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1
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Frenette C, Mendiratta-Lala M, Salgia R, Wong RJ, Sauer BG, Pillai A. ACG Clinical Guideline: Focal Liver Lesions. Am J Gastroenterol 2024; 119:1235-1271. [PMID: 38958301 DOI: 10.14309/ajg.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/25/2024] [Indexed: 07/04/2024]
Abstract
Focal liver lesions (FLLs) have become an increasingly common finding on abdominal imaging, especially asymptomatic and incidental liver lesions. Gastroenterologists and hepatologists often see these patients in consultation and make recommendations for management of multiple types of liver lesions, including hepatocellular adenoma, focal nodular hyperplasia, hemangioma, and hepatic cystic lesions including polycystic liver disease. Malignancy is important to consider in the differential diagnosis of FLLs, and healthcare providers must be familiar with the diagnosis and management of FLLs. This American College of Gastroenterology practice guideline uses the best evidence available to make diagnosis and management recommendations for the most common FLLs.
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Affiliation(s)
| | | | - Reena Salgia
- Department of Gastroenterology/Hepatology, Henry Ford Health, Detroit, Michigan, USA
| | - Robert J Wong
- Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System and Stanford University School of Medicine, Palo Alto, California, USA
| | - Bryan G Sauer
- Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, Virginia, USA
| | - Anjana Pillai
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Chicago Medical Center, University of Chicago, Chicago, Illinois, USA
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2
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Manevska N, Bozinovska N, Stoilovska-Rizova B, Jankulovska A, Makazlieva T, Stojanoski S. Nuclear medicine hybrid imaging (SPECT/CT) in distinguishing the presence of a hepatic hemangioma: Single center study. MEDICINSKI CASOPIS 2023; 57:53-58. [DOI: 10.5937/mckg57-47416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Objective. Hepatic hemangioma (HH) is the most common benign liver tumor, and the second most frequent tumor in the liver after hepatic metastasis. The SPECT/CT hybrid technique will be beneficial for the investigation of this type of HH since it can precisely identify the hepatic lesions. The aim of this study was to reevaluate the sensitivity and specificity of the nuclear medicine method for confirmation or exclusion of benign hemangioma of the liver based on a series of cases at our department and briefly review the literature. Methods. We retrospectively analyzed 107 patients, 62 females (57.94%) and 45 males (42.05%) with mean age 50.05±11.92 years, referred to the Nuclear Medicine Department for 99mTc-RBC scintigraphy of the liver to conclude or exclude the presence of HH, in the period 2019 to 2020. Results. Hepatic scintigraphy located the hemangiomas mostly in the right hepatic lobe. The size of the lesion varied from to 6-140 mm (46.04 ± 27.1); 13 hemangiomas were described as giant. SPECT-CT confirmed HH in 1 patient that was negative on ultrasound, besides 30/87 (34.48%) patients who were described as positive on US and turned out to be negative on the scintigraphic method. In 53 (60.92%) patients, positive matching of the US images and hybrid SPECT/CT imaging for HH was found. Most of the patients had benign referral diagnosis, while 12 of them had confirmed malignant diagnosis in whom eight (n=8, 66.67%) were confirmed free of hepatic metastasis and SPECT-CT detected HH, while in 4 patients who were described as positive for HH on the CT scan, the scintigraphic method excluded HH and further evaluation of the hepatic lesion was needed. Conclusion. Hepatic hemangiomas require a careful diagnosis to differentiate from other focal hepatic lesions, cooccurring diagnoses are also possible. Differentiating between HH and hepatic metastatic disease is a typical clinical difficulty when the problem is present in staging or monitoring patients with oncological disease.
