Giant Cavernous Hemangioma Research Articles

Tuberculosis Arising in a Giant Cavernous Haemangioma of the Liver: A Case Report

Tuberculosis Arising in a Giant Cavernous Haemangioma of the Liver: A Case Report

Robotic right hepatectomy for giant hemangioma in a Jehovah's Witness

The use of minimally invasive surgery for the resection of benign liver tumors has increased in recent years as results show decreased abdominal damage and significant cosmetic advantages. Herein, we describe the first reported application of minimally invasive surgery for the removal of a giant symptomatic hemangioma, using robotic surgery, in a Jehovah's Witness (JW) patient. A 32-year-old JW presented with abdominal discomfort and recent episodes of acute abdominal pain due to a giant cavernous hemangioma involving segments VI and VII of the liver. Because of the location and size of the lesion, a right hepatectomy was planned. After a careful preoperative evaluation, a robotic right hepatectomy was performed using the da Vinci Surgical System. The procedure was successfully completed in minimally invasive fashion with an operative time of 310 min and with an intraoperative blood loss of only 300 ml. The postoperative course was uneventful and the patient was discharged on postoperative day 10. At 30-month follow up the patient reported complete relief of symptoms and good esthetic results. In experienced hands, a minimally invasive robotic major hepatic resection is a viable option that can be performed with minimal blood loss in a JW patient. A careful preoperative and intraoperative strategy is required and significant experience in liver and robotic surgery is mandatory.

A Giant Cavernous Hemangioma of the Heart

Cardiac hemangiomas are exceptionally rare, vascular neoplasms of the heart, with an incidence of 1% to 2% among all detected benign heart tumors. With the availability of the advanced imaging modalities of the heart, asymptomatic cardiac tumors are detected more frequently. These tumors are composed either of capillaries or larger cavernous channels. Herein, we report a rare case of a huge cardiac hemangioma involving both ventricles, which is not amenable to a curative surgical resection.

Surgical Management of a Giant Cavernous Hemangioma Involving the Lower Lip: Report of a Case and Review of the Literature

Surgical Management of a Giant Cavernous Hemangioma Involving the Lower Lip: Report of a Case and Review of the Literature

Giant cerebral cavernous hemangiomas. a report of two cases and review of literature.

Giant cerebral cavernous malformations (GCM) are rare vascular anomalies. They occur predominantly as solitary lesions in the supratentorial compartment. They are usually not associated with any other vascular malformations. Clinical Presentation GCM are common in the second decade, affecting females predominantly, and occur without familial association. They are all symptomatic due to their giant size and location. The GCM mimic neoplastic lesions because of their size and need to be considered in the differential diagnosis. A complete surgical extirpation is the treatment of choice. Use of intraoperative neuronavigation, diffusion tensor imaging (DTI) of fiber tracts and electrophysiological monitoring assist in safe and total excision of the lesions. A complete surgical excision of GCM is possible without significant surgical morbidity and results in long term cure.

Extrahepatic Portal Venous Obstruction due to a Giant Hepatic Hemangioma Associated with Kasabach-Merritt Syndrome

We describe a patient with extrahepatic portal venous obstruction due to a giant hepatic hemangioma associated with Kasabach-Merritt syndrome. A 67-year-old woman presented with upper abdominal distension and appetite loss. The medical history was not relevant to the current disorder. Initial laboratory tests revealed the following: serum platelet count, 9.9 × 10⁴/µL; serum fibrinogen degradation products, 12 µg/mL; prothrombin time, 1.26; and serum fibrinogen, 111 mg/dL. Computed tomography demonstrated homogenous low-density areas, 15 cm in diameter, in the left lobe of the liver. Common hepatic arteriography revealed a hypervascular tumor with pooling of contrast medium in the delayed phase. The portal venous phase of supramesenteric arteriography revealed obstruction and cavernous transformation of the portal vein. We diagnosed extrahepatic portal venous obstruction due to a giant hepatic hemangioma associated with Kasabach-Merritt syndrome. Laparotomy was performed, and the liver was found to be markedly enlarged. After mobilization of the left lobe, left hepatectomy was performed with intermittent clamping. After resection, Doppler ultrasonography revealed recovery of the portal venous flow. The cavernous transformation shrank. Pathologic examination of the surgical specimen confirmed the presence of a giant benign hepatic cavernous hemangioma. The patient was discharged 16 days after operation. Laboratory data and complications improved after 2 months.

