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Obana A, Sato Y. Autologous Partial Liver Transplantation for a Symptomatic Giant Hepatic Hemangioma. A Case Report. Transplant Proc 2022; 54:2787-2790. [PMID: 36404155 DOI: 10.1016/j.transproceed.2022.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/13/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Ayato Obana
- Department of General Surgery, Kashiwa Kousei General Hospital, Kashiwa, Chiba, Japan
| | - Yoshinobu Sato
- Department of General Surgery, Kashiwa Kousei General Hospital, Kashiwa, Chiba, Japan.
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2
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Zhao Y, Li XP, Hu YY, Jiang JC, Zhao LJ. Liver transplantation for giant hemangioma of the liver: A case report and review of the literature. Front Med (Lausanne) 2022; 9:985181. [PMID: 36186795 PMCID: PMC9523786 DOI: 10.3389/fmed.2022.985181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Large benign hepatic masses as a rare indication for liver transplantation have been reported less frequently. These liver transplantations are complex, with high intraoperative bleeding, high perioperative complication rates, and high mortality rates due to difficulties in visualization, especially when they have undergone various percutaneous operations or open surgery, resulting in severe perihepatic adhesions. Here is a case report of a patient admitted to our hospital who underwent liver transplantation after suffering from a giant hemangioma in liver transplantation for 10 years and who had received multiple interventional treatments ineffective in the past.
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3
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Ostojic A, Mrzljak A, Mikulic D. Liver transplantation for benign liver tumors. World J Hepatol 2021; 13:1098-1106. [PMID: 34630877 PMCID: PMC8473500 DOI: 10.4254/wjh.v13.i9.1098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/12/2021] [Accepted: 07/21/2021] [Indexed: 02/06/2023] Open
Abstract
Benign liver tumors are common lesions that are usually asymptomatic and are often found incidentally due to recent advances in imaging techniques and their widespread use. Although most of these tumors can be managed conservatively or treated by surgical resection, liver transplantation (LT) is the only treatment option in selected patients. LT is usually indicated in patients that present with life-threatening complications, when the lesions are diffuse in the hepatic parenchyma or when malignant transformation cannot be ruled out. However, due to the significant postoperative morbidity of the procedure, scarcity of available donor liver grafts, and the benign course of the disease, the indications for LT are still not standardized. Hepatic adenoma and adenomatosis, hepatic hemangioma, and hepatic epithelioid hemangioendothelioma are among the most common benign liver tumors treated by LT. This article reviews the role of LT in patients with benign liver tumors. The indications for LT and long-term outcomes of LT are presented.
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Affiliation(s)
- Ana Ostojic
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
| | - Danko Mikulic
- Department of Surgery, University Hospital Merkur, Zagreb 10000, Croatia.
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Xie QS, Chen ZX, Zhao YJ, Gu H, Geng XP, Liu FB. Outcomes of surgery for giant hepatic hemangioma. BMC Surg 2021; 21:186. [PMID: 33832476 PMCID: PMC8033692 DOI: 10.1186/s12893-021-01185-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The surgical indications for liver hemangioma remain unclear. METHODS Data from 152 patients with hepatic hemangioma who underwent hepatectomy between 2004 and 2019 were retrospectively reviewed. We analyzed characteristics including tumor size, surgical parameters, and variables associated with Kasabach-Merritt syndrome and compared the outcomes of laparoscopic and open hepatectomy. Here, we describe surgical techniques for giant hepatic hemangioma and report on two meaningful cases. RESULTS Most (63.8%) patients with hepatic hemangioma were asymptomatic. Most (86.4%) tumors from patients with Kasabach-Merritt syndrome were larger than 15 cm. Enucleation (30.9%), sectionectomy (28.9%), hemihepatectomy (25.7%), and the removal of more than half of the liver (14.5%) were performed through open (87.5%) and laparoscopic (12.5%) approaches. Laparoscopic hepatectomy is associated with an operative time, estimated blood loss, and major morbidity and mortality rate similar to those of open hepatectomy, but a shorter length of stay. 3D image reconstruction is an alternative for diagnosis and surgical planning for partial hepatectomy. CONCLUSION The main indication for surgery is giant (> 10 cm) liver hemangioma, with or without symptoms. Laparoscopic hepatectomy was an effective option for hepatic hemangioma treatment. For extremely giant hemangiomas, 3D image reconstruction was indispensable. Hepatectomy should be performed by experienced hepatic surgeons.
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Affiliation(s)
- Qing-Song Xie
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Zi-Xiang Chen
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Yi-Jun Zhao
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Heng Gu
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Xiao-Ping Geng
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Fu-Bao Liu
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China.
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Shi Y, Song J, Ding M, Tang X, Wang Z, Chi J, Wang T, Ji J, Zhai B. Microwave ablation versus transcatheter arterial embolization for large hepatic hemangiomas: clinical outcomes. Int J Hyperthermia 2020; 37:938-943. [PMID: 32762267 DOI: 10.1080/02656736.2020.1766122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the safety and effect of microwave ablation (MWA) compared with transcatheter arterial embolization (TAE) for the treatment of large hepatic hemangiomas. MATERIALS AND METHODS A total of 135 patients with symptomatic or/and enlarging hepatic hemangiomas (5-10 cm) from two centers underwent either MWA (n = 82) or TAE (n = 53) as first-line treatment. We compared the two groups in terms of radiologic response, clinical response, operative time, postoperative analgesic requirements, hospital stay and complications. RESULTS MWA had a significantly higher rate of complete radiologic response (89.0% vs. 37.7%, p<.001) and complete clinical response (88.6% vs. 69.2%, p=.046), fewer minor complications (43.9% vs. 66.0%, p=.019), shorter time of using analgesics (p<.001) and shorter hospital stays (p=.003) than did TAE. The operative time and major complications were comparable between the two groups. CONCLUSION Both MWA and TAE are safe and effective in treating patients with large hepatic hemangiomas. MWA had a higher rate of complete response than did TAE, and it was associated with fewer minor complications, faster recovery and shorter hospital stay.