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3
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Casabianca AS, Hernandez Caballero AI, Thornburg LL, Carpizo D. Management of hepatic haemangioma in pregnancy. BMJ Case Rep 2022; 15:e248932. [PMID: 35688570 PMCID: PMC9189827 DOI: 10.1136/bcr-2022-248932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/03/2022] Open
Abstract
Hepatic cavernous haemangioma is a benign tumour of vascular origin found within the liver. Often incidentally diagnosed, the management of these vascular masses is frequently determined by the size of the mass and symptoms associated with its compression of adjacent structures. Tumours >10 cm are known as giant haemangiomas and are associated with increased risks of compression symptoms, coagulopathies and haemorrhage. Known to express hormone receptors for oestrogen, intervention for these masses remains controversial in the setting of pregnancy where concerns for tumour growth and life-threatening complications are increased. Here we present the case of a woman in her 30s recently diagnosed with a giant haemangioma who is found to be pregnant, their management and a review of the literature.
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Affiliation(s)
| | | | - Loralei L Thornburg
- Obstetrics and Gynecology, University of Rochester, Rochester, New York, USA
| | - Darren Carpizo
- Surgical Oncology, University of Rochester Wilmot Cancer Institute, Rochester, New York, USA
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4
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Wang A, Chen H, Huang Z, Tang H, Shi H, Wen J, Li Q, Jiang Y, Fu W. Spontaneous internal hemorrhage of a giant hepatic hemangioma with infection: a case report and literature review. J Int Med Res 2021; 48:300060520976474. [PMID: 33284661 PMCID: PMC7724420 DOI: 10.1177/0300060520976474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Ankang Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China.,Department of General Surgery, Nanchong Central Hospital, The second Clinical College of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Hao Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Zhiwei Huang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Hong Tang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Hao Shi
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Jian Wen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Qiu Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Yu Jiang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, China
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5
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Mogahed MM, Zytoon AA, Essa B, Abdellatif W, Ghanem N, ElWakeel B. Natural history of hepatic hemangiomas as a guide for surgical indication. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00065-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Generally, hemangiomas are asymptomatic and most lesions are incidentally diagnosed on abdominal ultrasonography. The indications for surgery are still debated mainly due to limited data about the natural history of hepatic hemangiomas. The aim of this study is to investigate the natural history of hepatic hemangiomas, the effects of age and sex on their growth, and their tendency to increase in size or causing symptoms or complications as a guide for surgical indication. In this current study, combined retrospective and prospective analysis was conducted on 186 Egyptian adult patients having 244 hepatic hemangiomas who attended to the outpatient clinics. Follow-up was performed to observe the accurate site, size, number, rate of growth of the lesions, and their tendency to cause symptoms or complications.
Results
Ninety-one percent of patients were asymptomatic and 9% were symptomatic. During follow-up, 48% of patients showed an increase in tumor diameter, 22% decreased, and 30% were stable. The growth rate at 18–45-year group showed an increasing trend that was higher in females; it was 3.3 ± 2 mm/year for males and 3.9 ± 1.8 mm/year for females. At ˃ 45 year group, the female patients showed a decreasing trend (− 2.1 ± 1.1 mm/year) while in males showed an increasing trend that was slower than in 18–45-year group (2.6 ± 1.7 mm/year).
Conclusion
Growth pattern of liver hemangiomas is affected by age and sex. The majority of hemangiomas are asymptomatic and complications are rare. Hemangioma size alone is not an indication for surgery in asymptomatic patients. Surgical indications are limited to patients with severe symptoms, complications, or suspicious lesions. Most hemangiomas can be managed conservatively even giant hemangiomas.
