Giant Liver Hemangioma Research Articles

Laparoscopic left lateral sectionectomy for a giant liver hemangioma

Presenter: Jose-Luis Beristain-Hernandez MD | "La Raza" National Medical Center Background: We present the case of a 65 year old female, with a revious history of cholecystectomy and hysterectomy. She was referred to our clinic with a previous history of liver hemangioma for years. History of colicky abdominal pain on upper quadrants, becoming more important during the last few months, presenting almost on a daily basis. Methods: On CT scan a 15 cm diameter hemangioma on SII-SIII, with classic uptake of contrast on arterial phase. Tumoral markers and hepatitis viral panel was negative. She had no signs of liver insufficency. A laparoscopic left lateral sectionectomy was proposed. Results: Surgery was performed. It lasted 140 minutes, an a 300 mL intraoperative hemorrhage was accounted, taking into account the tumor blood. No Pringle manœuvre was used during the resection. Postoperative course was uneventful and patient was discharged on PO day 3. Conclusion: The patient remains asymptomatic and tumor free at 6 months posoperatively. Laparoscopic left lateral sectionectomy can be safely performed for giant liver hemangioma in selected patients.

Pure laparoscopic liver resection for giant liver hemangioma with extrahepatic growth based on preoperative 3-dimensional simulation: A case report

BackgroundPerforming laparoscopic liver resection for giant hemangiomas is challenging, and careful preoperative planning is essential. Controlling intraoperative bleeding and handling surgical instruments within a limited workspace is necessary.Case presentationIn the present case, the patient was a 38-year-old woman diagnosed with a 16-cm giant liver hemangioma in segment 5/6, with extrahepatic growth. Preoperative three-dimensional simulations for port placement and the laparoscopic view from the left upper abdomen were performed to complete the pure laparoscopic liver resection. The laparoscopic resection was then safely performed on the same way.ConclusionsPure laparoscopic resection could be applied to giant hemangiomas with extrahepatic growth, and the preoperative three-dimensional simulation of port placement and the laparoscopic view might be helpful when the intraabdominal workplace is restricted.

Liver Transplantation for Giant Hepatic Hemangioma: A Systematic Review

IntroductionDespite 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 methodsA 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. ResultsFifteen 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. ConclusionsLH 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.

Embolizations of the hepatic tumors - two-year single center experience

Background/Aim. Transcatheter arterial chemoembolization (TACE) and portal vein embolizations (PVE) are established methods of treatment of patients with hepatic tumors. The aim of the study was to present our experience in the treatment of liver tumors with embolization as a preliminary treatment for surgery or a part of palliative treatment. Methods. The analysis included 29 patients who had undergone 34 embolizations. Results. TACE was performed in 26 cases with hemangiomas in the unfavorable location, or mass effect and inoperable malignant tumors both primary and metastatic. PVE was performed in 8 cases with primary liver tumors and colon liver metastases.All included patients presented inoperable hepatic tumors. TACE was carried out in the patients with hepatocellular carcinoma (n = 1), cholangiocarcinoma (n = 1), metastatic tumor (n = 8), and hemangioma (n = 16), while PVE in the patients with cholangiocarcinoma (n = 2), metastatic tumor (n = 5) and neuroendocrine tumor (n = 1). The embolization was followed by surgery in the 5 PVE patients and 6 TACE patients. The postembolization syndrome was observed in 7 subjects. Death due to cancer progression occurred in the 4 PVE patients and 7 TACE patients. One patient died during TACE due to hemorrhagic shock. Conclusions. Right PVE and selective TACE are efficient for preliminary preparation of patients with healthy hepatic parenchyma for major liver resections, but the patients with liver cirrhosis require careful assessment. In the patients with hemangioma, embolization allows to avoid surgical treatment by reducing the lesion mass, or the extent of hepatic resection. The preliminary results of arterial embolizations with bleomycin, leading to tumor reduction in cases of giant liver hemangiomas are promising.