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Affiliation(s)
- Yaoping Shi
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
| | - Jingjing Song
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Min Ding
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
| | - Xiaoyin Tang
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
| | - Zhi Wang
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
| | - Jiachang Chi
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
| | - Tao Wang
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
| | - Jiansong Ji
- Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, China
| | - Bo Zhai
- Department of Interventional Oncology, School of Medicine, Renji Hospital, Shanghai Jiao-tong University, Shanghai, China
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Tangled Up in Red Cells: A Large Liver Mass with Intravascular Hemolysis. Dig Dis Sci 2020; 65:1960-1963. [PMID: 32394332 DOI: 10.1007/s10620-020-06311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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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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Tang X, Ding M, Lu B, Chi J, Wang T, Shi Y, Wang Z, Cui D, Li P, Zhai B. Outcomes of ultrasound-guided percutaneous microwave ablation versus surgical resection for symptomatic large hepatic hemangiomas. Int J Hyperthermia 2020; 36:632-639. [PMID: 31244349 DOI: 10.1080/02656736.2019.1624837] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: Microwave ablation (MWA) has become increasingly popular as a minimally invasive treatment for benign and malignant liver tumors. However, few studies have demonstrated the benefits and disadvantages of MWA compared to surgical resection (SR) for large hepatic hemangiomas. This study aimed to evaluate the safety and effectiveness of MWA compared to SR for large (5-10 cm) hepatic hemangiomas. Methods and materials: This retrospective comparative study included 112 patients with large, symptomatic hepatic hemangiomas who had been treated with MWA (n = 44) or SR (n = 68) and followed up for a median of 44 months using enhanced computed tomography (CT) or magnetic resonance imaging (MRI). Intraoperative information, postoperative recovery time, postoperative discomfort and complications and treatment effectiveness between groups were compared using a chi-square test or an independent t-test. Results: The operative time was significantly shorter (31.3 ± 21.76 versus 148.1 ± 59.3 min, p < .001) and the blood loss (10.2 ± 60.6 versus 227.9 ± 182.9 mL, p < .0001) and rate of prophylactic abdominal drainage [1 (2.3%) versus 57 (83.8%), p < .001] were significantly lower in the MWA group than in the SR group. Postoperative recovery of the MWA group in regard to indwelling catheter time, normal diet time, incision cicatrization time and hospital stay (p < .001) was significantly better than the SR group. However, no statistically significant difference in effectiveness was noted between the groups (p = .58). Conclusions: MWA may be as effective as SR, and potentially safer for treating large, symptomatic hepatic hemangiomas. To confirm our findings, large-sample, multicentered, randomized controlled trials are needed.
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Affiliation(s)
- Xiaoyin Tang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Min Ding
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Bingwei Lu
- b Department of Anesthesiology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Jiachang Chi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Tao Wang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Yaoping Shi
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Zhi Wang
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Dan Cui
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Ping Li
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
| | - Bo Zhai
- a Department of Tumor Interventional Oncology, Renji Hospital, School of Medicine , Shanghai Jiaotong University , Shanghai , China
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Prodromidou A, Machairas N, Garoufalia Z, Kostakis ID, Tsaparas P, Paspala A, Stamopoulos P, Sotiropoulos GC. Liver Transplantation for Giant Hepatic Hemangioma: A Systematic Review. Transplant Proc 2019; 51:440-442. [PMID: 30879561 DOI: 10.1016/j.transproceed.2019.01.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite their benign nature, liver hemangiomas (LH) are lesions that can cause major complications requiring intervention. Liver transplantation (LT) has been suggested as an effective treatment option in selected patients with giant LHs causing severe symptoms and cannot be treated otherwise. The aim of our study was to investigate the indications, aspects and post-operative outcomes of patients with a LH who underwent LT. MATERIALS AND METHODS A meticulous search of the literature was performed. Studies presenting cases of LT due to LH were evaluated. Studies presenting patients characteristics and symptoms, aspects of the disease, transplantation indications and details were selected. RESULTS Fifteen studies were included in the present review that involved 16 patients. Among them, 4 were male while the remaining 12 were female with a mean age of 39.9 ± 8.7 years. The main indications for LT included respiratory distress, massive hemorrhage, Kasabach-Merritt syndrome, and unsuccessful previous treatment strategies. Four patients were transplanted from living donors and the remaining 12 from cadaveric donors. No post-operative deaths were reported and all patients returned to normal activity. No deaths during the long-term follow-up were reported. CONCLUSIONS LH is an extremely rare indication for LT. Nevertheless, the currently available data suggest that LT is a safe and efficient treatment in the management of symptomatic or complicated LH in selected patients.
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Affiliation(s)
- A Prodromidou
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
| | - N Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece; 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Z Garoufalia
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - I D Kostakis
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Tsaparas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - A Paspala
- 3rd Department of Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - P Stamopoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - G C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
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Wang Z, Tang X, Qi X, Shi Y, Chi J, Li P, Zhai B. Feasibility, safety, and efficacy of ultrasound-guided percutaneous microwave ablation for giant hepatic hemangioma. Int J Hyperthermia 2018; 35:246-252. [PMID: 30130992 DOI: 10.1080/02656736.2018.1493541] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hepatic hemangioma is a common benign liver tumor. The majority of cases are asymptomatic and require no specific treatment. The aim of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) for symptomatic or enlarging giant hepatic hemangioma (≥10 cm). METHODS From December 2013 to June 2016, 12 patients with giant hepatic hemangioma (≥10 cm) underwent ultrasound-guided percutaneous MWA, and ablation-related complications were observed. All patients were followed up with magnetic resonance or enhanced CT imaging at one month postoperatively to evaluate efficacy. RESULTS This study included a total of 13 giant hepatic hemangiomas (mean: 11.7 ± 1.6 cm) in 12 patients who initially underwent 16 sessions of MWA; three lesions were treated with two sessions of planned ablation. The average ablation time for a single hepatic hemangioma was 39.0 ± 14.4 minutes. Two patients had acute postoperative non-oliguric renal insufficiency without intra-abdominal hemorrhage, liver failure or other complications. Initially, complete ablation was achieved in ten lesions in nine patients (76.9%, 10/13). One patient underwent a second session of MWA at 5 months postoperatively due to fast growing residual tissue; complete necrosis was achieved after treatment. The remaining two cases did not receive any invasive treatment due to small residual volumes. The total complete ablation rate was 84.6% (11/13). CONCLUSION Image-guided MWA is a safe, feasible, effective treatment for giant hepatic hemangioma; these findings may open a new avenue for treatment.
