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Kacała A, Dorochowicz M, Matus I, Puła M, Korbecki A, Sobański M, Jacków-Nowicka J, Patrzałek D, Janczak D, Guziński M. Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:449. [PMID: 38541175 PMCID: PMC10972168 DOI: 10.3390/medicina60030449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 10/30/2024]
Abstract
Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. Giant hemangiomas (>5 cm) have a higher risk of complications. A variety of imaging methods are used for diagnosis. Cavernous hemangioma is the most frequent type, but radiologists must be aware of other varieties. Conservative management is often adequate, but some cases necessitate targeted interventions. Although surgery was traditionally the main treatment, the evolution of minimally invasive procedures now often recommends transarterial chemoembolization as the treatment of choice.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
| | - Mateusz Dorochowicz
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.D.); (I.M.)
| | - Iwona Matus
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.D.); (I.M.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Jagoda Jacków-Nowicka
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
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Zhang Z, Li JZ, Li HM. Hepatic Hemangioma Treatment Using Microwave Coagulation Therapy—a Systematic Review. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02372-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Oldhafer KJ, Habbel V, Horling K, Makridis G, Wagner KC. Benign Liver Tumors. Visc Med 2020; 36:292-303. [PMID: 33005655 DOI: 10.1159/000509145] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Due to the frequent use of medical imaging including ultrasonography, the incidence of benign liver tumors has increased. There is a large variety of different solid benign liver tumors, of which hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) are the most frequent. Advanced imaging techniques allow precise diagnosis in most of the patients, which reduces the need for biopsies only to limited cases. Patients with benign liver tumors are mostly asymptomatic and do not need any kind of treatment. Symptoms can be abdominal pain and pressure effects on adjacent structures. The 2 most serious complications are bleeding and malignant transformation. Summary This review focuses on hepatic hemangioma (HH), FNH, and HCA, and provides an overview on clinical presentations, surgical and interventional treatment, as well as conservative management. Treatment options for HHs, if indicated, include liver resection, radiofrequency ablation, and transarterial catheter embolization, and should be carefully weighed against possible complications. FNH is the most frequent benign liver tumor without any risk of malignant transformation, and treatment should only be restricted to symptomatic patients. HCA is associated with the use of oral contraceptives or other steroid medications. Unlike other benign liver tumors, HCA may be complicated by malignant transformation. HCAs have been divided into 6 subtypes based on molecular and pathological features with different risk of complication. Key Message The vast majority of benign liver tumors remain asymptomatic, do not increase in size, and rarely need treatment. Biopsies are usually not needed as accurate diagnosis can be obtained using modern imaging techniques.
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Affiliation(s)
- Karl J Oldhafer
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Victoria Habbel
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | | | - Georgios Makridis
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Kim Caroline Wagner
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
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Leon M, Chavez L, Surani S. Hepatic hemangioma: What internists need to know. World J Gastroenterol 2020; 26:11-20. [PMID: 31933511 PMCID: PMC6952297 DOI: 10.3748/wjg.v26.i1.11] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/26/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. This tumor arises from a vascular malformation; however, the pathophysiology has not been clearly elucidated. Symptoms usually correlate with the size and location of the tumor. Less commonly the presence of a large HH may cause life-threatening conditions. The diagnosis can be established by the identification of HH hallmarks in several imaging studies. In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause. In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm. Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation. Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques. Progression of the tumor is seen in less than 40%. Hormone stimulation may play a role in HH growth; however, there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence. When clinicians encounter this condition, they should discern between observation and surgical or non-surgical management based on the clinical presentation.
