Giant Cavernous Hemangioma Of Liver Research Articles

Anesthetic management of a giant cavernous hemangioma of liver posted for right hepatectomy

Anesthetic management of a giant cavernous hemangioma of liver posted for right hepatectomy

Stapler hepatectomy in giant cavernous hemangioma of liver

Stapler hepatectomy in giant cavernous hemangioma of liver

Cadaveric Liver Transplantation for a Giant Mass

Question: A 44-year-old woman was admitted to our institution complaining of abdominal fullness, evident shortness of breath, weight loss, anorexia, petechial hemorrhages, ecchymosis, and swelling of feet and ankles that have been present for 3 years. There was no significant property at her medical history besides the absence of family history for hemangioma, and she was not taking any medications. At physical examination, increased abdominal circumference was noticed, and the edge of the liver was palpated well at right lower quadrant. Laboratory tests revealed abnormal hepatic functions, albumin (3.3 g/dL; control, 3.5–5.2), prolonged prothrombin time (20 s; control, 10–15.8), prolonged International Normalized Ratio (1.92; control, 0.9–1.3), and borderline low platelet count (119/mm3), which were compatible with Kasabach–Merritt syndrome. On coronal abdominal computed tomography and 3-dimensional volume-rendered imaging, a 22 × 18 × 23-cm mass in the right hepatic lobe which nearly replaced the right hepatic lobe was showed. The right diaphragm was elevated, and there was a mass effect on right atrium, and right ventricle. The inferior vena cava, main and left portal veins, and gastric outlet were compressed by the lesion, and then truncus coliacus was deviated to the left. Right kidney displaced inferomedially, and rotated 90° around its long axis (Figure A, B). What is the most likely diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI. The dynamic hepatic computed tomography of the patient revealed that the mass had peripheral nodular centripetal enhancement with persistent nonenhancement areas in the central part of the mass might be secondary to fibrous scar (Figure C). She was considered to have cadaveric liver transplantation because of respiratory distress, risk of bleeding owing to trauma, and the presence of Kasabach–Merritt syndrome. The patient underwent transplantation, and the removed liver weighed 4.8 kg (dry weight). Pathologic examination of the surgical specimen affirmed the diagnosis of cavernous hemangioma with peripheral sponge-like matrix full of blood products, and central fibrous scar tissue (Figure D). Her clinical status gradually improved posttransplantation and platelet count (193/mm3), prothrombin time (13 s), International Normalized Ratio (1.2), and albumin (3.8 g/dL) levels all returned to normal the 1-month follow-up. Giant cavernous hemangiomas are a minor atypical subgroup of hepatic hemangiomas, which are defined as ≥1 diameter >5 cm.1Vilgrain V. Boulos L. Vullierme M.P. et al.Imaging of atypical hemangiomas of the liver with pathologic correlation.RadioGraphics. 2000; 20: 379-397Crossref PubMed Scopus (331) Google Scholar Giant cavernous hemangiomas are symptomatic with their complications, which are Kasabach–Merritt syndrome (consumptive coagulopathy with intravascular coagulation, clotting, and fibrinolysis within the hemangioma), compression of adjacent organs, inflammatory changes, and potential volvulus of a pedunculated lesion.2Prasanna P.M. Fredericks S.E. Winn S.S. et al.Best cases from the AFIP: giant cavernous hemangioma.RadioGraphics. 2010; 30: 1139-1144Crossref PubMed Scopus (14) Google Scholar The pathognomonic imaging characteristics of hemangioma are peripheral nodular puddling with progressive centripetal enhancement on dynamic studies.1Vilgrain V. Boulos L. Vullierme M.P. et al.Imaging of atypical hemangiomas of the liver with pathologic correlation.RadioGraphics. 2000; 20: 379-397Crossref PubMed Scopus (331) Google Scholar When hemangiomas are >3 cm, central scarring is typically seen in lesions, owing to intralesional ischemia or hemorrhage.2Prasanna P.M. Fredericks S.E. Winn S.S. et al.Best cases from the AFIP: giant cavernous hemangioma.RadioGraphics. 2010; 30: 1139-1144Crossref PubMed Scopus (14) Google Scholar Management of very large (>10 cm) hepatic hemangiomas include surgical resection, enucleation, arterial embolization, hepatic irradiation, and liver transplantation.3Sood D. Mohan N. Singh A. et al.Living donor liver transplantation for giant cavernous hemangioma of liver in a child.Pediatr Transplant. 2011; 15: E135-138Crossref PubMed Scopus (4) Google Scholar

Living donor liver transplantation for giant cavernous hemangioma of liver in a child

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.

Treatment of giant cavernous hemangioma of liver by local sclerosis

目的 评价平阳霉素碘油乳剂(PLE)局部给药治疗5 cm以上肝海绵状血管瘤(CHL)的临床疗效及安全性.方法对156例CHL行PLE局部治疗,其途径包括:经肝动脉154例,经门静脉1例、经皮直接瘤内注射1例.分别观察其治疗前后肿瘤大小变化、临床症状的缓解和并发症的情况.结果经肝动脉154例,除2例治疗后仍手术切除者外,其余152例栓塞前肿瘤直径(8.7±2.4) cm,栓塞后3个月为(4.8±1.8) cm(P<0.01),栓塞后6个月为(1.9±1.6) cm(P<0.01).经门静脉和直接穿刺各1例治疗后瘤体均缩小.临床症状大部缓解.结论 CHL的局部PLE硬化治疗是疗效良好且安全的方法。