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Affiliation(s)
- Zhi Wang
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Xiaoyin Tang
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Xingxing Qi
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Yaoping Shi
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Jiachang Chi
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Ping Li
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
| | - Bo Zhai
- a Department of Interventional Oncology , Renji Hospital, School of Medicine, Shanghai Jiaotong University , Shanghai , China
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Yang Z, Tan H, Liu X, Sun Y. Extremely Giant Liver Hemangioma (50 cm) with Kasabach-Merritt Syndrome. J Gastrointest Surg 2017; 21:1748-1749. [PMID: 28424986 DOI: 10.1007/s11605-017-3429-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 04/10/2017] [Indexed: 01/31/2023]
Abstract
A 33-year-old male has been found with a giant liver hemangioma of initial size 29 cm for 5 years. He received arterial embolization twice in order to shrink the tumor; however, no effect was obtained. The tumor had rapidly grown to 50 cm and caused abnormalities in the hematological and coagulative systems. Preoperative computed tomography revealed that the right hepatic vein, right hepatic artery, and right portal vein were not involved by the hemangioma. Resection of the giant liver hemangioma was successfully performed after intraoperative intentional bloodletting with concurrent blood salvage. All hematological and coagulative abnormalities had returned to normal after the procedure.
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Affiliation(s)
- Zhiying Yang
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China.
| | - Haidong Tan
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Xiaolei Liu
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
| | - Yongliang Sun
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Hepingli, Beijing, 100029, China
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Liu X, Yang Z, Tan H, Xu L, Sun Y, Si S, Liu L, Zhou W, Huang J. Giant liver hemangioma with adult Kasabach-Merritt syndrome: Case report and literature review. Medicine (Baltimore) 2017; 96:e7688. [PMID: 28767598 PMCID: PMC5626152 DOI: 10.1097/md.0000000000007688] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
RATIONALE Adult Kasabach-Merritt syndrome associated with giant liver hemangioma is rare; to date, most reports have been single-case reports, and no multi-case reports or literature reviews are available. DIAGNOSES We conducted a retrospective analysis of 5 cases of adult Kasabach-Merritt syndrome associated with giant liver hemangioma treated at our hospital between 2011 and 2016. All 5 patients had varying severities of leukopenia, anemia, thrombocytopenia, prolonged prothrombin time, and hypofibrinogenemia. INTERVENTIONS All the patients underwent surgery: 2 patients had left hemihepatectomy; 1 had enucleation; 1 had a right hemihepatectomy; and 1 had a left trisectionectomy. OUTCOMES The 5 patients had an average operative time of 6.9 hours and an average blood loss of 3200 mL. One patient developed a biliary fistula (grade II) after the operation. There was no mortality among 5 patients. The white blood cell counts, hemoglobin, platelets, and prothrombin times of all 5 patients returned to normal after the operation. To date, a total of 11 cases of adult Kasabach-Merritt syndrome associated with giant liver hemangioma have been reported, of which 8 patients underwent surgery, and their platelets and coagulation returned to normal after the operation. LESSONS Adult Kasabach-Merritt syndrome associated with giant liver hemangioma is uncommon, and surgical treatment is risky. However, resection of the tumor corrected the abnormalities in hematological and coagulative systems.
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Lee JH, Yoon CJ, Kim YH, Han HS, Cho JY, Kim H, Jang ES, Kim JW, Jeong SH. Living-donor liver transplantation for giant hepatic hemangioma with diffuse hemangiomatosis in an adult: a case report. Clin Mol Hepatol 2017; 24:163-168. [PMID: 28719965 PMCID: PMC6038937 DOI: 10.3350/cmh.2017.0002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/03/2017] [Indexed: 12/26/2022] Open
Abstract
Hepatic hemangioma represents the most common benign primary hepatic neoplasm. Although most such tumors are small and asymptomatic, giant hepatic hemangioma is frequently symptomatic, and requires intervention. Moreover, diffuse multiple hepatic hemangiomatosis occupying almost the entire liver is extremely rare in adults, and the optimal management for this condition is unclear. We report a case of a rapidly growing, symptomatic giant hepatic hemangioma with diffuse hepatic hemangiomatosis in a 50-year-old female patient who was treated by living-donor liver transplantation. This case shows malignant behavior of a benign hemangioma that required liver transplantation. Although this case could not meet the criteria for transplantation according to the MELD (model for end-stage liver disease) score system, it should be considered as an exceptional indication for deceased-donor liver allocation. Further studies of the mechanism underlying hemangioma growth are warranted.