Sclerosed hemangioma of the liver

Cavernous hemangioma of the liver is the most common benign neoplasm, and the liver is its most common visceral site, having been found at that location in about 19% of cases in one series.1 It is usually found incidentally during a radiologic workup. However, it can result in specific symptoms or manifest with large size or enlargement. Cavernous hemangiomas usually present as solitary well-delineated, subcapsular, discolored nodules that are smaller than 5 cm. They can exhibit various forms of pathology, such as necrosis, scarring, and calcification, some of which mimic the primary or metastatic malignancy. We present herein a case of sclerosed hemangioma in a 52-year-old man. We discuss the histopathologic features of this case along with another case of giant cavernous hemangioma of the liver.

Two-stage excision of giant cavernous hemangioma involving the bilateral lobes of the liver: a report of one case

Two-stage excision of giant cavernous hemangioma involving the bilateral lobes of the liver: a report of one case

Brachial plexus paralysis due to giant cavernous hemangioma with Kasabach-Merritt syndrome: Successful management with interferon alpha

Brachial plexus paralysis due to giant cavernous hemangioma with Kasabach-Merritt syndrome: Successful management with interferon alpha

Giant cavernous haemangioma mimicking a fifth nerve neurofibroma involving the orbit and brain

We illustrate an unusual case of a giant cranio-orbital cavernous haemangioma that mimicked a fifth nerve neurofibroma. A 54-year-old male presented with a right orbital mass involving the upper lid...

A Rare Mass Formation of the Vulva

Vulvar hemangioma is an extremely rare pathology in adult women causing sexual dysfunction, pain, and cosmetic problems requiring therapeutic intervention. We present a case of an isolated giant vulvar cavernous hemangioma with a 2-year history that macroscopically seemed to be a vulvar varicosis but was actually detected at the end to be cavernous hemangioma in an adult patient with no history of other disease. The patient was treated with surgical excision because of progressive complaints. Histopathologic evaluation suggested cavernous hemangioma. Hemangiomas can undergo spontaneous involution; thus, treatment may be reserved for those lesions of functional or psychological concern. In this case, surgical correction was used both as a diagnostic method and as a therapeutic intervention because of progressive complaints such as pain, feeling of pressure, and sexual dysfunction.

Giant cavernous hemangioma of the liver with coagulopathy: Adult Kasabach–Merritt syndrome

A 42-year-old Taiwanese woman was admitted to our institution complaining of abdominal fullness, recurrent anemia, petecchial hemorrhages, and ecchymoses over the extremities that have been present for 1 month. Laboratory tests revealed prolonged prothrombin time (15.5 s; control 11.0), prolonged activated partial thromboplastin time (45.8 s; control 28.6), presence of fibrin degradation products (≥100 ug/mL), and borderline low platelet count (17.7 × 103/mm3). Imaging modalities showed a 24-cm tumor over the right lobe of the liver whose tumor border encroached over segment 4 of the left lobe (Fig 1). After careful preoperative preparation and fresh frozen plasma transfusion, she underwent laparotomy. The operative findings showed a huge liver tumor measuring 35 × 25 cm involving segments 4–8 (Fig 2, A). A right hepatic trisegmentectomy was performed. The postoperative course was unremarkable. She was discharged 1 week after the operation and remained well in follow-up after 39 months without recurrence. The platelet count was 18.0 × 103/mm3 on discharge. The prothrombin and activated partial thromboplastin times were 11.4 s (control 11.0) and 30.1 s (control 28.6) 10 days after the operation, respectively. The platelet count increased to 43.4 × 103/mm3 on subsequent follow-up.

Diffuse Hemangiomatosis of Colon, Liver and Skin

Purpose: A 58 yr old man came for routine colonoscopy screening. He had no history of gastrointestinal bleeding. Prior tests for fecal occult blood were negative. His past medical history was significant for resection of giant cavernous hemangioma of the left lobe of liver, 10 year ago and multiple residual hemangiomas in the right hepatic lobe. Physical exam revealed multiple cherry red vascular blebs on the back and upper chest, which blanch with pressure. Colonoscopy showed multiple, red colored vascular blebs, seen in the cecum and the adjacent ascending colon. None of the lesions showed active bleeding. The patient demonstrated multiple hemangiomas, involving the colon, liver and skin. At 1 year follow up, the patient continues to remain asymptomatic with no gastrointestinal bleeding or increase in size of liver hemangiomas. To our knowledge, there is no previous case report of multi-organ involvement by hemangiomas.

