Benign Hemangioma Research Articles

Pathological features and diagnostic process of common benign hemangioma

Pathological features and diagnostic process of common benign hemangioma

The Role of Natural Extracts in the Management of Infantile Hemangiomas and Vascular Tumors.

Hemangiomas are vascular tumors resulting from the proliferation of endothelial-like cells; they are the most common childhood tumors, affecting approximately 5-10% of newborns and infants. Besides hemangiomas, which are definitely benign tumors despite their overgrowth potential, there are other vascular tumors like hemangioendotheliomas, which may display intermediate characteristics between benign hemangiomas and highly malignant angiosarcomas. Standard therapy may be constricted by serious adverse effects, high cost, or traumatic influence. Diet is a major resource for health preservation, disease prevention, and treatment. The therapeutic property of edible berries, marine products, or medicinal plants have long been known and used in traditional medicine; a plant-based nutrition can prevent the development and progression of diseases associated with extensive neo-vascularization. The purpose of our review is to highlight those natural treatments that hemangioma and vascular tumor patients can receive in the future, both for their benefit and that of their families. We performed the review according to the Preferred Reporting Items for Systematic Reviews and Metanalysis Statement. We used the Web of Science, PubMed, and EMBASE engines for the study, and searched for the association of hemangioma with naturopathic treatment/plant extract/plants in published articles. We found that natural extracts from plants and fruits are cost-effective and safe treatments for hemangiomas and vascular tumors, as well as for other forms of cancer. In any case, more in vitro and in vivo studies are needed to confirm the proposed signaling pathways in tumors and validate the improvement parameters after natural products administration. The era of molecularly targeted therapy and personalized medicine is approaching and naturally occurring substances are very useful tools for tumor treatment and prevention. Plant extract substances have strong specificity and pertinence, are non- toxic and have few side effects, and may become an emerging cancer treatment.

Hemangioendothelioma: A Rare Entity at an Unusual Location

Abstract Epithelioid hemangioendothelioma (EHE) is a rare type of vascular tumor that behaves in a manner halfway between benign hemangiomas and malignant angiosarcomas. It is histologically distinguished by angiocentricity and solid, cord-like arrangements of epithelioid cells with intracytoplasmic lumina containing red blood cells. Although uncommon in childhood, it can develop at any age and affects both sexes equally. Accurate diagnosis may require further evaluation with tru-cut biopsy due to its potential for false-positive metastatic cancer diagnoses. Treatment approaches vary based on symptomatology, ranging from regular follow-ups for asymptomatic patients to surgical resection with embolization for symptomatic cases. With the help of this case, we want to discuss the importance of considering EHE in the differential diagnosis of vascular lesions and the significance of tailored treatment strategies based on individual patient characteristics.

Update on the Pathology of Pediatric Liver Tumors: A Pictorial Review

Liver tumors in children are uncommon and show remarkable morphologic heterogeneity. Pediatric tumors may arise from either the epithelial or mesenchymal component of the liver and rarely may also show both lines of differentiation. Both benign and malignant liver tumors have been reported in children. The most common pediatric liver tumors by age are benign hepatic infantile hemangiomas in neonates and infants, malignant hepatoblastoma in infants and toddlers, and malignant hepatocellular carcinoma in teenagers. Here, we provide an up-to-date review of pediatric liver tumors. We discuss the clinical presentation, imaging findings, pathology, and relevant molecular features that can help in the correct identification of these tumors, which is important in managing these children.

Scrotal Cavernous Haemangioma: A Case Report

A case of scrotal hemangioma in a 21-month-old boy is described. There is evidence of a well-defined heterogeneously hypoechoic mass arising from the anterior-inferior aspect of the scrotal sac in the midline since birth. Mild vascularity is noted when tested on the colour doppler. The mass Lesion is well separated from the bilateral testicles. The mass lesion showed features of benign hemangioma.

Papilledema with acute profound visual loss in capillary haemangioma of the sphenoid sinus with sellar and parasellar extensions – a triple rarity presentation

Intracranial capillary haemangioma (ICH) is rare. We report a unique case of a young man with ICH who was presented with papilledema and acute profound visual loss. A 27-year-old man presented with bilateral eye reduced vision for 2 weeks with headaches. Examination showed optic disc swelling with severe visual loss. Neuroimaging revealed a vascular tumour epicentre at the sphenoid sinus with sellar and parasellar extensions. The patient developed massive bleeding during transsphenoidal surgery, in which intraarterial embolization was done, followed by a second surgery. Histopathology revealed benign capillary haemangioma. There was minimal visual improvement. He then developed tumour recurrence at 4 months postoperatively. ICH may cause rapid and acute blindness. Management is challenging with a guarded visual prognosis.