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Affiliation(s)
- Ju Hyun Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Chang Jin Yoon
- Department of Radiology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Young Hoon Kim
- Department of Radiology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Seongnam, Korea
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Li G, Mu X, Huang X, Qian X, Qin J, Tan Z, Zhang W, Xu X, Tan S, Zhu Z, Li W, Wang X, Wang X, Sun B. Liver transplantation using the otherwise-discarded partial liver resection graft with hepatic benign tumor: Analysis of a preliminary experience on 15 consecutive cases. Medicine (Baltimore) 2017; 96:e7295. [PMID: 28723742 PMCID: PMC5521882 DOI: 10.1097/md.0000000000007295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE The shortage of available donor organs limits the development of liver transplantation. This case-serial study presents a novel way to expand the donor pool by using the other-wise discarded partial liver resection graft with hepatic benign tumor. PATIENT CONCERNS From 2012 to 2016, 15 patients with hepatic lesions were admitted to our hospital. 12 patients suffered from right epigastric discomfort and 3 patients worried about uncertain diagnosis. INTERVENTIONS Regular hepatic lobectomy was performed for all patients and after back-table management the resected partial liver grafts were used for patients with end-stage liver disease for liver transplantation. OUTCOMES All patients had improved liver function within 1 week of transplantation. Patients had no serious small-for-size syndrome despite graft-to-recipient weight ratio less than 0.8%. Back-table hepatic venous reconstruction with prosthetic vascular grafts was performed without serious early complications, and late thrombosis in vessel graft did not affect liver function. Postoperative computed tomography scans demonstrated a remarkable growth in graft volume and a continuous decrease in hemangioma in recipients using the grafts with hemangioma. One patient died from pulmonary embolism on day 7 after transplant, and the rest of 14 recipients had been surviving well, especially recipient 1 for more than 4 years, although 3 recipients had tumor recurrence and had been treated with sorafenib. DIAGNOSES The postoperative pathological diagnosis reported cavernous hemangioma (n = 11), perivascular epithelioid cell tumor (n = 2), inflammatory pseudotumor for (n = 1), and focal nodular hyperplasia (n = 1). LESSONS The partial liver grafts with hepatic benign tumors are safe for liver transplantation. In addition, prosthetic vascular grafts can be used for hepatic venous outflow reconstruction, especially in right lobe liver transplantation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Shanbai Tan
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province
| | - Zhijun Zhu
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University
| | - Wei Li
- Institute of Liver Transplantation, the General Hospital of Armed Forced Police, Beijing
| | - Xuan Wang
- Department of Surgical Oncology, The Eighty-First Hospital of People's Liberation Army, Nanjing, Jiangsu Province, P.R. China
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Liu X, Yang Z, Tan H, Liu L, Xu L, Sun Y, Si S, Huang J, Zhou W. Characteristics and operative treatment of extremely giant liver hemangioma >20 cm. Surgery 2017; 161:1514-1524. [PMID: 28126252 DOI: 10.1016/j.surg.2016.12.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/03/2016] [Accepted: 12/07/2016] [Indexed: 02/07/2023]
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16
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Jing L, Liang H, Caifeng L, Jianjun Y, Feng X, Mengchao W, Yiqun Y. New recognition of the natural history and growth pattern of hepatic hemangioma in adults. Hepatol Res 2016; 46:727-33. [PMID: 26492419 DOI: 10.1111/hepr.12610] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 12/12/2022]
Abstract
AIM Surgical indications for hepatic hemangiomas are still not clearly defined due to limited data on their natural history. This study aimed to investigate the natural history and growth pattern of hepatic hemangiomas in adults. METHODS From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled. A routine follow up was performed to observe the natural history of the lesions and their tendency to cause complications. RESULTS A total of 236 patients were enrolled in the study. The median size of hemangiomas was 4.5 cm (range, 0.6-19.2). During a median follow-up period of 48 months (range, 3-266), 61.0% patients had hemangiomas that increased in size, 23.7% patients had stable lesions and 8.5% patients had hemangiomas that decreased in size. The peak growth period of hemangiomas was in patients of less than 30 years of age (0.46 ± 0.41 cm/year) and the growth rate decreased significantly after 50 years of age (0.21 ± 0.40 cm/year). Hemangiomas of less than 2 cm had the lowest growth rate (0.16 ± 0.42 cm/year). The peak growth rate of hemangioma size was 8-10 cm (0.80 ± 0.62 cm/year), then decreased rapidly to 0.47 ± 0.91 cm/year while the hemangiomas were of more than 10 cm. Only nine patients had severe symptoms caused by hemangioma. No patients presented with hemangioma-related complications. CONCLUSION The majority of hepatic hemangiomas have the tendency to increase in size but rarely cause complications. All the hemangiomas can be safely managed by observation, and surgery is only considered for patients with severe complications.
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Affiliation(s)
- Li Jing
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Huang Liang
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Liu Caifeng
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan Jianjun
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xu Feng
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wu Mengchao
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan Yiqun
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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17
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Lange UG, Bucher JN, Schoenberg MB, Benzing C, Schmelzle M, Gradistanac T, Strocka S, Hau HM, Bartels M. Orthotopic liver transplantation for giant liver haemangioma: A case report. World J Transplant 2015; 5:354-359. [PMID: 26722664 PMCID: PMC4689947 DOI: 10.5500/wjt.v5.i4.354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 07/24/2015] [Accepted: 11/25/2015] [Indexed: 02/05/2023] Open
Abstract
In liver haemangiomas, the risk of complication rises with increasing size, and treatment can be obligatory. Here we present a case of a 46-year-old female who suffered from a giant haemangioma causing severe portal hypertension and vena cava compression, leading to therapy refractory ascites, hyponatremia and venostasis-associated thrombosis with pulmonary embolism. The patients did not experience tumour rupture or consumptive coagulopathy. Surgical resection was impossible because of steatosis of the non-affected liver. Orthotopic liver transplantation was identified as the only treatment option. The patient’s renal function remained stable even though progressive morbidity and organ allocation were improbable according to the patient’s lab model for end-stage liver disease (labMELD) score. Therefore, non-standard exception status was approved by the European organ allocation network “Eurotransplant”. The patient underwent successful orthotopic liver transplantation 16 mo after admission to our centre. Our case report indicates the underrepresentation of morbidity associated with refractory ascites in the labMELD-based transplant allocation system, and it indicates the necessity of promptly applying for non-standard exception status to enable transplantation in patients with a severe clinical condition but low labMELD score. Our case highlights the fact that liver transplantation should be considered early in patients with non-resectable, symptomatic benign liver tumours.