Giant cavernous hemangioma of the distal esophagus treated with esophagectomy

Generalized lymphangiomatosis management can be challenging. Surgical treatment is indicated for complications (such as chylopericardium and chylothorax) or for biopsy. An important issue for management of chylous effusions is that there is not one specific source of chyle that can be stopped through the thoracic duct ligation; instead, there is a wide abnormal network of lymphatic channels. However, the best results have been reported with pleurectomy, with or without thoracic duct ligation, whereas thoracic duct ligation alone was unsuccessful in all cases. Fibrin glue application may help control lymphatic leakage from exposed surfaces after pleurectomy. 2 Other treatment options include inter feron alfa and systemic chemotherapy with limited success, and radiation in fractioned dose has been promising for patients with extensive mediastinal disease. 5

CAVERNOUS HEMANGIOMA OF THE CAVERNOUS SINUS, SKIN, AND RETINA

There are several reports concerning cavernous hemangiomas of the skin and central nervous system. Additional retinal involvement has also been reported. The authors report a 69-year-old woman with a giant extra-axial cavernous hemangioma of the right cavernous sinus involving the supra- and parasellar region, retina, and skin. Shrinkage of its cutaneous part lead to subsequent increase of the volume of the intracranial part. Owing to compression of the optic and the oculomotor nerves, oculomotor disturbances, ptosis, and visual impairment to 0.2 occurred. Via a pterional approach microsurgical removal of the tumor except for a remnant of the intracavernous part was performed. Hemodynamic connection between cutaneous, retinal, and intracranial hemangiomas should be considered.

Giant isolated cavernous hemangioma of the stomach

Giant isolate cavernous hemangiomas of the stomach are extremely rare. An eight year old boy with recurrent episodes of massive hematemesis and involvement of both the anterior and posterior walls of the stomach is presented. Awareness of the lesion, a combination of endoscopy and contrast enhanced CT scan are helpful in reaching a diagnosis. Surgical excision is curative.

Comparison of laparoscopic radiofrequency ablation with surgical resection for treatment of giant hepatic cavernous hemangioma

目的 比较分析腹腔镜射频消融(RFA)与外科切除治疗巨大肝脏海绵状血管瘤(HCH)的疗效、并发症及各临床参数.方法 2001年3月至2005年2月,31例病人共39个HCH病灶在全麻下进行了腹腔镜RFA治疗或外科切除术.男7例,女24例,平均年龄(47.7±8.6)岁.病人均表现为上腹部不适、疼痛或腹胀等症状.术前经超声、螺旋CT及MRI检查获得确诊,平均最大肿瘤直径(9.6±1.4)cm.结果 17例HCH成功实施了腹腔镜RFA治疗,14例进行了外科切除术.腹腔镜RFA组及外科切除组的平均出血量分别为(192.4±85.0)ml及(714.3±276.3)ml(P＜0.01),平均手术时间为(107.5±34.4)min及(115.4±23.7)min(P＞0.05),平均术后住院日为(4.9±1.2)d及(11.6±3.0)d(P＜0.01).腹腔镜RFA组均未输血,外科切除组中10例输血.腹腔镜治疗组中,2例出现一过性血红蛋白尿;外科切除组中,1例出现术后腹腔渗血,另1例肺部感染.所有病例术后均出现血清转氨酶(ALT及AST)一过性升高.随访6～35个月(中位21个月),腹腔镜RFA治疗组病灶完全坏死率达100%,外科切除组均未见残留病灶.腹腔镜RFA治疗组中,15例症状完全消失,2例症状明显改善;外科切除组中,13例无症状,1例右上腹轻度不适.结论 外科切除仍然是巨大HCH最有效的治疗方法.腹腔镜RFA治疗巨大HCH具有微创、避免输血、缩短住院日等优点,治疗效果肯定,适用于病灶位于肝脏表面或临近胆囊等空腔脏器的病人,术中超声的应用可有效避免相关并发症的发生。

Giant cavernous hemangiomas: report of three cases

Giant cavernous hemangiomas occur very rarely, and little has been reported about their behavior. In this case report three cavernous hemangiomas with a diametric measure between 6 cm and 7 cm and distinct features will be described. A 36-year-old female patient presented with headache and nausea. A CT scan disclosed a large circumscribed tumor with strong contrast enhancement in the temporo-parieto-occipital region of the right cerebral hemisphere and extension into the right cerebellar hemisphere. A 35-year-old woman was admitted to our emergency ward with a generalized seizure and a dilated pupil. The CT scan showed an extensive left frontal lesion containing a substantial hyperintense part, suspicious for hemorrhage. A 3-year-old girl was admitted with generalized seizure and progressively declining consciousness. A large left frontotemporal paraventricular multi-cystic lesion was encountered on the CT scan. All three patients were operated on. Two recovered very well. In the case of the 3-year-old girl stable disease was reached. Giant cavernomas do not differ from average-sized cavernomas in clinical, surgical or histopathological presentation but may differ radiologically. However, the possible diagnosis of cavernoma can be overlooked, due to their size and possible differential diagnosis.

