Giant Cavernous Hemangioma Research Articles

A clinical case of staged X-ray endovascular and laparoscopic surgery of giant cavernous hemangioma of the left lobe of the liver and clear cell renal cell carcinoma of the left kidney

A clinical case of staged X-ray endovascular and laparoscopic surgery of giant cavernous hemangioma of the left lobe of the liver and clear cell renal cell carcinoma of the left kidney

Think Hemangioma Think Well: Giant Pedunculated Hepatic Cavernous Hemangioma. A Case Report

Hepatic haemangiomas are the most common benign hepatic tumour; they are usually solitary, less than 5 cm in size, and clinically silent. Giant cavernous haemangiomas are a minor subset of hepatic haemangiomas, often symptomatic due to a mass lesion, complications or compression of adjacent structures. Few of these are pedunculated—often difficult to diagnose because of their exophytic development and greater tendency towards complications through the twisting of their peduncle. We report the case of a 55-year-old woman with a giant pedunculated hepatic cavernous haemangioma causing abdominal pain, with epigastralgia mimicking a gastric stromal tumour. We discuss the diagnostic workup, focusing on the useful of computed tomography and magnetic resonance imaging findings and giving a brief report of the therapeutic management and literature review.

Giant cavernous haemangioma in cavernous sinus

The aim of this article is show the neuroimaging, the pathological analysis and makes a brief review regarding to a giant cavernous haemangioma located in cavernous sinus in a 72 years old patient. A brief review was made in the literature searching for the key words “hemangioma” and “cavernous sinus” in the databases PubMed and Scielo for the last ten years. The images addressed were obtained by magnetic resonance imaging (MRI) in FLAIR, T1 and T1-weighted contrast-enhanced. The intracranial cavernous haemangiomas are rare conditions that comprise from 0,1 to 4% of intracranial vascular malformations. Diagnosis is made by MRI, when available SPECT (99mTc) is used to confirm and the treatment is done surgically with complement of radiotherapy and radiosurgery. The reported neuroimaging and pathological analysis show a giant cavernous hemangioma in cavernous sinus, a benign neoplasm involving the left internal carotid artery and maintaining contact with the contralateral internal carotid artery formed by abundant vascular structures, but without the presence of a muscular tunic.

Hepatic Hemangioma Treatment Using Microwave Coagulation Therapy—a Systematic Review

Hepatic hemangiomas (HH) are the most common benign liver tumors, with a prevalence ranging from 5 to 7.35% of all benign tumors of the liver. Most lesions occur to the fifth and sixth decades of life more frequently in females (female/male ratio = 5:1). Hepatic hemangiomas are composed of blood-filled cavities lined by a single layer of endothelial cells, fed by the hepatic artery. Hepatic hemangiomas are composed of blood-filled cavities lined by a single layer of endothelial cells, fed by the hepatic artery. The exact etiology of hepatic hemangiomas still is unclear though the genetic predisposition and estrogen in stimulating and/or contraceptive use have been proposed. A majority of hepatic hemangiomas are often asymptomatic and discovered incidentally. It is a slow-growing, so medical/surgical intervention is often not needed. However, the so-called giant cavernous hemangiomas (GCH) (greater than 5 cm in diameter) will usually develop symptoms and complications, which pose a higher risk of rupture that a radical intervention needs to be considered. Nowadays, hepatic hemangiomas therapy included surgical resection, intervention embolization, radio frequency ablation, microwave ablation, and drug therapy. There have been existing heated debates on the treatment strategies of hepatic hemangiomas for a long time because of the researchers lacked the evidence-based medical evidence data to analyze those treatment methods respectively. The present study is a comprehensive review of various treatments specially use of microwave ablation in large and symptomatic hepatic hemangiomas.

Fractionated Radiation Therapy for Large and Giant Cavernous Sinus Hemangioma: A Retrospective Study.