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18
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Onishi Y, Kamei H, Imai H, Kurata N, Hori T, Ogura Y. Successful adult-to-adult living donor liver transplantation using liver allograft after the resection of hemangioma: A suggestive case for a further expansion of living donor pool. Int J Surg Case Rep 2015; 16:166-170. [PMID: 26476494 PMCID: PMC4643476 DOI: 10.1016/j.ijscr.2015.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/17/2015] [Accepted: 09/30/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Hepatic hemangioma is one of the most common benign liver tumors. There are few published reports regarding liver transplantation using liver allografts with hemangioma. PRESENTATION OF CASE A 45-year-old man was evaluated as a living donor for 19-year-old son with cirrhosis due to hepatic fibrosis. Preoperative investigations revealed 20 and 7mm hemangiomas, at segment 2 (S2) and 4 (S4) respectively. Considering the anatomical relation of S2 hemangioma and Glisson 2, liver graft was designed as left lobe excluded S2 hemangioma by partial resection. Estimated graft recipient weight ratio (GRWR) even after partial resection of hemangioma was reasonable. During the donor operation, a partial hepatic resection of S2 hemangioma was performed. Intraoperative pathologic findings revealed a cavernous hemangioma, and then, the left hepatic graft with the caudate lobe was harvested. Actual GRWR was 0.90%. Donor's postoperative course was uneventful. Recipient's post-operative course was almost uneventful. Postoperative computed tomography of the recipient showed the graft regeneration without increase or recurrence of hemangioma. DISCUSSION Organ shortage is a major concern in the field of liver transplantation. A novel donor source with a further option is extremely crucial for a guarantee of liver transplantation. We experienced the first case of adult-to-adult living donor liver transplantation using liver allograft after the resection of hemangioma. CONCLUSION We advocate that the use of liver allograft with hemangiomas in adult-to-adult LDLT settings can be remarkable strategy to reduce the problem of organ shortage without any unfavorable consequences in both living donor and recipient.
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Affiliation(s)
- Yasuharu Onishi
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.
| | - Hideya Kamei
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Hisashi Imai
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Nobuhiko Kurata
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Tomohide Hori
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
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19
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Tang XY, Wang Z, Wang T, Cui D, Zhai B. Efficacy, safety and feasibility of ultrasound-guided percutaneous microwave ablation for large hepatic hemangioma. J Dig Dis 2015; 16:525-30. [PMID: 24945806 DOI: 10.1111/1751-2980.12169] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy, safety and feasibility of microwave ablation (MWA) for large (5-10 cm in diameter) hepatic hemangioma. METHODS In all, 46 patients with 47 large hepatic hemangiomas were treated with ultrasound-guided percutaneous MWA. The effect of MWA for all patients was evaluated by enhanced magnetic resonance imaging or computed tomography within two months after ablation. RESULTS A total of 27 male and 19 female patients were enrolled, with an average age of 46 ± 11 years. The average size of hemangiomas was 6.3 ± 1.4 cm (range 5.0-9.6 cm). The initial complete ablation rate was 91.5% (43/47) and the volume of ablated lesions was significantly reduced. The rate of complete necrosis was not associated with the tumor size or location (P = 0.899 and 0.758, respectively). The total complete ablation rate was 95.7% (45/47). Major complications included acute renal dysfunction, hyperbilirubinemia and pleural effusion. No procedure-related death occurred. The average hospitalization stay was 5.7 ± 2.5 days (range 3-17 days). During a follow-up period of 18.2 months (range 4-40 months), one patient developed local tumor progression at the radiofrequency ablation site. Three patients had new hemangiomas in other sites of the liver. At the end of the study all patients were alive and no severe complications occurred. CONCLUSION Image-guided MWA is an effective and safe treatment for large hepatic hemangiomas, and can potentially be regarded as the first-line therapy.
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Affiliation(s)
- Xiao Yin Tang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhi Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Tao Wang
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Dan Cui
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Bo Zhai
- Department of Interventional Oncology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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20
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Sharma A, Kaspar M, Siddiqui M, Kim J. Enucleation after Embolization of Liver Failure-Causing Giant Liver Hemangioma. AMERICAN JOURNAL OF CASE REPORTS 2015; 16:563-7. [PMID: 26301888 PMCID: PMC4554336 DOI: 10.12659/ajcr.893298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patient: Female, 73 Final Diagnosis: Giant liver hemangioma Symptoms: Abdominal discomfort • abdominal enlargement • Icterus Medication: — Clinical Procedure: Enucleation after embolization of liver failure-causing giant liver Specialty: Surgery
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Affiliation(s)
- Amit Sharma
- Division of Transplantation Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Matthew Kaspar
- Division of Transplantation Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Mohammad Siddiqui
- Division of Transplantation Surgery, Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA
| | - Joohyun Kim
- Division of Transplantation Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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21
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Kang LY, Huang FD, Liu YY. Blunt abdominal injury with rupture of giant hepatic cavernous hemangioma and laceration of the spleen. Hepatobiliary Pancreat Dis Int 2015; 14:109-10. [PMID: 25655300 DOI: 10.1016/s1499-3872(14)60310-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 41-year-old woman with blunt abdominal trauma due to a motor vehicle accident presented to our emergency department. The patient had a history of a giant hepatic cavernous hemangioma. Emergency exploratory laparotomy was performed for suspected intra-abdominal bleeding with abdominal compartment syndrome, and more than 4 liters of blood and blood clots were removed. An active bleeding laceration (5 cm) of a hepatic cavernous hemangioma was detected in segment III of the liver. The bleeding was controlled by sutures, Teflon patches and tamponade. The abdomen was closed temporarily using the vacuum-assisted method. Because of the presence of persistent fresh blood through abdominal drainage at a rate of >1 L/h, splenectomy was performed to control the bleeding again by sutures and Teflon patches. Finally, the abdomen was closed using a biologic mesh. The patient was discharged home 30 days after trauma. Bleeding of trauma-caused hepatic hemangioma is rare, but splenic injury due to blunt abdominal trauma is common. An in-depth investigation is necessary to avoid second intervention.
