benign tumour
• Foie
• Haemangioma
• Hémangiome
• Liver
• Radiotherapy
• Radiothérapie
• Tumeur bénigne

• Carcinoma, Hepatocellular
• Hemangioma/radiotherapy
• Hemangioma/surgery
• Humans
• Liver Neoplasms/surgery

• Bleeding
• Embolization
• Enucleation
• Giant
• Hemangioma
• Hepatectomy
• Hybrid
• Immediate
• Liver
• On-table
• Resection

Spontaneous internal hemorrhage from a hepatic hemangioma is rare. This case describes a 59-year-old woman who was hospitalized with recurrent cough and fever for 6 months. The doctor thought that she had pneumonia, but other infectious diseases could not be ruled out. Therefore, related tests were performed and strong antibiotics were used, but the symptom of fever was persistent and recurred. Enhanced computed tomography (CT) findings showed a right hepatic giant hemangioma with hemorrhage, while tuberculosis, liver abscess, and immune disease were excluded by the physician. Because the patient’s fever was associated with a large hepatic hemangioma, the patient was transferred to surgery. During treatment, the amount of bleeding increased, so she underwent a right hepatic hemangioma resection in the emergency department. Her postoperative fever symptoms subsequently resolved. Pathological examination confirmed hemorrhagic necrosis with infection in hepatic hemangioma. Follow-up showed that the patient was afebrile.

• Hepatic hemangioma
• benign mesenchymal tumor
• fever
• hemorrhagic necrosis
• infection
• spontaneous internal hemorrhage

• Computed tomography
• Diffuse hepatic hemangiomatosis
• Giant hemangioma
• Magnetic resonance imaging

• 3D image reconstruction
• Giant
• Hepatic hemangioma
• Surgical indication
• Surgical management
• Surgical technique

Hepatic cavernous hemangioma is the most common type of benign liver tumor. Although ruptures and hemorrhages of hepatic hemangioma are rare complications, they are associated with high mortality. Most practitioners only pay more attention to abdominal hemorrhages caused by the rupture of hepatic hemangiomas. However, spontaneous intracapsular hemorrhages can often be neglected and poorly understood.

A 65-year-old man was referred to our institution with right upper quadrant pain, which had occurred suddenly and without a history of recent trauma. The blood test results were normal. Magnetic resonance imaging (MRI) of the abdomen showed a cystic mass in the right liver lobe. Considering the possibility of hepatic cystadenoma with hemorrhage, the patient underwent a right hepatic lobectomy. The pathological findings unexpectedly revealed intratumoral hemorrhage of hepatic hemangioma. The patient recovered well and was discharged eight days after surgery.

Intracapsular hemorrhage of hepatic cavernous hemangioma is challenging to diagnose and has a high potential risk of rupture. MRI is beneficial for diagnosing subacute internal hemorrhage cases, and it is recommended to undergo surgery for patients with a definitive diagnosis.

• Hepatic hemangioma
• Intracapsular hemorrhage
• Magnetic resonance imaging

• Bleomycin
• Hepatic hemangioma
• Lipiodol
• Pingyangmycin
• Transarterial embolization

To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.

From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.

There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 h of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n = 19) and the LH group (n = 13), patients in the OH group (n = 25) had a significantly longer postoperative hospital stay (P < 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 h of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P<0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P<0.05).

Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

• Clinical effects
• Giant liver haemangioma
• Hemihepatectomy
• Laparoscopic liver resection
• Robotic liver resection

• Hepatic hemangiomas
• microwave ablation
• outcome comparison
• safety and effectiveness
• surgical resection

• Giant hepatic hemangioma
• efficacy
• microwave ablation
• safety
• ultrasound-guided

• Bleomycin–lipiodol
• Hepatic hemangioma
• Transarterial bleomycin–lipiodol embolization (B/LE)

• hepatic hemangioma
• internal hemorrhage
• spontaneous rupture

• Embolization, Therapeutic/methods
• Female
• Hemangioma/complications
• Hemangioma/diagnosis
• Hemorrhage/etiology
• Hemorrhage/surgery
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/diagnosis
• Middle Aged
• Radiography, Interventional

• Arterial embolization
• Embolización arterial
• Embolización terapéutica
• Liver tumor
• Therapeutic embolization
• Tratamiento
• Treatment
• Tumor hepático

• benign
• liver neoplasms
• microwave ablation
• ultrasound guidance

• Enucleation
• Hepatectomy
• Hepatic hemangioma
• Hepatic portal system

• growth pattern
• hepatic hemangioma
• natural history
• surgical indication

• Hepatic haemangioma
• Risk of rupture
• Treatment

• Adverse Effects
• Hemangioma
• Hepatectomy
• Liver

The present article is aimed at reporting the author’s experience with transcatheter arterial embolization using a lipiodol-ethanol mixture in three cases of unresectable symptomatic giant hepatic hemangiomas.