Purpose: Surgical resection has been traditionally used as a treatment for cavernous sinus hemangioma (CSH). However, this is usually difficult due to tumor vascularity and results in complications especially in large and giant CSH (volume >20 cm3). Previous studies have reported that radiotherapy (RT) provides an alternative treatment modality for hemangiomas. However, the optimized dose and fractions which control CSH and also protect the cognitive function remain unclear. This study reports our experience in the management of symptomatic large and giant CSH.Methods: Fifty-four patients with symptomatic large (20 cm3 <tumor volume ≤ 40 cm3, 3–4 cm in diameter) and giant (tumor volume>40 cm3, >4 cm in diameter) CSH were enrolled in a retrospective study between January 2007 and December 2018. The prescription dose to the target margin was 50 Gy in 25 fractions.Results: The mean pre-RT tumor volume was 60.9 cm3 which ranged from 20.2 to 230.5 cm3. The clinical data obtained was analyzed retrospectively following a mean follow-up period of 35.0 months which ranged from 1 to 140 months. All patients experienced tumor shrinkage within 3 months after radiotherapy. There was an average mean tumor reduction of 79.7% (range, 48.4–98.5%) with no patients experiencing tumor progression and recurrence. All the 54 patients experienced symptomatic improvement within 1 month to 12 months after radiotherapy. Within the entire follow up period, no patients experienced any form of permanent complications or symptomatic radiation toxicity. Neurocognitive impairment studies were conducted before and after radiotherapy on 28 patients while the studies were conducted after the last follow up in 40 patients. The cognitive function of all the participants had normal MoCA-scores of 28.25 pre-radiotherapy. The post-treatment MoCA-scores were also clinically stable (28.04, p = 0.78), and the average MoCA-score did not show any decline until the last follow-up (27.61, p = 0.13).Conclusion: The optimal dose and fractions of radiotherapy treatment for symptomatic large and giant cavernous sinus hemangioma remain unclear. This study, therefore, used a marginal dose of 50 Gy in 25 fractions in radiotherapy and this was proven to be effective and relatively safe in the treatment of symptomatic large and giant CSHs.

Extremely rare and giant cavernous cardiac hemangioma.

Extremely rare and giant cavernous cardiac hemangioma.

Pregabalin: A Drug Useful in the Management of Pain after Craniotomy?

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Heme-Pigment Induced Acute Kidney Injury after Cavernous Hemangioma Ablation.

Cavernous hemangiomas are the most common benign liver mass, occurring with up to 7.3% incidence.[1] Giant cavernous hemangiomas—defined as those exceeding 5 cm in diameter—can stretch the liver capsule and prompt abdominal pain in approximately 40% of patients.[2] Radiofrequency ablation (RFA) is employed to treat symptomatic cavernous hemangiomas, and has shown superior effectiveness at alleviating pain—as well as shorter procedure time and reduced blood loss—in comparison to traditional open surgical resection.[3] Acute kidney injury (AKI) is a rare complication of RFA of giant cavernous hemangiomas. This complication, which is due to heme-pigment released in the setting of massive red blood cell (RBC) hemolysis during the procedure, is uncommon, having been described in only a few cases in the literature.[4] [5] Herein, we present an illustrative case of AKI following RFA of a giant cavernous hemangioma requiring hospitalization and aggressive intravenous (IV) hydration, and we discuss risk factors, diagnostic criteria, avoidance strategies, and management approaches for this uncommon adverse event.

Symptomatic giant cavernous hemangioma of the liver in a 42-year-old man

Most cases of liver hemangioma are asymptomatic and discovered incidentally on liver ultrasound or computed tomography scan. Giant cavernous hemangioma (GCH) are however clinically distinct from smaller asymptomatic ones and may be confused with primary or metastatic malignancy. Symptomatic GCH of the liver are rare. The aim of the study was to show the rare case of symptomatic giant cavernous hemangioma of the liver which may be confuse with primary or metastatic malignancy. The patient’s images (abdominal ultrasound and computed tomography scans) and case file were reviewed and summarized. The subject matter of giant cavernous hemangioma was reviewed in the literature. The index case was discussed and compared with literature. We report a 42-year-old man who presented with a 2-year history of right upper abdominal pain and 6-month history of chest pain. No history of jaundice, body swelling or previous history of blood transfusion. No history of smoking or alcohol consumption. The patient is a known diabetic. Abdominal ultrasound scan showed hepatomegaly with a huge well defined oval shaped mixed echogenic mass lesion with lobulated margins occupying 4th and 5th segments of liver, measuring 84.9×111 mm in size suggestive of adenoma. The remaining hepatic parenchyma was normal. No intrahepatic biliary dilatation was seen. Initial histological examination revealed adenoma. Repeat histology done later however revealed hepatitis. Abdominal CT scan was later carried out and showed hepatomegaly but with no discernible mass lesion on precontrast images. Contrast enhanced images however, showed a fairly rounded mass lesion with peripheral enhancement and delayed filling-in at the venous phase, seen in the superior aspect of the right lobe extending to the dome. The intrahepatic vasculature and biliary ducts are not dilated. A diagnosis of cavernous hemangioma was made based on criteria of delayed (centripetal) filling-in. The patient however was lost to follow up. Hepatic hemangioma can be giant and symptomatic and despite its rarity, may still be encountered in practice.