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Affiliation(s)
- Lung-Yun Kang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, China.
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22
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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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23
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Hoekstra LT, Bieze M, Erdogan D, Roelofs JJTH, Beuers UHW, van Gulik TM. Management of giant liver hemangiomas: an update. Expert Rev Gastroenterol Hepatol 2013; 7:263-8. [PMID: 23445235 DOI: 10.1586/egh.13.10] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Liver hemangiomas are the most common benign liver tumors and are usually incidental findings. Liver hemangiomas are readily demonstrated by abdominal ultrasonography, computed tomography or magnetic resonance imaging. Giant liver hemangiomas are defined by a diameter larger than 5 cm. In patients with a giant liver hemangioma, observation is justified in the absence of symptoms. Surgical resection is indicated in patients with abdominal (mechanical) complaints or complications, or when diagnosis remains inconclusive. Enucleation is the preferred surgical method, according to existing literature and our own experience. Spontaneous or traumatic rupture of a giant hepatic hemangioma is rare, however, the mortality rate is high (36-39%). An uncommon complication of a giant hemangioma is disseminated intravascular coagulation (Kasabach-Merritt syndrome); intervention is then required. Herein, the authors provide a literature update of the current evidence concerning the management of giant hepatic hemangiomas. In addition, the authors assessed treatment strategies and outcomes in a series of patients with giant liver hemangiomas managed in our department.
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Affiliation(s)
- Lisette T Hoekstra
- Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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24
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Successful Treatment of Kasabach-Merritt Phenomenon With Intralesional Corticosteroid Injections. Ann Plast Surg 2012; 69:627-32. [DOI: 10.1097/sap.0b013e3182749b5c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Sood D, Mohan N, Singh A, Buxi TBS, Nundy S, Soin AS. Living donor liver transplantation for giant cavernous hemangioma of liver in a child. Pediatr Transplant 2011; 15:E135-8. [PMID: 20598089 DOI: 10.1111/j.1399-3046.2010.01320.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 10-yr-old girl presented with a seven-month history of upper abdominal discomfort and weight loss. Physical examination revealed an abdominal lump in the right hypochondrium and epigastrium. Ultrasound examination and a computerized tomographic scan showed a large lobulated mass arising from segments I, 1V, and VIII of liver with arteriovenous shunting and multiple small masses in segments VI and VII. An initial diagnosis of hemangioendothelioma with metastasis was made elsewhere following which she received chemotherapy. She had persistent abdominal discomfort because of which she became dependent on narcotics. The patient had fever because of tumor necrosis and also developed peripheral neuropathy. Finally, owing to progressively worsening of symptoms, she underwent left lobe living donor liver transplantation. Histopathological examination showed the mass to be a cavernous hemangioma, and the patient is now well.
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Affiliation(s)
- Disha Sood
- Department of Surgical Gastroenterology & Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India
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26
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Vagefi PA, Klein I, Gelb B, Hameed B, Moff SL, Simko JP, Fix OK, Eilers H, Feiner JR, Ascher NL, Freise CE, Bass NM. Emergent orthotopic liver transplantation for hemorrhage from a giant cavernous hepatic hemangioma: case report and review. J Gastrointest Surg 2011; 15:209-14. [PMID: 20549381 PMCID: PMC3023038 DOI: 10.1007/s11605-010-1248-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 05/25/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Cavernous hemangiomas represent the most common benign primary hepatic neoplasm, often being incidentally detected. Although the majority of hepatic hemangiomas remain asymptomatic, symptomatic hepatic hemangiomas can present with abdominal pain, hemorrhage, biliary compression, or a consumptive coagulopathy. The optimal surgical management of symptomatic hepatic hemangiomas remains controversial, with resection, enucleation, and both deceased donor and living donor liver transplantation having been reported. CASE REPORT We report the case of a patient found to have a unique syndrome of multiorgan cavernous hemangiomatosis involving the liver, lung, omentum, and spleen without cutaneous involvement. Sixteen years following her initial diagnosis, the patient suffered from intra-abdominal hemorrhage due to her giant cavernous hepatic hemangioma. Evidence of continued bleeding, in the setting of Kasabach-Merritt Syndrome and worsening abdominal compartment syndrome, prompted MELD exemption listing. The patient subsequently underwent emergent liver transplantation without complication. CONCLUSION Although cavernous hemangiomas represent the most common benign primary hepatic neoplasm, hepatic hemangioma rupture remains a rare presentation in these patients. Management at a center with expertise in liver transplantation is warranted for those patients presenting with worsening DIC or hemorrhage, given the potential for rapid clinical decompensation.
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Affiliation(s)
- Parsia A. Vagefi
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
- Department of Surgery, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143 USA
| | - Ingo Klein
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Bruce Gelb
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Bilal Hameed
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Stephen L. Moff
- Department of Gastroenterology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA 95051 USA
| | - Jeff P. Simko
- Department of Pathology, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Oren K. Fix
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Helge Eilers
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143 USA
| | - John R. Feiner
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Nancy L. Ascher
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Chris E. Freise
- Division of Transplant Surgery, University of California, San Francisco, San Francisco, CA 94143 USA
| | - Nathan M. Bass
- Division of Gastroenterology, University of California, San Francisco, San Francisco, CA 94143 USA
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Pulvirenti E, Toro A, Di Carlo I. An update on indications for treatment of solid hepatic neoplasms in noncirrhotic liver. Future Oncol 2010; 6:1243-50. [DOI: 10.2217/fon.10.85] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During recent years, we have experienced an increased detection of previously unsuspected liver masses in otherwise asymptomatic patients owing to the widespread application of imaging techniques. Regardless of the malignant or cystic tissues, a remarkable percentage of these masses are represented by benign solid neoplasms. Treatment of benign liver tumors still represents a major concern in the hepatic surgery field. Indications for surgery have remained unchanged for many years, but the laparoscopic approach could determine in some cases a broadening of indications, which may result in overtreatment. In this article, the main surgical indication for hepatic hemangioma, focal nodular hyperplasia and hepatocellular adenoma are discussed with regard to the most recent advancements in literature. In addition, a separate section deals with the role of laparoscopy in the treatment of benign liver neoplasms.