Enucleation plus caudate lobe resection for central giant hemangioma of the liver

Background: Hepatic hemangiomas warrant therapy if they are causing significant symptoms or are increasing in size. Enucleation is easier and safer than partial hepatectomy. Giant centrally located lesions are more challenging but can be treated with the same approach. Methods: A 70 years old man was referred to our hospital for pain in the right upper abdomen. CT scan revealed a central giant liver hemangioma compressing the cava and the suprahepatic veins with fissuration on segment 8. No signs of active bleeding were detected. The right diaphragm was elevated with concomitant right basal effusion and pneumonia. The size of the hemangioma was significantly increased in comparison with a previous exam taken 4 years before (main diameter from 9 to 12 cm). Patient was monitored after admission and surgey was delayed until the resolution of the pneumonia. Results: Resection of the caudate lobe and enucleation of the giant hemangioma under intermittent clamping was performed. After the caudate lobe was dissected from the caval vein the plan of dissection followed the capsule of the hemangioma to complete the enucleation from the surrounding parenchyma and the suprahepatic veins. Patient did't require transfusion. Postoperative course was uneventful and the patient was discharged 5 days after operation. Conclusion: Combined resection and enucleation is feasible also for centrally located giant hemangioma and need to be considered the safest approach when surgery become mandatory. It avoids complex liver resections.

Effect of Bleomycin Embolization on Symptomatic Improvement and Hemangioma Size among Patients with Symptomatic Giant Liver Hemangiomas

Effect of Bleomycin Embolization on Symptomatic Improvement and Hemangioma Size among Patients with Symptomatic Giant Liver Hemangiomas

An Unexpected Cause of Coagulopathy

Hepatic hemangiomas are generally asymptomatic and rarely cause symptoms of consumptive coagulopathy and thrombocytopenia. We present a case of Kasabach-Merritt Syndrome in a patient found to have extensive hepatic hemangiomatosis. A 37-year-old male with a medical history of an abdominal hernia repair and an essential tremor presented with worsening fatigue, increased bruising, and abdominal distention over a 4-month period. Labs were significant for a hemoglobin of 8.4 g/dL, total bilirubin of 1.5 mg/dL, platelet count of 70,000/uL, INR 2.3, and fibrinogen level of less than 60 mg/dL. Abdominal magnetic resonance imaging (MRI) revealed variably sized lesions representing hepatic hemangiomas that replaced a majority of his hepatic parenchyma (Figure 1). Based on abnormal imaging and laboratory data revealing consumptive coagulopathy and hemolysis, a diagnosis of Kasabach-Merritt syndrome (KMS) was made. He was started on high dose methylprednisolone and transfused aggressively with packed red blood cells, cryoprecipitate, prothrombin complex concentrate, and fibrinogen concentrate with minimal improvement in his consumptive coagulopathy. Given his extensive hepatic dysfunction, he was listed for liver transplantation. He remained clinically stable with no signs of active bleeding and was discharged home. Two months after initial diagnosis, he underwent a successful liver transplant. His liver explant weighed 6.7 kg and measured 28cm in the right lobe and 30 cm in the left lobe. Kasabach-Merritt Syndrome is a rare but serious complication defined by the triad of hemangioma, consumptive coagulopathy, and thrombocytopenia. The incidence of this syndrome in adults is unknown and the majority of cases reported in children. Due to its rarity, there are no clinical guidelines for the treatment of this syndrome and the general approach is the correction of the hematologic derangements. Other cases reported the successful use of corticosteroids, antiplatelet therapy, and chemotherapeutic agents. Primary treatments of hepatic hemangiomas consist of embolization, enucleation, and resection with surgery reserved for symptomatic or complicated cases. Among previous case reports, the majority of giant liver hemangiomas (diameter greater than 20cm) underwent transplant, with one undergoing enucleation, and proved curative. Given his extensive hemangiomatosis, liver size, and coagulopathy refractory to medical therapy, a liver transplant was performed and proved curative.2414 Figure 1. Magnetic resonance imaging revealing multiple hepatic lesions without evidence of cirrhosis.

Kasabach-Merritt phenomenon with concurrent appearance of antiphospholipid antibodies in a patient with giant liver haemangioma.

Kasabach-Merritt phenomenon with concurrent appearance of antiphospholipid antibodies in a patient with giant liver haemangioma.