Giant cavernous hemangioma of the eleventh rib

BackgroundCavernous hemangioma of the rib is extremely rare benign vascular tumor. It is difficult to diagnose in time because both invasive and noninvasive examinations usually fail to distinguish it from other tumors of the rib and other bones.Case presentationWe described an asymptomatic 44-year-old woman with cavernous hemangioma of the rib that was incidentally discovered in the bathing. The tumor was completely resected by minithoracotomy through posterolateral incision. The pathological tissue was diagnosed as a cavernous hemangioma composed of thin-walled blood vessels and red blood cells.ConclusionsWe reported this case of giant cavernous hemangioma of the rib for its extremely rare occurrence. The preoperative diagnosis is a challenge both clinically and radiologically, and difficult to distinguish this tumor from other tumors of the rib or long bones.

Clinical Features, Intradural Transcavernous Surgical Management, and Outcomes of Giant Cavernous Sinus Hemangiomas: A Single-Institution Experience

Cavernous sinus hemangiomas (CSHs) are rare vascular tumors. Stereotactic radiosurgery is an effective treatment for small CSHs. The optimal treatment for giant CSHs is controversial. This study reports advantages of a complete intradural transcavernous approach in total resection of CSHs. Between January 2012 and January 2017, 15 patients with giant CSHs were treated surgically. All cases were evaluated with a contrast-enhanced magnetic resonance imaging scan and confirmed histopathologically. A complete intradural approach was used for all patients. Clinical manifestations, radiographic characteristics, operative techniques, and outcomes of patients were analyzed. Headache was the most common initial symptom, followed by decreased visual acuity and diplopia. Postoperative magnetic resonance imaging showed that gross total resection was achieved in 13 patients. Two patients had experienced total ipsilateral visual loss for several years before surgery; vision improved in all remaining patients with preoperative visual diminution. The most common early neurologic deficit was cranial nerve VI dysfunction, which was observed in 9 patients (60%; 5 new deficits). Only 2 patients (13.3%) experienced permanent morbidity on long-term follow-up. The early postoperative morbidity rate for cranial nerve III dysfunction was 33.3% (5 patients), and only 1 patient (6.7%) experienced permanent morbidity. Four patients (26.7%) had slight postoperative facial numbness. Surgical total resection is the primary and reasonable choice for giant CSHs. Microsurgical resection of giant CSHs through a completely intradural transcavernous approach is an alternative treatment option for giant CSHs.

Surgical treatment of an asymptomatic giant supratentorial cavernous hemangioma. Case report

A case is reported of a 19-year old patient with a supratentorial giant cavernous malformation (GCM). This was an incidental finding in the context of acute head trauma. Brain computed tomography (CT) scan and magnetic resonance imaging (MRI) revealed a giant supratentorial right mass. Surgical excision was performed, and histopathology findings were consistent with a cavernous malformation (CM). The patient had a complete neurological recovery. To our knowledge, this is the first case of a GCM in an asymptomatic patient with total surgical excision.

Transarterial embolization of symptomatic giant liver hemangiomas

Background: In the present study, the clinical and radiologic results of transcatheter transarterial embolization (TAE) for the treatment of symptomatic giant cavernous hemangiomas of the liver were evaluated. Methods: Eleven patients (5 males, 6 females) with giant hemangiomas of the liver were treated by TAE. Hepatic angiography revealed hemangiomas up to 21.57 cm in diameter. Indications for TAE were abdominal pain (n=10) and rapid tumor enlargement (n=6). Two patients had Kasabach-Merritt syndrome (KMS). The percutaneous transarterial access was performed. The common femoral artery was puncture and hepatic artery was catheterized under fluoroscopic control. Embolization was performed with polyvinyl alcohol (PVA) particles of 500 - 900 micron Results: No treatment-related deaths were registered and morbidity was minimal. Post embolization syndrome (abdominal pain, fever, and leukocytosis) occurred in 7 patients within 1 – 4 days after TAE lasting for 3 - 7 days and was has been treated conservatively. Symptomatic improvement was documented in all patients. The haematologycal disorders normalized in both patients with KMS during 1 – 3 month after TAE. The mean size of the tumor did not show significant change on follow-up radiologic examinations. In two patients, the tumor significantly regressed in size after embolization. Two-year follow-up showed no recurrence of the clinical symptoms and hematological abnormalities in any patient. Conclusion: TAE is an effective procedure for the therapy of symptomatic hemangiomas