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Eghlimi H, Arasteh P, Azade N, Vinnars E. Orthotopic liver transplantation for Management of a Giant Liver Hemangioma: a case report and review of literature. BMC Surg 2020; 20:142. [PMID: 32600292 PMCID: PMC7324977 DOI: 10.1186/s12893-020-00801-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/16/2020] [Indexed: 12/11/2022] Open
Abstract
Background Hepatic hemangioma (HH) is the most common benign tumor of the liver. In special conditions such as rapidly growing tumors, persistent pain, hemorrhage and when pressure effect on adjacent organs exist treatment is indicated. Surgical management is the most common treatment for HH. Case presentation A 38-year-old male patient was diagnosed with HH for 7 years. The initial presentation of the mass was progressive abdominal distention causing early satiety, gastro-esophageal reflux disease, vomiting, dysphagia and weight loss. Later, the patient developed bilateral lower extremity edema. Imaging with computed tomography (CT scan) showed a large mass measuring 32.4*26*3.1 cm which was considered unresectable. The patient underwent a deceased donor liver transplantation. The excised mass was 9 kg. After nine days of hospitalization the patient was discharged in good condition. Three months later, the patient was admitted due to fever and cytomegalovirus infection for which he received intravenous ganciclovir and was discharged. In the latest follow-up the patient had no liver or kidney dysfunction eight months after the transplantation. Conclusion With appropriate patient selection, liver transplantation can be considered as a treatment option for patients with huge HHs which are life-threatening and surgically unresectable.
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Affiliation(s)
- Hesameddin Eghlimi
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Arasteh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Azade
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Shin Y, Rhu J, Choi GS, Kim JM, Joh JW, Kwon CHD. Feasibility of laparoscopic liver resection for liver cavernous hemangioma: A single-institutional comparative study. Ann Hepatobiliary Pancreat Surg 2020; 24:137-143. [PMID: 32457257 PMCID: PMC7271101 DOI: 10.14701/ahbps.2020.24.2.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/25/2020] [Accepted: 01/29/2020] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims While minimal invasive surgery has become popular, the feasibility of laparoscopy for liver cavernous hemangioma has not been shown. Methods Patients who underwent hepatectomy for liver cavernous hemangioma from January 2008 to February 2019 at the Samsung Medical Center were reviewed. Patients who underwent trisectionectomy were excluded. Background characteristics, along with operative and postoperative recovery, were compared between the laparoscopy and open surgery groups. Results Forty-three patients in the laparoscopy group and 33 patients in the open surgery group were compared. The differences in the background characteristics were presence of symptoms (14.6% in laparoscopy vs. 57.1% in open, p<0.001) and tumor location (right, left and both side p=0.017). The laparoscopy group had smaller blood loss (p=0.001), lesser blood transfusion requirements (p=0.035), lower level of post-operative total bilirubin, prothrombin time (INR) (p=0.001, 0.003 each), shorter hospital stay (p=0.001), earlier soft diet start (p<0.001), earlier drain removal (p<0.001) and shorter amount and duration of additional pain control (p=0.001, p=0.017 each). There was no significant difference in complication after surgery between two groups (p=0.721). All the patients showed pathologic report of benign hemangioma regardless of type of surgery (100%). Almost every patients reported no symptom or relief of symptom in both groups (97.7%, 93.9% each). Conclusions Laparoscopic liver resection for liver cavernous hemangioma can be safely performed with improved postoperative recovery. However, surgery for liver cavernous hemangioma should be conducted with informed consent of the patients.
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Affiliation(s)
- Younghuen Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinsoo Rhu
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Gyu-Seong Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Man Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Won Joh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Choon Hyuck David Kwon
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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8
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Wang A, Deng J, Qian B, Chen H, Li M, Yang D, Li Q, Lei Z, Fu W. Natural history of hepatic hemangioma: a follow-up analysis of 534 patients. FRONTIERS IN LIFE SCIENCE 2019. [DOI: 10.1080/21553769.2019.1684389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ankang Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Jiaqi Deng
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Baolin Qian
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Hao Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Mingxing Li
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Dayin Yang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Qiu Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Zhengming Lei
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
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Abstract
Hepatic hemangioma is common among benign liver tumors and usually grows slowly. About 50-70% of hepatic hemangiomas are asymptomatic, and management is not necessary; however, management should be considered in symptomatic patients. The optimal management of symptomatic hepatic hemangioma depends on multiple factors. Invasive management of symptomatic hepatic hemangioma mainly consists of surgery and interventional radiology, including transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy. Although both surgery and interventional radiology are promising in the management of symptomatic hepatic hemangioma, multiple and/or giant hemangiomas represent a clinical dilemma because the complication rate and recurrence rate are relatively high, and symptom relief is not always achieved. However, a review of recent advances in treatment is lacking. We therefore summarized the current invasive management techniques for symptomatic hepatic hemangioma to potentially facilitate clinical decision-making.