Редкий случай хирургического лечения гигантской гемангиомы печени

Редкий случай хирургического лечения гигантской гемангиомы печени

The effect of bleomycin embolization on symptomatic improvement and hemangioma size among patients with giant liver hemangiomas

Highlights:

The Effect of Bleomycin Embolization on Symptomatic Improvement and Hemangioma Size among Patients with Giant Liver Hemangiomas

Objective: The optimal treatment of giant liver hemangiomas is controversial. Although surgery is the usual treatment for symptomatic giant hemangiomas, minimally invasive techniques have been recently recommended as an alternative therapy. Aim: we aimed to assess the effect of bleomycin embolization with lipiodol on symptomatic improvement and hemangioma size among patients with symptomatic giant liver hemangiomas. Methods: This study retrospectively involved 17 patients [10 women, 7 men; Age range 35 - 67 years (mean 46.41 ± 2.6 years)] with giant liver hemangioma who presented to our clinic between August 2014 and October 2016. Bleomycin mixed with lipiodol was administered using selective arterial embolization. The patients were followed by clinical, laboratory, ultrasonography and abdominal tomographic examination (mean 14.47 ± 2.21 months). All statistical analyses were performed using SPSS 15.0; a p value of less than 0.05 was considered statistically significant. Results: The mean volume of hemangiomas was 1799.3 cm3 (range 480 - 9925.1 cm3) before the procedure and 405.7 cm3 (range 38.7 - 3856 cm3) after the procedure. No treatment-related death was observed. All patients demonstrated symptomatic improvement and significant volume reduction (p = 0.001). Conclusions: Minimally invasive bleomycin embolization is an effective alternative to surgery for patients with giant liver hemangiomas.

A Case of a Spontaneous Disappeared Giant Liver Hemangioma and its Literature Review

Hepatic hemangioma is the most common benign tumor of the liver. It is reported that the change of hemangioma may be related to VEGF. In our case, a 62-year-old male patient, who had a 20 years history of HBV, was diagnosed as giant liver hemangioma (102 mm × 73 mm) 17 years ago and did not receive any review and treatment before admission. After admission, CT showed liver cirrhosis and hepatocellular carcinoma. Compared with the CT of 17 years ago, the giant hemangioma disappeared completely. To date, the giant liver hemangioma, which had spontaneously disappeared without treatment, has not been reported.

Preoperative Trans-Arterial Embolization and Surgical Resection for Giant Liver Hemangioma: A Multidisciplinary Approach

Preoperative Trans-Arterial Embolization and Surgical Resection for Giant Liver Hemangioma: A Multidisciplinary Approach

Major liver resection in pregnancy: three cases with different etiologies and review of the literature

Background: Major liver resection during pregnancy is extremely rare. When required, the associated physiologic and anatomic changes pose specific challenges and greater risk for both mother and fetusMaterials and methods: Three cases of major liver resection during pregnancy due to different etiologies are presented. The relevant literature is reviewed and discussed.Results: We present three cases of major liver resection due to giant liver hemangioma with Kasabach–Merrit syndrome, giant hydatid cyst, and intrahepatic cholangiocarcinoma, at gestational week (GW) 17, 19, and 30, respectively. All patients had an uneventful postoperative course, continued the pregnancy and gave birth at GW 38.Conclusion: Major liver resection can be performed safely during pregnancy. A multidisciplinary team of surgeons, anesthesiologists and gynecologists, in a highly experienced tertiary hepatobiliary center, should be involved.

Risk factors of massive blood loss during resection of giant liver hemangioma

Objective To evaluate the risk factors of massive blood loss in resection of giant liver hemangioma. Method The clinical data of 141 patients who underwent giant liver hemangioma resection were retrospectively studied. These data included general physical condition, laboratory tests, radiologic findings, and various surgical parameters. The patients were divided into the massive blood loss group (>1 000 ml, n=27) and the minor blood loss group (≤1 000 ml, n=114). Logistic regression was performed to determine the risk factors of intraoperative massive blood loss. Results The average diameter of the liver hemangioma was significantly greater in the massive blood loss group than that in the minor blood loss group [(21.7±8.5) cm vs. (14.1±5.3) cm, P<0.05]. The incidences of preoperative leukopenia, anemia, thrombocytopenia and prolonged prothrombin time were higher in the massive blood loss group than that in the minor blood loss group (48.1% vs. 16.7%, 37.0% vs. 11.4%, 25.9% vs. 3.5%, 22.2% vs. 3.5%, respectively, all P<0.05). Hepatic hemangioma with compressed hepatic veins, inferior vena cava and porta hepatis were more frequently found in the massive blood loss group than in the minor blood group (55.6% vs. 14.9%, 44.4% vs. 14.0%, 55.6% vs. 12.3%, respectively, all P<0.05). Logistic regression analysis demonstrated a diameter of hemangioma greater than 15 cm was a risk factor of intraoperative massive blood loss during surgical resection. Conclusions Giant hepatic hemangioma may cause disorders in the hematological and coagulation systems. Compression of major hepatic vessels raised technical difficulty and risks in surgery. Hemangioma with a diameter greater than 15 cm was recognized as a high-risk factor of intraoperative massive blood loss. Key words: Liver tumor; Giant hemangioma; Surgical procedure; Massive blood loss

Effectiveness of Sorafenib in Hepatic Hemangioma.