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Affiliation(s)
- Monica Leon
- Centro Medico ABC, Ciudad de Mexico, CDMX 01120, Mexico
| | - Luis Chavez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Salim Surani
- Texas A&M University, Corpus Christi, TX 78405, United States
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Shah LM, Bui JT, Gaba RC. Heme-Pigment Induced Acute Kidney Injury after Cavernous Hemangioma Ablation. Semin Intervent Radiol 2019; 36:275-278. [PMID: 31435136 DOI: 10.1055/s-0039-1694064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Love M Shah
- University of Illinois College of Medicine, Chicago, Illinois
| | - James T Bui
- Division of Interventional Radiology, Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Ron C Gaba
- Division of Interventional Radiology, Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
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Li X, An C, Liu F, Cheng Z, Han Z, Yu X, Dong L, Yu J, Liang P. The value of 3D visualization operative planning system in ultrasound-guided percutaneous microwave ablation for large hepatic hemangiomas: a clinical comparative study. BMC Cancer 2019; 19:550. [PMID: 31174503 PMCID: PMC6555953 DOI: 10.1186/s12885-019-5682-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 05/07/2019] [Indexed: 12/18/2022] Open
Abstract
Background To evaluate the value of a three dimension (3D)visualization operative planning system in ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs). Methods Fifty-eight patients with LHHs were divided into 3D and 2D groups. The therapeutic efficacy was assessed by contrast-enhanced imaging during follow-up. Hepatic and renal function were examined. The complete ablation, tumor volume shrinkage, and complication rates were analyzed. Results The ablation time and energy of the 3D group were lower than those of the 2D group (1152.0 ± 403.9 s vs. 1379.7 ± 375.8 s and 87,407.2.9 ± 50,387.0 J vs. 117,775.8 ± 46,245.6 J, P = 0.031 and 0.021, respectively). The 3D group had a higher complete ablation rate than the 2D group (97.7 ± 2.4% vs. 94.5 ± 3.7%, P < 0.001). The incidence of hemoglobinuria after ablation in the 3D group was lower than that in the 2D group (32.0% vs. 57.6%, P = 0.047). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and creatinine (Cre) after ablation in the 3D group were lower than those in the 2D group (126.7 ± 56.4 U/L vs. 210.9 ± 96.2 U/L, P < 0.001; 141.0 ± 60.8 U/L vs. 211.4 ± 90.0 U/L, P = 0.001; 57.3 ± 17.6 U/L vs. 80.8 ± 41.9 U/L, P = 0.010; and 66.6 ± 16.6 mmol/L vs. 84.5 ± 39.6 mmol/L, P = 0.037, respectively). There were no significant differences in antenna insertion and the volume reduction rate between the groups. One patient developed acute kidney injury shortly after ablation in the 2D group and recovered after hemodialysis. No other severe complications occurred during the follow-up period. Conclusions The 3D visualization operative planning system has a relatively high clinical application value in providing scientific, reasonable, quantifiable, and individualized therapy for LHHs by US-PMWA.
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Affiliation(s)
- Xin Li
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Chao An
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Linan Dong
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Ketchum WA, Lin-Hurtubise KM, Ochmanek E, Ishihara K, Rice RD. Management of Symptomatic Hepatic "Mega" Hemangioma. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2019; 78:128-131. [PMID: 30972235 PMCID: PMC6452022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The majority of giant hepatic cavernous hemangiomas are asymptomatic and can safely be observed. However, when a lesion becomes symptomatic, affecting quality of life or cannot be distinguished from a malignancy, then operative therapy should be considered. We herein present a case of a symptomatic 12cm × 14cm × 17cm "mega" hemangioma (>10cm) of the left hepatic lobe. This lesion was initially refractory to transarterial embolization of the left hepatic artery, but was subsequently treated successfully with a left lateral extended hepatic segmentectomy (resection). We thus advocate a rational treatment algorithm for management of hepatic "mega" hemangiomas.