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Affiliation(s)
- Wenfang Dong
- Department of Liver Surgery, Peking Union Medical College.,The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Qiu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College
| | - Leren He
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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10
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Guan H, Zou Y, Lv Y, Wang C. Hepatic perivascular epithelioid cell tumor treated by transarterial embolization plus radiofrequency ablation: A case report and literature review. Medicine (Baltimore) 2017; 96:e6969. [PMID: 28562547 PMCID: PMC5459712 DOI: 10.1097/md.0000000000006969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Perivascular epithelioid cell tumors (PEComas) are extremely rare mesenchymal entities with potentially malignant properties; the liver cases are not encountered frequently. Owing to themalignant potential, these tumors are treated by surgical methods to ensure total resection. In the present report, a case of liver PEComa treated by embolization combined with radiofrequency ablation (RFA) has been described. CASE SUMMARY A 40-year-old female was admitted for the detection of a liver mass during an annual physical examination. The patient did not have any liver disease background, enhanced computed tomography (CT), and magnetic resonance revealed a huge mass in the right lobe. Pathology gave the diagnosis of PEComa, for disagreement of open surgery, a combination of transarterial embolization (TAE) and RFA were applied for treatment and the outcomes were acceptable, the patient was under follow-up to observe the long-term effect. CONCLUSION Interventional procedures such as TAE and RFA are feasible and effective for such lesions and may serve as an alternate when resection is not indicated. Prospective studies are warranted to verify the long-term outcomes.
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Laparoscopic Versus Open Resection for Liver Cavernous Hemangioma. Surg Laparosc Endosc Percutan Tech 2015; 25:e145-7. [DOI: 10.1097/sle.0000000000000196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Zozzaro-Smith PE, Fountaine E, Thornburg L. Enlargement of hepatic hemangioma in successive pregnancies. CASE REPORTS IN PERINATAL MEDICINE 2015. [DOI: 10.1515/crpm-2014-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Hemangiomas are the most common benign tumor of the liver and are commonly seen as incidental findings on abdominal imaging. Little is known regarding the natural course and pathogenesis of hepatic hemangiomas during pregnancy. It is believed estrogen may play a role in their growth; however, the precise mechanism remains undefined. Here we describe a patient with hepatic hemangioma enlargement in consecutive pregnancies suggesting a hormonal role in their growth.
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Affiliation(s)
- Paula E. Zozzaro-Smith
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Elizabeth Fountaine
- Department of Obstetrics and Gynecology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Loralei Thornburg
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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14
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Right hepatectomy for giant hepatic hemangioma with progressive growth in a case of relative hyperestrogenism. Cir Esp 2015; 94:363-4. [PMID: 25986889 DOI: 10.1016/j.ciresp.2015.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/28/2015] [Indexed: 11/22/2022]
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15
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Jin S, Shi XJ, Sun XD, Wang SY, Wang GY. Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma. World J Gastroenterol 2014; 20:17680-17685. [PMID: 25516686 PMCID: PMC4265633 DOI: 10.3748/wjg.v20.i46.17680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/17/2014] [Accepted: 07/22/2014] [Indexed: 02/06/2023] Open
Abstract
Sclerosing cholangitis (SC) is a rarely reported morbidity secondary to transcatheter arterial chemoembolization (TACE) with bleomycin-iodinated oil (BIO) for liver cavernous hemangioma (LCH). This report retrospectively evaluated the diagnostic and therapeutic course of a patient with LDH who presented obstructive jaundice 6 years after TACE with BIO. Preoperative imaging identified a suspected malignant biliary stricture located at the convergence of the left and right hepatic ducts. Operative exploration demonstrated a full-thickness sclerosis of the hilar bile duct with right hepatic duct stricture and right lobe atrophy. Radical hepatic hilar resection with right-side hemihepatectomy and Roux-en-Y hepaticojejunostomy was performed because hilar cancer could not be excluded on frozen biopsy. Pathological results showed chronic pyogenic inflammation of the common and right hepatic ducts with SC in the portal area. Secondary SC is a long-term complication that may occur in LCH patients after TACE with BIO and must be differentiated from hilar malignancy. Hepatic duct plasty is a definitive but technically challenging treatment modality for secondary SC.