Radiofrequency ablation therapy combined with suture and ligation surgery for patients with giant cavernous hemangiomas of the liver

To evaluate the feasibility and efficacy of radiofrequency ablation (RFA) therapy combined with suture and ligation surgery for patients with giant hepatic cavernous hemangioma (HCH). Between June 2004 and June 2005, a total of 30 patients were treated by RFA therapy after suture and ligation surgery (SL group, n = 15, with 18 liver lesions) or RFA therapy without suture and ligation surgery (non-SL group, n = 15, with 17 liver lesions) under general anesthesia. All patients had obvious symptoms such as abdominal discomfort, pain and swelling. Preoperative diagnosis of HCH was established by means of ultrasonography, helical computed tomography (CT) scans, and magnetic resonance imaging (MRI). The mean maximum diameter of the lesions was 8.8 cm +/- 1.4 cm. All of the 35 lesions were located on the liver surface, in the caudate lobe of the liver, or adjacent to the gallbladder. Seven patients had chronic calculous cholecystitis, 6 common duct stones, 5 thrombocytopenias, and one posthepatitic cirrhosis. Thirteen of the 30 patients had previous laparotomy. Therapeutic efficacy and clinical data of RFA therapy were compared between these two groups. RFA therapy under ultrasound guidance was performed successfully in all the patients. Cholecystectomy was performed simultaneously for gallstones in 7 patients and for abutting of gallbladder from hemangioma in 2 patients. Choledochotomy with T-tube drainage was performed in 6 patients. The mean blood loss, the mean RFA time per lesion and reduction rate of maximum diameter of the lesions 6 months after RFA in the SL group and non-SL group were 88.0 ml +/- 22.4 ml vs. 255.0 ml +/- 71.7 ml (P < 0.001), 23.0 min +/- 7.5 min vs. 53.3 min +/- 16.0 min (P < 0.001), and 61.8% vs. 44.8% (P < 0.001) respectively. No severe complication related to RFA was observed in all patients. At a median follow-up of 12 months (6 approximately 17 months), a complete lesion necrosis was achieved on the contrast-enhanced helical CT scans in both groups. During the follow-up, all of the 15 patients were free of upper abdominal pain in the SL group, and 12 patients were symptom-free and 3 obtained significant amelioration of symptoms in the non-SL group. RFA therapy combined with suture and ligation surgery is a feasible, safe, and effective treatment modality for patients with giant HCHs. It can reduce blood loss, shorten RFA therapy time, and increase therapeutic efficacy of RFA. Intraoperative ultrasonography is a useful adjunct for increasing the therapeutic efficacy of RFA and reducing the complications related to RFA.

Transcatheter arterial embolization in the management of hemobilia

This retrospective analysis evaluated the clinical and radiologic results of transcatheter arterial embolization (TAE) in the treatment of significant hemobilia. The imaging findings, embolization technique, complications, and efficacy are described. Thirty-two consecutive patients (21 male, 11 female, age range 8-61 years) who were referred to the radiology department for severe or recurrent hemobilia were treated by TAE. Causes of hemobilia were liver trauma (n = 19; iatrogenic in six and road traffic accident in 13), vasculitis (n = 6), vascular malformations (n = 2), and hepatobiliary tumors (n = 5). Iatrogenic liver trauma was secondary to cholecystectomy in those six patients. Four of five hepatobiliary tumors were inoperable malignant tumors and one was a giant cavernous hemangioma. Arterial embolization was done after placing appropriate catheters as close as possible to the bleeding site. Embolizing materials used were Gelfoam, polyvinyl alcohol particles or steel coils, alone or in combination. Postembolization angiography was performed in all cases to confirm adequacy of embolization. Follow-up color Doppler ultrasound and contrast-enhanced computed tomography was done in all patients. Ultrasonic, computed tomographic, and angiographic appearances of significant hemobilia were assessed. Angiogram showed the cause of bleeding in all cases. Three patients with liver trauma due to accidents required repeat embolization. Eight patients required surgery due to failed embolization (continuous or repeat bleeding in four patients, involvement of the large extrahepatic portion of hepatic artery in two, and coexisting solid organ injuries in two). Severity of hemobilia did not correlate with grade of liver injury. All 13 patients with blunt hepatic trauma showed the cause of hemobilia in the right lobe. No patient with traumatic hemobilia showed an identifiable cause in the left lobe. There were no clinically significant side effects or complications associated with TAE except one gallbladder infarction, which was noted at surgery, and cholecystectomy was performed with excision of the hepatic artery aneurysm. TAE is a safe and effective interventional radiologic procedure in the nonoperative management of patients who have significant hemobilia.