The cases of three patients with giant unresectable symptomatic hepatic hemangiomas embolized in the period 2009–2010 were retrospectively reviewed. In all the cases, transarterial embolization was performed with an ethanol-lipiodol mixture.

Symptoms regression and quality of life improvement were observed in all the cases. No complications were observed and all the patients were discharged within 12 hours after the procedure.

Transcatheter arterial embolization using ethanol mixed with lipiodol was a safe and effective treatment for symptomatic giant hepatic hemangiomas in this small series of patients.

• Ethanol
• Ethiodizedoil
• Hemangioma
• Therapeutic embolization

• Hepatectomy
• Hepatic hemangioma
• Laparoscopy
• Radiofrequency ablation

Hemangioma is the most common type of benign tumor that arises in the liver. Although rupture and hemorrhage of hepatic hemangioma are rare complications, they can be the cause of mortality. The authors report a case of hemorrhagic hepatic hemangioma: in a 54-year-old woman who was admitted with epigastric pain. She had taken oral contraceptives several weeks prior. The results of a blood examination were normal. An abdominal computed tomography scan revealed a tumor in hepatic segment 4, and a hemorrhage inside the cystic mass was suspected. The mass was removed laparoscopically to confirm the tumor properties and control the hemorrhage. The pathologic findings of the resected mass were consistent with hepatic hemangioma with intratumoral hemorrhage. The patient was discharged 8 d after the surgery, without further complications or complaints, and the patient’s condition was found to have improved during follow-up.

• Hemangioma
• Liver
• Hemorrhage
• Tumor
• Complication

• Abdominal Pain/etiology
• Biopsy
• Female
• Hemangioma/complications
• Hemangioma/pathology
• Hemangioma/surgery
• Hemorrhage/etiology
• Hepatectomy
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Middle Aged
• Rupture, Spontaneous
• Tomography, X-Ray Computed
• Treatment Outcome
• Ultrasonography, Doppler

• Hemangioma
• Liver
• Patients

• Bleeding
• Hepatic adenoma
• Hepatocellular carcinoma
• Liver tumors
• Surgery

• Adenoma/complications
• Adenoma/diagnosis
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/diagnosis
• Hemorrhage/diagnosis
• Hemorrhage/etiology
• Hemorrhage/surgery
• Hemorrhage/therapy
• Humans
• Liver Neoplasms/complications
• Liver Neoplasms/diagnosis
• Magnetic Resonance Imaging
• Resuscitation
• Tomography, X-Ray Computed

Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment. Giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significantly reduced, and it was completely resected by a left hepatectomy. A 21-year-old Asian man visited our hospital for left upper quadrant pain. Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity, with a maximum diameter of 31.5 cm. Embolization of the left hepatic artery was performed and confirmed a decrease in its size. However, the patient was readmitted to our hospital one month after embolization for intestinal obstruction. A left hepatectomy was completed through a herringbone incision, and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight. Pre-operative arterial embolization is effective for reducing tumor size, but a close follow-up to decide the time for hepatectomy is important.

• Hepatic hemangioma
• Transcatheter arterial embolization
• Intestinal obstruction
• Complications
• Hepatectomy

• Embolization, Therapeutic
• Hemangioma/complications
• Hemangioma/pathology
• Hemangioma/surgery
• Hemangioma/therapy
• Hepatectomy
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Liver Neoplasms/complications
• Liver Neoplasms/pathology
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Magnetic Resonance Imaging
• Male
• Predictive Value of Tests
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• Tumor Burden
• Young Adult

Here we report a case of a 76-year-old man with a giant cavernous hepatic hemangioma of more than 20 cm in diameter. Since the hepatic hemangioma was actually growing and might possibly rupture and he complained of abdominal symptoms, we decided to perform interventional therapy. First we performed transcatheter arterial embolization (TAE) of the hepatic arteries. However, since this was not sufficiently effective, we added sorafenib (600 mg/day). As a result, the tumor shrank with symptomatic improvement. Subsequently, an adverse event occurred, and we suspended the sorafenib therapy. Then, the tumor began to grow, and we resumed administering sorafenib at 400 mg/day. The tumor shrank again, and we continued the sorafenib therapy thereafter. The tumor shrinkage, although possibly induced by the effect of TAE, is considered primarily due to the effect of treatment with sorafenib, because (1) TAE did not sufficiently reduce the blood supply to the inside of the tumor; (2) other tumors shrank in the area not targeted by TAE; and (3) the tumor grew during suspension of sorafenib therapy and shrank again after resuming the treatment.

• Hepatic hemangioma
• Sorafenib
• Transcatheter arterial embolization