Differential pericyte marker expression in craniofacial benign and malignant vascular tumors.

Vascular anomalies and tumors are common in the head, neck, and craniofacial areas and are associated with abnormalities in the angiomatous architecture. However, the etiology and molecular basis for the pathogenesis of most vascular lesions are still unknown. Pericytes are mural cells that surround endothelial cells. Besides angiogenesis and other physiological functions, pericytes play an important role in vascularized tissue repair and as resident mesenchymal stem/progenitor cells. Perivascular cells demonstrate a distinct immunohistochemical profile, including expression of alpha-smooth muscle actin (α-SMA), CD146, CD105, and PDGFRβ, without endothelial differentiation (absence of CD31 and CD34 immunoreactivity). These pericyte markers have been shown to be expressed in soft tissue hemangiomas. However, they have not been fully examined in intraosseous hemangiomas. In this study, we compared mesenchymal stem cell (MSC)expression of CD146 and α-SMA markers inpericytes from hemangiomas from different tissues and malignant vascular tumors. The results demonstrated an increased expression of pericyte markers in perivascular cells of benign hemangiomas, especially intraosseous hemangiomas and a significantly reduced expression of pericyte markers in malignant angiosarcomas. The evidence provides insight into the function of pericytes in vascular tumors and suggests their role in vascular tumor disease types.

Posterior choroidal leiomyoma: new findings from a case and literature review.

Posterior choroidal leiomyoma is a sporadic, rare benign tumor that is always confused with anaplastic melanoma. Here we report a case and provide a review. Most of the preoperative findings in our case were suggestive of malignant choroidal melanoma. However, the contrast enhanced ultrasound (CEUS) suggested a benign hemangioma. In summary, the posterior choroidal leiomyomas were yellowish-white in color and most commonly located in the temporal quadrant of the fundus (11/15). They were more frequent in Asians (13/16), the prevalence was almost equal in males and females (9:7), with a mean age of 35y. Microscopically, the tumor typically showed spindle cell bundles and nonmitotic ovoid nuclei arranged in intersecting fascicles. Vitrectomy is now a popular treatment option and definitive diagnosis can be made after immunohistochemistry. Finally, some summarized features of this tumor differ from those previously described. These may help in the diagnosis of posterior choroidal leiomyoma and differentiation from malignant melanoma.

Rare Intraosseous Cavernous Hemangioma of the Orbit

A healthy 52-year-old man presented with a painless, enlarging, right lateral orbital nodule of 1-year duration (A, arrow). Clinical examination revealed a 2.3-cm firm immobile lateral orbital rim mass. Computed tomography displayed an expansile and osteolytic neoplasm of the zygoma with orbital and extraorbital extension (B). Lateral orbitotomy exposed a porous neoplasm of the anterior zygomatic face (C). The exophytic component was resected, and histopathological examination demonstrated multiple, dilated, blood-filled cavities between bony trabeculae, consistent with a benign intraosseous cavernous hemangioma (D). Orbital intraosseous cavernous hemangiomas are rare, and malignancy should be ruled out in the setting of a progressive osteolytic neoplasm (Magnified version of Figure A-D is available online at www.aaojournal.org/).

Challenges in the Diagnosis of Gaucher Disease with Multiple Splenic Lesions

The progressive nature, multisystem involvement, and delayed diagnosis of Gaucher disease (GD) make it a challenging disorder. Herein, we report the clinical and genetic findings of a patient with GD of Saudi-Arab ethnicity. In this case, a young patient was discovered to have hepatosplenomegaly and whose radiological image revealed an unusual presentation of multiple nodular lesions in the spleen that were initially thought to represent benign hemangiomas. He had a splenectomy with a liver biopsy, which revealed features consistent with GD. The activity of β-glucocerebrosidase in dry blood spots was below its cutoff value. Molecular genetic analysis of the glucosylceramidase beta gene confirms the diagnosis. Enzyme replacement therapy was initiated.