Giant Hepatic Hemangioma: An Incidental Finding Causing Pulmonary Embolism

Hepatic hemangiomas are typically discovered as incidental findings.1 We present a patient with pulmonary embolism (PE) likely due to IVC thrombosis caused by a giant hepatic hemangioma. Diagnosing IVC thrombosis is a difficult task and often requires a high index of suspicion as early recognition can help decrease the risk of PE through appropriate intervention. A 44-year old female with no significant past history presented to the ER with a six-month history of chest pain, leg heaviness, abdominal fullness, and dyspnea. A few weeks ago, she was evaluated for lower extremity (LE) DVT which was negative. On admission she was hemodynamically stable with a benign physical exam. She had no recent surgery, prolonged immobilization, prior venous thromboembolic event, or family history of a hypercoagulable disorder. D-dimer was elevated, however, other labs were unremarkable and a repeat ultrasound (US) to assess for LE DVT was negative. PE was diagnosed by CTA of the chest. A 7.4 x 7.5 x 8.7 cm giant hemangioma (incidentally diagnosed earlier that year) was also evident. As she could not tolerate an MRI, CT abdomen with portal venous phasing was obtained. It showed complete compression of the intrahepatic inferior vena cava (IVC) and portal vein abutment. She was started on anticoagulation and referred to specialists. Giant hepatic hemangiomas may present with a constellation of symptoms depending on size, location, and compression of adjacent structures.1 PE attributable to giant hepatic hemangiomas has been reported in the past. IVC thrombosis can lead to PE in 30% of the population with 2.6% - 4.0% of patients with LE DVT having IVC thrombosis.2 Presenting as a diagnostic challenge due to nonspecific symptoms, insidious course, and physician unfamiliarity, IVC thrombosis is often diagnosed when clot migration has already occurred.2 Mechanisms for IVC thrombosis include sluggish flow caused by IVC compression from a mass, migration of thrombi from a hemangioma into the IVC, and prothrombotic factors.1,2 Individuals with DVT and one or more high-risk features (Table I) for IVC thrombosis should undergo initial screening with an IVC duplex US with anticoagulation as the mainstay of treatment in IVC thrombosis.2 Although this patient's clinical presentation made diagnosing IVC thrombosis a challenge, recognizing that it can result in PE is of paramount importance as early detection and treatment can decrease the risk of PE.2379_A Figure 1. Computed tomography with IV contrast of the abdomen, axial image of liver demonstrates 7.4 x 7.5 x 8.7 cm lesion with evidence of globular discontinuous enhancement on portal venous phase (red arrow) compatible with giant cavernous hemangioma. The lesion causes mass effect on the intrahepatic portion of the inferior vena cava with evidence of complete compression (yellow arrowhead).2379_B Figure 2. Table adapted from: 2. Mohamad, Alkhouli, Mohammad Morad, et al. “Inferior Vena Cava Thrombosis.” JACC: Cardiovascular Interventions [Online], Volume 9, Issue 7, Pages 629-643

Role of selective intra-arterial embolization in benign liver tumors

ObjectiveTo present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. Material and methodsWe present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas.Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500μm–700μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4–7 days after embolization. ResultsAll 7 patients were women (age range, 23–74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. ConclusionsProvided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors.

Sudden death in a child caused by a giant cavernous hemangioma of the anterior mediastinum

A 4-year-old girl who had been treated for asthma since the age of 2 years had a severe coughing fit and died suddenly. The patient had a history of occasional severe coughing fits, and these fits had been worsening in severity during the week before her death. Prior to death, she was taken to a clinician, and thymic hypertrophy was suspected based on chest X-ray findings. The clinician recommended that she visit a general hospital at a later date; however, she died that night. Postmortem radiology and autopsy revealed a large mass in the anterior mediastinum compressing the heart and airway, and no other findings attributable to sudden death were observed. Therefore, we concluded that the patient's death was attributable to acute respiratory and cardiac circulatory failure secondary to the pressure induced by the mass. Microscopically, the mass showed a cavernous structure composed of cystically dilated, thin-walled large vessels filled with blood. The final diagnosis was a cavernous hemangioma. Hemangiomas are the most common benign vascular anomalies seen in young children; however, mediastinal hemangiomas are rare and can cause life-threatening complications because of their size and location. Therefore, forensic pathologists should include hemangioma as a differential diagnosis in children with anterior mediastinal masses.