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Affiliation(s)
- Elia Pulvirenti
- Department of Surgical Sciences, Organ Transplantation & Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
| | - Adriana Toro
- Department of Surgical Sciences, Organ Transplantation & Advanced Technologies, University of Catania, Cannizzaro Hospital, Via Messina 829, 95126 Catania, Italy
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Schwartz ME, Roayaie S, Konstadoulakis MM, Gomatos IP, Miller CM. The Mount Sinai experience with orthotopic liver transplantation for benign tumors: brief report and literature review: case reports. Transplant Proc 2008; 40:1759-62. [PMID: 18589189 DOI: 10.1016/j.transproceed.2008.02.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Accepted: 02/26/2008] [Indexed: 02/09/2023]
Abstract
Orthotopic liver transplantation (OLT) is performed for benign hepatic lesions that are symptomatic, too large to be resected, have a malignant transformation potential, cause debilitating/life-threatening manifestations, or in patients experiencing posthepatectomy acute liver failure. Among benign tumors, polycystic liver disease (PLD) is the most common indication for OLT alone, or combined liver-kidney transplantation. Our 10-year experience with OLT for benign tumors includes two patients with PLD and one with a benign giant fibrous tumor. In this report, we present our experience with OLT for benign liver tumors, commenting on relevant published studies.
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Affiliation(s)
- M E Schwartz
- Recanati-Miller Transplantation Institute, Mount Sinai School of Medicine, New York, NY, USA
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29
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Moya Herráiz Á, Torres-Quevedo R, Mir Pallardó J. Trasplante hepático en pacientes con lesiones hepáticas benignas. Cir Esp 2008; 84:60-6. [DOI: 10.1016/s0009-739x(08)72135-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Meguro M, Soejima Y, Taketomi A, Ikegami T, Yamashita YI, Harada N, Itoh S, Hirata K, Maehara Y. Living donor liver transplantation in a patient with giant hepatic hemangioma complicated by Kasabach-Merritt syndrome: report of a case. Surg Today 2008; 38:463-8. [PMID: 18560973 DOI: 10.1007/s00595-007-3623-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Accepted: 07/16/2007] [Indexed: 02/07/2023]
Abstract
We herein present a case of unresectable giant hepatic hemangiomas with Kasabach-Merritt syndrome which was successfully treated by living donor liver transplantation using a left lobe graft. The patient was a 45-year-old woman who complained of abdominal distension. Two sessions of transarterial embolization were performed, but failed to reduce the size of the tumor. The hepatic tumors were thus judged untreatable and the only option for a cure was to offer living donor liver transplantation, because of the tumor size, its location, and the association with Kasabach-Merritt syndrome. A left lobe graft with the middle hepatic vein donated by her 47-year-old brother was transplanted under venovenous bypass. The postoperative course of the recipient was complicated by small-for-size graft syndrome, which developed after episodes of acute cellular rejection on postoperative day 8 and sepsis on day 31. The patient successfully recovered from the complications and was discharged on day 72, and she remains well at 10 months after transplantation. In conclusion, living donor liver transplantation was found to be an effective option for the treatment of a patient with unresectable giant hepatic hemangiomas complicated by Kasabach-Merritt syndrome.
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Affiliation(s)
- Makoto Meguro
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Yoshida A, Okuda K, Sakai H, Kinoshita H, Aoyagi S. 3D anatomical variations of hepatic vasculature and bile duct for right lateral sector of liver with special reference to transplantation. Kurume Med J 2008; 55:43-53. [PMID: 19571492 DOI: 10.2739/kurumemedj.55.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
To achieve a safer living related liver transplantation (LRLT) using the right lateral sector, anatomical variations of the portal vein, hepatic artery and bile duct for the right lateral sector and their three dimentional (3D) relationship were assessed by integrated 3D-CT images. 52 patients who underwent contrast enhanced multi-detector row CT (MD-CT) and MD-CT cholangiography were enrolled. Data from contrast enhanced MD-CT were used to reconstruct the 3D images of the hepatic artery and portal vein. 3D images reconstructed from MD-CT data of the hepatic artery, portal vein and bile duct were integrated into a single image. The dual branching of the right lateral portal vein was observed in 22 (42.3%) patients. Three (5.8%) had dual right lateral ducts and 14 (26.9%) had dual right lateral arteries. Among them, "south-turning" artery and "north-turning" bile duct was observed in 22 (42.3%). "South-turning" artery and "south-turning" bile duct were 3 (5.8%). "North-turning" artery and "north-turning" bile duct were 2 (7.4%). Only 27 (51.9%) had single portal vein, bile duct and artery for the right lateral sector, those were preferable as candidates for right lateral sector graft transplantation. 3D anatomical variations of portal vein, artery and bile duct for the right lateral sector were complexed, and only half of the donor candidates had preferable hepatic structures for right lateral sector graft transplantation. Understanding of the 3D hepatic structures by 3D-CT may contribute to a better definition of anatomical contraindications for LRLT which may further results in more safe and widely applied right lateral sector graft LRLT.