CHARACTERIZATION OF FOCAL LIVER LESIONS ON CONTRAST ENHANCED ULTRASOUND

Aim: The purpose of the study was to characterize the focal liver lesions on contrast enhanced USG on the basis of enhancement pattern and establishing the potential of this technique and determining sensitivity and diagnostic accuracy of this technique in comparison with CECT/biopsy. Material and methods:Prospective study was conducted from Oct 2018 to Mar 2020 at tertiary care hospital and CEUS was done for 34 lesions in 30 patients. Lesions characterized on the basis of enhancement pattern in arterial, portal and porto-venous phases. Final diagnosis was established on the basis of CECT or/and biopsy/FNAC of lesion (if available). Out of 34 focal li Results: ver lesions, 24 were malignant (HCC and metastasis) and 10 were benign (hemangioma). 32 lesions were correctly characterized by CEUS examination in comparison with CECT/tissue diagnosis. Overall sensitivity, PPV and diagnostic accuracy of CEUS with 95% CI was 94.12 (80.32 -99.28), 100 (89.11 – 100%) and 94.12% (80.32 – 99.28) respectively. Our study showed that CEUS is a sensitive modality to c Conclusion: haracterize focal liver lesions. CEUS can objectively demonstrate contrast enhancement comparable and corresponding to enhancement of same lesion on CECT.

Recurrent Symptoms From Multifocal Cavernous Hemangioma in the Orbit.

A 48-year-old woman presented with complaints of pulsating retro-orbital pain and progressive proptosis of her left globe for the past several weeks with a measured difference of 3 mm (Panel A). The patient reported similar symptoms when she was diagnosed with multifocal orbital cavernous hemangioma 9 years prior. The prior lesions were resected with a lateral orbitotomy, and 2 discrete lesions were described. New CT imaging of her orbit (Panel B) revealed multiple, well-defined, slightly heterogenous lesions within the left orbit immediately posterior to the left globe. An additional hyperdense lesion was noted within the left anterior ethmoid air cell. A radiologic diagnosis of recurrent/residual multifocal cavernous hemangioma was made. Our patient underwent simultaneous endoscopic sinus surgery for the ethmoid lesion and an anterior orbitotomy via the transconjunctival lower eyelid approach. Pathology revealed all lesions to be benign cavernous hemangiomas. It is uncertain whether the recurrence of symptoms and proptosis are from prior incomplete resection or new lesions. This case highlights the uncommon finding of multifocal cavernous hemangiomas rather than the usual circumscribed solitary lesion. Her course also highlights the possibility of growth of residual lesions or the development of new lesions when a multifocal disease is present. Future studies could assist in delineating the natural course of these lesions for better prognostic discussion.

S2974 Common Variable Immune Deficiency With Atypical Hepatic Disease

Introduction: Common variable immunodeficiency (CVID) is a primary B-cell immunodeficiency disorder leading to hypogammaglobulinemia. Liver involvement may rely on immune dysregulation and includes abnormal liver biochemistries, primarily elevation of alkaline phosphatase (ALP), nodular regenerative hyperplasia (NRH) leading to chronic cholestasis, portal hypertension, and disruption of liver function. We present a case of CVID with atypical liver involvement on imaging and biopsy revealing focal nodular hyperplasia. Case Description/Methods: A 24-year-old female with a past medical history of CVID on Intravenous immunoglobulin (IVIG) present for follow-up with chronically elevated liver enzymes that is a cholestatic pattern (ALP 1050 U/L, AST 114 U/L, ALT 214 U/L, Total bilirubin 1.0 mg/dL) along with normal synthetic liver function. Previous comprehensive work up including autoimmune (Antinuclear, Anti-smooth muscle, anti-mitochondrial antibodies) were negative. Viral hepatitis including Hepatitis B, Hepatitis C, Herpes simplex, Varicella zoster, and Epstein Barr viruses polymerase chain reaction were all negative. other causes of elevated liver enzymes including genetic and metabolic work up all came back negative. The medications list included Ursodiol and Multivitamins. She reports no alcohol, recreational or herbal drugs use. She underwent liver protocol magnetic resonance imaging and magnetic resonance cholangiopancreatography that showed no biliary tree abnormalities, Innumerable hepatic lesions with characteristics suggestive of multiple focal nodular hyperplasias largest measures up to 3.8 cm, two benign hepatic hemangiomas with the larger measuring 1.9 cm and splenomegaly. Ultrasound-guided biopsy of the left hepatic lobe showed concern for focal nodular hyperplasia (confirmed by an outside pathologist at another liver transplant center) with unremarkable trichrome and PAS stains (Figure). Discussion: At least 10% of CVID patients present with liver involvement, including anicteric cholestatic liver enzymes (65%) and portal hypertension (50%). Histological analysis in recent studies revealed non-fibrosing architectural abnormalities consistent with nodular regenerative hyperplasia in 84% of CVID and less commonly, typical histologic features of primary biliary cholangitis. Our case liver imaging and biopsy read by 2 pathologists (2 institutions) revealed focal nodular hyperplasia, a new entity not described in previous studies.Figure 1.: Liver protocol MRI showing focal nodular hyperplasia.