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MESH Headings
- Adult
- Anastomosis, Roux-en-Y
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/adverse effects
- Bile Duct Neoplasms/diagnosis
- Biopsy
- Bleomycin/administration & dosage
- Bleomycin/adverse effects
- Chemoembolization, Therapeutic/adverse effects
- Cholangiopancreatography, Endoscopic Retrograde
- Cholangiopancreatography, Magnetic Resonance
- Cholangitis, Sclerosing/chemically induced
- Cholangitis, Sclerosing/diagnosis
- Cholangitis, Sclerosing/surgery
- Diagnosis, Differential
- Female
- Hemangioma, Cavernous/therapy
- Hepatectomy
- Humans
- Iodized Oil/adverse effects
- Jaundice, Obstructive/chemically induced
- Jejunostomy
- Liver Neoplasms/therapy
- Predictive Value of Tests
- Time Factors
- Tomography, X-Ray Computed
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Giant hepatic hemangioma versus conventional hepatic hemangioma: clinical findings, risk factors, and management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2014; 79:229-37. [PMID: 25438870 DOI: 10.1016/j.rgmx.2014.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 06/27/2014] [Accepted: 08/01/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Giant hepatic hemangiomas (GHHs) are those that are larger than 4 cm in size. AIMS The aim of this study was to describe GHH clinical findings, their risk factors, diagnostic approach and management, and to compare these data with those of conventional hemangiomas. METHODS We performed a retrospective analysis of patients diagnosed with hemangiomas, whether by imaging studies or histopathology, at our hospital within the time frame of 1990-2008. The medical records of each patient were reviewed to obtain clinical and surgical data. RESULTS Of the 57 patients with liver hemangioma, 41 (72%) were women and 32 (56%) had GHH. Liver hemangioma median size was 4.49 cm. In regard to the patients with GHH, 31.2% were asymptomatic and when symptoms presented, pain was the most common. Both symptoms and oral contraceptive exposure were more common in the GHH patients. Nine patients with GHH underwent surgery: 2 open biopsies due to diagnostic uncertainty, one enucleation, and 6 resections. CONCLUSIONS GHHs are more prevalent in women and when symptomatic, pain is the most frequent complaint. Diagnosis is usually made through imaging studies, but when there is diagnostic doubt, surgical exploration is sometimes needed. Oral contraceptive use is most likely more of a risk factor for GHH than for conventional hemangioma, but this association needs to be studied further.