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Affiliation(s)
- Atsushi Yoshida
- Department of Surgery, Kurume University School of Medicine, Kurume 830-0011, Japan
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Ikegami T, Soejima Y, Taketomi A, Kayashima H, Sanefuji K, Yoshizumi T, Harada N, Yamashita YI, Maehara Y. Extracorporeal hepatic resection for unresectable giant hepatic hemangiomas. Liver Transpl 2008; 14:115-7. [PMID: 18161765 DOI: 10.1002/lt.21272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Watanabe T, Segami K, Sasaki T, Kawashima H, Enomoto T, Jinnouchi Y, Koizumi S, Tobe N, Sakurai J, Shimamura T, Suda T, Asakura T, Nakano H, Ichiroh T, Otsubo T. A rare case of concomitant huge exophytic gastrointestinal stromal tumor of the stomach and Kasabach-Merritt phenomenon. World J Surg Oncol 2007; 5:59. [PMID: 17540038 PMCID: PMC1892781 DOI: 10.1186/1477-7819-5-59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 06/01/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We report an extremely rare case of concomitant huge exophytic GIST of the stomach and Kasabach-Merritt phenomenon (KMP). CASE PRESENTATION The patient was a 67-year-old man experiencing abdominal distension since September 2006. A physical examination revealed a 25 x 30 cm hard mass that was palpable in the middle and lower left abdomen minimal intrinsic mobility and massive ascites. Since the admitted patient was diagnosed with DIC, surgery could not be performed. The patient received a platelet transfusion and the DIC was treated. Due to this treatment, the platelet count recovered to 7.0 x 10(4); tumor resection was performed at 16 days after admission. Laparotomy revealed a huge extraluminal tumor arising from the greater curvature of the stomach that measured 25 x 30 cm and had not ruptured into the peritoneal cavity or infiltrated other organs. Partial gastric resection was performed. The resected mass measured 25 x 25 x 20 cm. In cross section, the tumor appeared hard and homogenous with a small polycystic area. Histopathology of the resected specimen showed large spindle cell GIST with >5/50 HPF (high-power field) mitotic activity. The postoperative course was uneventful, and the coagulopathy improved rapidly. CONCLUSION Since the characteristic of tumor in this case was hypervascularity with bleeding and necrotic lesions, coagulopathy was thought to be caused by the trapping of platelets within a large vasculized tumor mass.
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Affiliation(s)
- Taiji Watanabe
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Kohei Segami
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Takahiro Sasaki
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Hatsuya Kawashima
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Takeharu Enomoto
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Yuji Jinnouchi
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Satoshi Koizumi
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Naotaka Tobe
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Joh Sakurai
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Tsukasa Shimamura
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Tadashi Suda
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Takeshi Asakura
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Hiroshi Nakano
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Tanaka Ichiroh
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
| | - Takehito Otsubo
- Department of Gastoenterological and General Surgery, St. Marianna University School of Medicine 2-16-1, Sugao Miyamae, Kawasaki, Kanagawa, Japan
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Aucejo FN, Ortiz WA, Kelly D, Winans C, Vogt D, Eghtesad B, Fung JJ, Miller CM. Expanding the donor pool: safe transplantation of a cadaveric liver allograft with a 10 cm cavernous hemangioma--a case report. Liver Transpl 2006; 12:687-9. [PMID: 16555332 DOI: 10.1002/lt.20766] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Federico N Aucejo
- Department of General Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Hashimoto T, Sugawara Y, Kishi Y, Akamatsu N, Matsui Y, Kokudo N, Makuuchi M. Reconstruction of the middle hepatic vein tributary in a right lateral sector graft. Liver Transpl 2005; 11:309-313. [PMID: 15719389 DOI: 10.1002/lt.20349] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A right lateral sector graft (RLSG) was devised to overcome graft-size disparity in living donor liver transplantation (LDLT). When the RLSG has a middle hepatic vein (MHV) tributary, which drains a significant part of segment VI, the MHV tributary (V6) should be reconstructed to avoid congestion of the RLSG. In the donor operation, congestive area of segment VI was identified by 5 minutes of simultaneous clamping of V6 and the hepatic artery to the right lateral sector. An RLSG was harvested, preserving the V6 orifice. After plastic surgery of outflow veins including V6 using venous grafts, the RLSG was implanted into the recipient. In 19 patients who received RLSG in our institution, 2 RLSGs required V6 reconstruction. The postoperative courses of these two recipients and donors were uneventful. In conclusion, the present technique might be useful to avoid complications due to congestion and poor function of the relevant graft area and might help to expand the indications for RLSG.
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Affiliation(s)
- Takuya Hashimoto
- Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Ferraz AAB, Sette MJA, Maia M, Lopes EPDA, Godoy MMG, Petribú ATDS, Meira M, Borges ODR. Liver transplant for the treatment of giant hepatic hemangioma. Liver Transpl 2004; 10:1436-7. [PMID: 15497149 DOI: 10.1002/lt.20250] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Sugawara Y, Makuuchi M. Right lateral sector graft as a feasible option for partial liver transplantation. Liver Transpl 2004; 10:1156-7. [PMID: 15350007 DOI: 10.1002/lt.20248] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Slagel DE, DeSimone P, Dillon M, LePage DJ, Bogden AE, Xing TH, Fan JW, Peng ZH. Subrenal capsule assay: feasibility of transporting tissues to a central facility for testing. World J Surg Oncol 1985; 12:83. [PMID: 24708716 PMCID: PMC4016776 DOI: 10.1186/1477-7819-12-83] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/28/2014] [Indexed: 02/07/2023] Open
Abstract
Hepatic hemangioma patients with Kasabach-Merritt syndrome have reportedly been cured by liver transplantation. However, liver transplantation as a potential cure for a stable patient without Kasabach-Merritt syndrome remains debatable. We report the case of a 27-year-old female patient with a giant hepatic hemangioma. The hemangioma measured 50 × 40 × 25 cm in size and weighed 15 kg, which is the largest and heaviest hemangioma reported in the literature. The patient showed jaundice, ascites, anemia, and appetite loss; but no disseminated intravascular coagulation was observed through laboratory findings. We successfully operated using a right lobe graft without the middle hepatic vein from a 55-year-old donor. At the long-term follow-up, the patient experienced two acute rejections, which were confirmed by biopsy. However, the patient still survives with good graft function after 50 months.
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