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Affiliation(s)
- William A Ketchum
- National Cancer Consortium, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD (WAK)
- Department of Surgery, Tripler Army Medical Center (TAMC), Honolulu, HI (KML-H, KI)
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM (EO)
- Department of Surgery/Cardiothoracic Surgery Service, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA (RDR)
| | - Kevin M Lin-Hurtubise
- National Cancer Consortium, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD (WAK)
- Department of Surgery, Tripler Army Medical Center (TAMC), Honolulu, HI (KML-H, KI)
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM (EO)
- Department of Surgery/Cardiothoracic Surgery Service, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA (RDR)
| | - Emily Ochmanek
- National Cancer Consortium, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD (WAK)
- Department of Surgery, Tripler Army Medical Center (TAMC), Honolulu, HI (KML-H, KI)
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM (EO)
- Department of Surgery/Cardiothoracic Surgery Service, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA (RDR)
| | - Kelli Ishihara
- National Cancer Consortium, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD (WAK)
- Department of Surgery, Tripler Army Medical Center (TAMC), Honolulu, HI (KML-H, KI)
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM (EO)
- Department of Surgery/Cardiothoracic Surgery Service, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA (RDR)
| | - Robert D Rice
- National Cancer Consortium, Walter Reed National Military Medical Center (WRNMMC), Bethesda, MD (WAK)
- Department of Surgery, Tripler Army Medical Center (TAMC), Honolulu, HI (KML-H, KI)
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, NM (EO)
- Department of Surgery/Cardiothoracic Surgery Service, Dwight D. Eisenhower Army Medical Center (DDEAMC), Fort Gordon, GA (RDR)
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Gao J, Fan RF, Yang JY, Cui Y, Ji JS, Ma KS, Li XL, Zhang L, Xu CL, Kong XL, Ke S, Ding XM, Wang SH, Yang MM, Song JJ, Zhai B, Nin CM, Guo SG, Xin ZH, Lu J, Dong YH, Zhu HQ, Sun WB. Radiofrequency ablation for hepatic hemangiomas: A consensus from a Chinese panel of experts. World J Gastroenterol 2017; 23:7077-7086. [PMID: 29093616 PMCID: PMC5656455 DOI: 10.3748/wjg.v23.i39.7077] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 09/13/2017] [Accepted: 09/19/2017] [Indexed: 02/07/2023] Open
Abstract
Recent studies have shown that radiofrequency (RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.
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Affiliation(s)
- Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Rui-Fang Fan
- Department of Hepatobiliary Surgery, Lanzhou General Hospital of Lanzhou Military Region, Lanzhou 730050, Gansu Province, China
| | - Jia-Yin Yang
- Center of Liver Transplantation, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yan Cui
- Department of General Surgery, the 306th Hospital of Chinese People’s Liberation Army, Beijing 100012, China
| | - Jian-Song Ji
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Wenzhou 32300, Zhejiang Province, China
| | - Kuan-Sheng Ma
- Institute of Hepatobiliary Surgery, Southwest Hospital, The Third Military Medical University, Chongqing 400038, China
| | - Xiao-Long Li
- Department of General Surgery, Affiliated Hospital of Chifeng University, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Long Zhang
- Department of General Surgery, Affiliated Hospital of Chifeng University, Chifeng 024000, Inner Mongolia Autonomous Region, China
| | - Chong-Liang Xu
- Department of Hepatobiliary Surgery, Rizhao People’s Hospital, Rizhao 276801, Shandong Province, China
| | - Xin-Liang Kong
- Department of Hepatobiliary Surgery, Rizhao People’s Hospital, Rizhao 276801, Shandong Province, China
| | - Shan Ke
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Xue-Mei Ding
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Shao-Hong Wang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Meng-Meng Yang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
| | - Jin-Jin Song
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Wenzhou 32300, Zhejiang Province, China
| | - Bo Zhai
- Department of Tumor Intervention, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Chun-Ming Nin
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
| | - Shi-Gang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang 122000, Liaoning Province, China
| | - Zong-Hai Xin
- Department of General Surgery, Zhanhua People’s Hospital, Zhanhua 256800, Shandong Province, China
| | - Jun Lu
- Department of General Surgery, Shandong Provincial People’s Hospital, Jinan 250021, Shandong Province, China
| | - Yong-Hong Dong
- Department of General Surgery, Shanxi Provincial People’s Hospital, Taiyuan 032200, Shanxi Province, China
| | - Hua-Qiang Zhu
- Department of General Surgery, Shandong Provincial People’s Hospital, Jinan 250021, Shandong Province, China
| | - Wen-Bing Sun
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100043, China
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