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17
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Moctezuma-Velázquez C, López-Arce G, Martínez-Rodríguez L, Escalona-Huerta C, Chapa-Ibargüengoitia M, Torre A. Giant hepatic hemangioma versus conventional hepatic hemangioma: Clinical findings, risk factors, and management. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2014. [DOI: 10.1016/j.rgmxen.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Lamba R, Fananazapir G, Corwin MT, Khatri VP. Diagnostic Imaging of Hepatic Lesions in Adults. Surg Oncol Clin N Am 2014; 23:789-820. [DOI: 10.1016/j.soc.2014.07.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Hatanaka M, Nakazawa A, Nakano N, Matsuoka K, Ikeda H, Hamano I, Sakamoto S, Kasahara M. Successful living donor liver transplantation for giant extensive venous malformation. Pediatr Transplant 2014; 18:E152-6. [PMID: 24815871 DOI: 10.1111/petr.12280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/27/2014] [Indexed: 01/27/2023]
Abstract
We report our success in employing LDLT as a course of treatment for extensive hepatic VM. A 14-yr-old pediatric patient presented at our hospital with nosebleed, fatigability, orthopnea, and abdominal distension. He had a history of right hemicolectomy with primary anastomosis due to VM of the transverse colon at age seven. Coagulation abnormalities were apparent, characterized by high international normalized ratio of prothrombin time, decreased fibrinogen level, increased FDPs, and D-dimer. T2-weighted magnetic resonance imaging revealed numerous, variable-sized high signal intensity nodules. Abdominal ultrasonography and CT scan showed hepatomegaly with multiple hypo-echogenic lesions and arteriovenous shunting in the liver. Doppler ultrasound showed hypokinetic flow in the hypo-echogenic lesions of liver. Immediate LDLT was performed to avoid spontaneous rupture and DIC. The right lobe of the liver was implanted with temporary portocaval shunt to prevent intestinal congestion and bleeding. Pathologic examination of the explanted liver confirmed the presence of an extensive hepatic VM. The postoperative course was uneventful, and the patient remained symptom-free with normal liver function throughout the 12-month follow-up period.
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Affiliation(s)
- Masahiro Hatanaka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatric Surgery, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan
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20
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Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, Bertino G, Di Carlo I. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol 2014; 13:327-339. [PMID: 24927603 DOI: 10.1016/s1665-2681(19)30839-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. Patients affected by hemangioma usually have their tumor diagnosed by ultrasound abdominal examination for a not well defined pain, but pain persist after treatment of the hemangioma. The causes of pain can be various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease.The malignant trasformation is practically inexistent. Different imaging modalities are used to diagnosis liver hemangioma including ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging, and less frequently scintigraphy, positronemission tomography combined with CT (PET/CT) and angiography. Imaging-guided biopsy of hemangioma is usually not resorted to except in extremely atypical cases. The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.
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Affiliation(s)
- Adriana Toro
- Department of Surgery, Taormina Hospital, Messina, Italy
| | | | - Annalisa Ardiri
- Hepatology Unit. Department of Medical and Pediatric Science, University of Catania, Italy
| | | | - Giulia Malaguarnera
- University of Catania; Research Center "The Great Senescence". Cannizzaro Hospital, Italy
| | | | - Gaetano Bertino
- Hepatology Unit. Department of Medical and Pediatric Science, University of Catania, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania. Catania, Italy; Department of Radiology, Hamad General Hospital, Doha Qatar
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Aydin C, Akbulut S, Kutluturk K, Kahraman A, Kayaalp C, Yilmaz S. Giant hepatic hemangioma presenting as gastric outlet obstruction. Int Surg 2013; 98:19-23. [PMID: 23438272 PMCID: PMC3723163 DOI: 10.9738/cc170.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hemangioma, a most frequently encountered primary benign tumor of the liver, is generally determined incidentally during the course of radiologic tests for other reasons. Most lesions are less than 3 cm and a significant proportion of patients are asymptomatic, although the size and location of the lesion in some patients may be associated with the onset of symptoms. Pressure on the stomach and duodenum of giant hemagiomas developing in the left lobe of the liver, in particular, may result in the development of abdominal pain, nausea, vomiting, and feeling bloated, which are characteristic of a gastric outlet obstruction. A 42-year-old man presented with findings of gastric outlet obstruction and weight loss as a result of a giant hepatic hemangioma.
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Affiliation(s)
- Cemalettin Aydin
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sami Akbulut
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Koray Kutluturk
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Aysegul Kahraman
- Department of Radiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cuneyt Kayaalp
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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