S2093 Painless Voluminous Rectal Bleeding: It’s Not Always a “Tic”: A Case of a Recto-Sigmoid Hemangioma

Introduction: Hemangiomas are known as benign vascular tumors and may present as multiple or solitary lesions. Very few cases of colonic hemangiomas have been reported in literature. We present a case of rectal bleeding leading to a finding of recto-sigmoid hemangioma. Case Description/Methods: A 31-year-old female with no past medical history presented to the ED with complaints of bright red blood per rectum (BRBPR). She admitted to having 4 days of blood clots associated with bowel movements, in addition to diffuse lower abdominal pain which has occurred intermittently and progressively worsened for the past 2 years. In Cuba, she was told she had a rectal tumor which was “inoperable”. Lab work on admission was significant for iron deficiency anemia. CT of the abdomen and pelvis with oral and IV contrast revealed findings consistent with active gastrointestinal (GI) bleed in the ascending colon, as well as a 2.5 cm pelvic mass. However, an IR arteriogram revealed a large segment of angiodysplasia in the ascending colon but no evidence of active GI bleed. Transvaginal ultrasound ruled out an adnexal mass. Sigmoidoscopy revealed a large recto-sigmoid mass suspicious for an hemangioma as well as surrounding vascular ectasias. Carefully taken biopsies revealed a benign rectal hemangioma. Ultimately, the patient was stabilized and discharged, with follow-up outpatient with surgical oncology due to the extent of her disease (Figure 1). Discussion: Colonic hemangiomas are extremely rare benign vascular lesions of the GI tract. Often located in the recto-sigmoid, they may be discovered during workup for recurrent painless rectal bleed and rarely presenting as life-threatening bleeding. Large cavernous hemangiomas may be associated with Kasabach-Merritt syndrome, hemolytic anemia, thrombosis and bowel ischemia. Studies reveal that it may take on average up to 19 years before a proper diagnosis is established. There are few reported cases of local invasion to surrounding structures such as bladder and uterus. Despite being incidentally found in colonoscopy, insufflation may flatten these lesions which may be also misinterpreted as proctitis. Imaging studies such as MRI, CT and rectal EUS are helpful in determining the diagnosis. Sclerotherapy, angiographic embolization and ligation of mesenteric vessels may be attempted for small lesions. Surgical resection, if possible, is generally the treatment of choice for more extensive lesions. Due to its mimicking presentation of common GI diseases, hemangiomas risk being overlooked.Figure 1.: Extensive recto-sigmoid hemangioma with associated vascular ectasias.

Point Shear Wave Elastography and 2-Dimensional Shear Wave Elastography as a Non-Invasive Method in Differentiating Benign from Malignant Liver Lesions

Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.

3D variable flip angle T1 mapping for differentiating benign and malignant liver lesions at 3T: comparison with diffusion weighted imaging