Papel de la embolización selectiva intraarterial en los tumores hepáticos benignos

ObjectiveTo present cases of symptomatic benign liver tumors diagnosed and treated with intra-arterial embolization before surgery. Material and methodsWe present the cases of 7 patients diagnosed with symptomatic benign liver tumors that required treatment: 1 focal nodular hyperplasia, 2 giant cavernous hemangiomas, 1 hepatic adenomatosis, and 3 hepatic adenomas.Once the feeding arteries were identified, tumors were embolized with polyvinyl alcohol particles (500μm–700μm) and then the feeding artery was plugged with coils if there was an arterial pedicle to ensure the total vascular exclusion of the tumor. The surgical intervention took place 4 to 7 days after embolization. ResultsAll 7 patients were women (age range, 23–74 years); presurgical intra-arterial embolization was done in 6. In 1 patient with adenomatosis, embolization was done to control intraparenchymal hepatic hemorrhage. In the 6 patients who underwent surgery, the tumor was completely excised and no intraoperative bleeding events or postoperative complications occurred. ConclusionsProvided there is a consensus among the multidisciplinary team, embolization is a useful option in the perioperative management of giant and/or symptomatic benign liver tumors.

Minor Fall Leading to Fatal Rupture of Solitary Giant Sub-Capsular Cavernous Haemangioma of Liver: a Case Report

Background : The liver which is a vascular organ can easily be lacerated or crushed, depending on the severity of trauma. Case Report: A 55 year-old lady who fell down was taken to a hospital within one hour and died two hours post-trauma. An autopsy revealed rupture a large sub capsular vascular lesion situated on the right lobe of liver with hemoperitoneum. There was a deep contusion on the abdominal wall adjacent to the costal margin on the right side, roughly overlying the rupture, but the skin showed no evidence of injury on external examination. Histopathology revealed that the lesion was a giant cavernous haemangioma of the liver which was undetected prior to the incident. Conclusion: Certain conditions like fatty liver disease, polycystic disease and cavernous haemangioma can predispose liver injury, even with considerably less amount of force than is ordinarily required.

Hypofractionated stereotactic radiosurgery: a new treatment strategy for giant cavernous sinus hemangiomas.

OBJECTIVE Cavernous sinus hemangiomas (CSHs) are rare benign vascular tumors that arise from the dural venous sinuses lateral to the sella. Stereotactic radiosurgery (SRS) has emerged as a principal alternative to microresection for small- and medium-sized CSHs. Resection is a reasonable option for large (3-4 cm in diameter) and giant (> 4 cm in diameter) CSHs. However, management of giant CSHs remains a challenge for neurosurgeons because of the high rates of morbidity and even death that stem from uncontrollable and massive hemorrhage during surgery. The authors report here the results of their study on the use of hypofractionated SRS (H-SRS) to treat giant CSH. METHODS Between January 2008 and April 2014, 31 patients with a giant CSH (tumor volume > 40 cm3, > 4 cm in diameter) treated using CyberKnife radiosurgery were enrolled in a cohort study. Clinical status and targeted reduction of tumor volume were evaluated by means of serial MRI. The diagnosis for 27 patients was determined on the basis of typical imaging features. In 4 patients, the diagnosis of CSH was confirmed histopathologically. The median CSH volume was 64.4 cm3 (range 40.9-145.3 cm3). Three or 4 sessions of CyberKnife radiosurgery were used with a prescription dose based on the intent to cover the entire tumor with a higher dose while ensuring dose limitation to the visual pathways and brainstem. The median marginal dose to the tumor was 21 Gy (range 19.5-21 Gy) in 3 fractions for 11 patients and 22 Gy (range 18-22 Gy) in 4 fractions for 20 patients. RESULTS The median duration of follow-up was 30 months (range 6-78 months) for all patients. Follow-up MRI scans revealed a median tumor volume reduction of 88.1% (62.3%-99.4%) at last examination compared with the pretreatment volume. Ten patients developed new or aggravated temporary headache and 5 experienced vomiting during the treatment; these acute symptoms were relieved completely after steroid administration. Among the 30 patients with symptoms observed before treatment, 19 achieved complete symptomatic remission, and 11 had partial remission. One patient reported seizures, which were controlled after antiepileptic drug administration. No radiation-induced neurological deficits or delayed complications were reported during the follow-up period. CONCLUSIONS Hypofractionated SRS was an effective and safe modality for treating giant CSH. Considering the risks involved with microsurgery, it is possible that H-SRS might be able to serve as a definitive primary treatment option for giant CSH.

GIANT HEPATIC HEMANGIOMA COMBINED WITH GENERALIZED SARCOIDOSIS

Case report of successful surgical treatment of giant cavernous hepatic hemangioma combined with generalized sarcoidosis is presented. Information about etiology, pathogenesis and management of these diseases, brief literature review are exhibited. The role of modern methods of diagnostic visualization, preoperative endovascular superselective embolization as well as features of blood-sparing extensive liver resection are discussed.