BackgroundDifferent methods have been used to improve the imaging diagnosis of focal liver lesions (FLL). Among them, magnetic resonance imaging (MRI) has received more attention since it provides significant amount of information without radiation exposure. However, atypical imaging characteristics of FLL on MRI may complicate the differential diagnosis between benign and malignant FLL. This study aimed to compare the diagnostic value of T1 mapping and diffusion-weighted imaging (DWI) for differentiating of benign and malignant FLLs.MethodsThis retrospective study enrolled 294 FLLs, including 150 benign and 144 malignant lesions. Whole liver T1 mapping sequences were obtained before and 2 min after the administration of Gd-DTPA to acquire native T1 and enhanced T1 and ΔT1%. Additionally, DWI sequence was conducted to generate apparent diffusion coefficient (ADC) maps. These quantitative parameters were compared using one-way analysis of variance, and the diagnostic accuracy of T1 mapping and ADC for FLLs was calculated by area under the curve (AUC).ResultsSignificant differences were observed regarding the native T1, enhanced T1, ΔT1%, and ADC between benign and malignant FLLs. Furthermore, the sensitivity and specificity of the parameters are as follows: native T1 0.797/0.702 (cut off value 1635.5 ms); enhanced T1, 0.911/0.976 (cutoff value 339.2 ms); ΔT1%, 0.901/0.905 (cutoff value 70.8%); and ADC, 0.975/0.952 (cutoff value 1.21 × 10−3 mm2/s). The ideal cutoff values for native T1 and ADC in identifying cyst and haemangioma were 2422.9 ms (AUC 0.990, P < 0.01) and 2.077 × 10–3 mm2/s (AUC 0.949, P < 0.01), respectively, with a sensitivity and specificity of 0.963/1 and 0.852/0.892, respectively. ADC was significantly positively correlated with T1 and ΔT1%, and significantly negatively correlated with enhanced T1.ConclusionThe 3D Variable flip angle T1 mapping technique with Gd-DTPA has a high clinical potential for identifying benign and malignant FLLs. The enhanced T1 and ΔT1% values have similar diagnostic accuracy compared with DWI in evaluating FLLs. Native T1 shows better performance than DWI in distinguishing benign liver lesions, specifically, cysts, and haemangioma.

Association between Blood Donation and Malignant and Benign Tumour Risk: A Population-Based Study of 3.4 Million Participants in China.

This study aims to identify the relationship between blood donation and malignant and benign tumour hospitalization risk. The cohort study was constructed in Shaanxi, China, to include blood donors and match nonblood donors one-to-one by gender, age, and county of residence. The study compared the hospitalization records of two groups from 2012 to 2018. A log-binomial regression model was used to estimate the relative risk (RR) of tumour risk between donors and nonblood donors among different age groups. A total of 1,625,599 donors were recruited (including 968,823 males) and compared with the matched nonblood donor group. Significantly lower risk of malignancy in males was found among donors (adjusted RR: 0.82, 95% CI: 0.75–0.92). Lower risks for specific types of tumours among donors were observed, including liver (0.42, [0.28–0.67]), lung (0.74, [0.59–0.87]), lymphoma (0.75, [0.62–0.85]), and oesophagus (0.55, [0.41–0.72]). However, the risk of brain cancer was higher among male donors (RR 1.19 [1.06–1.29]). Among female donors, lower risk of liver (0.57, [0.42–0.79]) and oesophagus malignancy (0.73, [0.62–0.88]) was observed. For benign tumours, male donors have a lower risk of benign skin tumour (0.79, [0.62–0.94]) and hemangioma and lymphangioma (0.75, [0.51–0.89]), while female donors have a lower risk in hemangioma and lymphangioma (0.65, [0.44–0.83]). We also found that the risk decreased with age among donors in the prevalence of tumours compared to that in nonblood donors (p < 0.05). Blood donation appears to be significantly associated with various tumour risks among both males and females. Overall, the risk of tumours decreased more substantially with age in blood donors compared with nonblood donors. Further research is warranted to investigate the impact of ‘health donor effects' on these findings.

Non-Wilms' renal tumors in children: experience with 139 cases treated at a single center

BackgroundPediatric non-Wilms renal tumors (NWRTs), which comprise a small proportion of renal tumors, are a heterogeneous group of neoplasms with variable malignant potential, mortality, and response to treatment. We performed this study to determine the clinical characteristics, management and prognosis of children with Pediatric NWRTs.MethodsMedical records of all patients (n = 139) treated for NWRTs over a 12-year period (2008.01–2019.10) at a single center were reviewed retrospectively.ResultsThe histopathological groups of NWRTs included malignant rhabdoid tumor of the kidney (MRTK) (n: 30, 21.6%), renal cell cancer (RCC) (n: 26,18.7%), clear cell sarcoma of the kidney (CCSK) (n: 24,17.3%), congenital mesoblastic nephroma (CMN) (n: 21,15.1%), cystic nephroma (CN) (n: 16,11.5%), metanephric tumors (n: 12, 8.6%), renal angiomyoliporma (RAML) (n: 3, 2.2%), renal primitive neuroectodermal tumor (n: 2, 1.4%), renal hemangioma (n: 2, 1.4%), inflammatory myofibroblastic tumor (n: 2, 1.4%), ossifying renal tumor of infancy (ORTI) (n: 1, 0.7%). The distribution of all malignant NWRTs, including MRTK, CCSK, RCC and PNET, according to stage was as follows: stages I (n = 26), II (n = 16), III (n = 29), and IV (n = 11). The summary table shows the treatment offered to children with NWRTs. A total of 123 children were followed up for an average of 42 months. Sixteen children were lost to follow-up. Tumor-free survival was observed in 94 children. One patient who suffered from RCC is currently receiving targeted therapy and survives with the tumor. Twenty-eight children (22.8%) died.ConclusionsPediatric NWRTs comprise 19.1% of all renal tumors in our single center. Most NWRTs can readily be distinguished using a range of immunohistochemical markers. Molecular genetic profiling has allowed much progress in the understanding of this group of tumors, making diagnosis and classification less difficult. The mainstay treatment of malignant NWRTs, including MRTK, CCSK, RCC and PNET, is comprehensive treatment. The mainstay treatment of benign NWRTs, including RAML, CN, ORTI, CMN, metanephric tumors, and renal hemangioma, is surgical resection alone and when the tumor diameter is smaller than 7 cm and the tumor locates in one pole, NSS can be performed.

The Role of Propranolol as a Repurposed Drug in Rare Vascular Diseases.

Rare Diseases (RD) are defined by their prevalence in less than 5 in 10,000 of the general population. Considered individually, each RD may seem insignificant, but together they add up to more than 7000 different diseases. Research in RD is not attractive for pharmaceutical companies since it is unlikely to recover development costs for medicines aimed to small numbers of patients. Since most of these diseases are life threatening, this fact underscores the urgent need for treatments. Drug repurposing consists of identifying new uses for approved drugs outside the scope of the original medical indication. It is an alternative option in drug development and represents a viable and risk-managed strategy to develop for RDs. In 2008, the “off label” therapeutic benefits of propranolol were described in the benign tumor Infantile Hemangioma. Propranolol, initially prescribed for high blood pressure, irregular heart rate, essential tremor, and anxiety, has, in the last decade, shown increasing evidence of its antiangiogenic, pro-apoptotic, vasoconstrictor and anti-inflammatory properties in different RDs, including vascular or oncological pathologies. This review highlights the finished and ongoing trials in which propranolol has arisen as a good repurposing drug for improving the health condition in RDs.

EP.TH.74An incidental finding of liver haemangioma on diagnostic laparoscopy for right sided abdominal pain in a young woman

Abstract Introduction Cavernous liver haemangiomas or hepatic haemangiomas are the most common benign neoplasm of the liver. They are more common in women with a male to female ratio of 2.5-5.1- likely due to estrogenic influence. They are composed of hepatic endothelial cells and are usually small in size (&amp;lt; 4 cm). They are asymptomatic in most of the cases and incidentally discovered on diagnostic tests. Occasionally haemangiomas can exceed a size of 5 cm where they can cause symptoms such as nonspecific abdominal pain. Their exact aetiology is not well understood; they are thought to be vascular malformations with hormonal or congenital background. Haemangiomas belong to ‘Incidentaloma’ tumours, since they can be found incidentally while investigating for other unrelated pathologies. Although rare, but rupture and hemorrhage of liver hemangiomas can be fatal. Case presentation A 33-year-old woman was presented with abdominal pain which was started in central abdomen and then shifted to right lower abdomen abdomen. No other significant symptoms at presentation or past medical history. On serial physical examination, the patient was more tender at the right lower quadrant of the abdomen. Although her inflammatory markers were normal the decision was made to proceed with diagnostic laparoscopy to rule out acute appendicitis. During laparoscopy normal appendix was found with multiple liver lesions. Appendix was not removed. Postoperatively CT Thorax, Abdomen and Pelvis with contrast and CT Liver Triple Phase was performed which confirmed benign liver haemangioma. The patient recovered well after surgery and was discharged home with no routine surgical follow up.