Hemangiomas are the most common benign tumors of the liver, with a frequency of 0.4% to 7.3%.1 Small liver hemangiomas (< 4 cm) are generally asymptomatic and can be observed without any chance of malignant transformation or complications. Hemangiomas are defined as giant if their size exceeds 4 cm.2 The most common site is the right lobe of the liver (subcapsular region). Small, asymptomatic hemangiomas do not show changes during long-term follow-up; hence they can be observed without any treatment.3 Giant liver hemangiomas are symptomatic and patients present with mild pain, abdominal mass, abdominal fullness and rarely with jaundice, consumptive coagulopathy (Kasabach-Merritt syndrome), or intra-abdominal bleeding as the result of rupture. Congestive heart failure and intraperitoneal bleeding can sometimes be fatal.4 Surgical resection is the only treatment option for symptomatic hemangiomas. Diagnosis is not easy to obtain because percutaneous biopsy is risky and the role of other treatment options such as steroids, hepatic artery ligation, and radiotherapy is controversial.5 Herein, we report an unusual case of a giant symptomatic hepatic hemangioma, which was initially diagnosed as an inoperable hepatocellular carcinoma (HCC) and treated with an oral tyrosine kinase inhibitor (ie, sorafenib).

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.

Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas

BackgroundThis study aimed to determine the feasibility of the extracapsular enucleation method for giant liver hemangiomas by infrahepatic inferior vena cava (IVC) clamping and the Pringle maneuver to control intraoperative bleeding under laparoscopic hepatectomy.MethodsFrom January 2012 to January 2016, 36 patients underwent laparoscopic extracapsular enucleation of giant liver hemangiomas. Patients were divided into two groups: infrahepatic IVC clamping + Pringle maneuvers group (IVCP group, n = 15) and the Pringle maneuvers group (Pringle group, n = 21). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed.ResultsThe mean size of liver hemangiomas was 13.3 cm (range 10–25 cm). Infrahepatic IVC clamping + the Pringle maneuvers with laparoscopic extracapsular enucleation significantly reduced intraoperative blood loss (586.7 vs 315.3 mL, p < 0.001) and transfusion rates (23.8 vs 6.7%, p = 0.001), compared with the Pringle maneuver alone. The gallbladder was retained in both groups. The mean arterial pressure (MAP) in Pringle group remained virtually stable before and after clamping of hepatic portal, while it was significantly decreased after IVC clamping in IVCP group than that pre-clamping (p < 0.001). The heart rate of all patients was significantly increased after clamping when compared to pre-clamping heart rates (p < 0.001). Once vascular occlusion was released, MAP returned to normal levels within a few minutes. There were no significant differences in postoperative complications between two groups. The vascular occlusion techniques in both groups had no serious effect on postoperative of hepatic and renal function.ConclusionsExtracapsular enucleation with infrahepatic IVC clamping + the Pringle maneuver is a safe and effective surgical treatment to control bleeding for giant liver hemangiomas in laparoscopic hepatectomy.

Characteristics and operative treatment of extremely giant liver hemangioma >20 cm

Giant liver hemangioma >20cm may cause severe complications; therefore, operative treatment can be highly difficult and risky. No studies have been performed to determine the characteristics of this subgroup. A retrospective study was performed on 141 patients who underwent operative treatment for liver hemangioma. The patients were divided into an extremely giant hemangioma group (>20cm, 36 cases) and a giant hemangioma group (>10cm but <20cm, 105 cases). A comparison was then made between the groups. For patients in the extremely giant hemangioma group, further comparison was also made between liver resection and enucleation. Compared with the giant hemangioma group, patients in the extremely giant hemangioma group had greater rates of leukopenia (P < .001), anemia (P < .001), thrombocytopenia (P < .001), pancytopenia (P < .001), prolonged prothrombin time (P < .001), and Kasabach-Merritt syndrome (P = .001). Patients in the extremely giant hemangioma group also had greater rates of compression of the hepatic vein (P < .001), inferior vena cava (P < .001), and porta hepatis (P < .001). The extremely giant hemangioma group had more blood loss (P < .001) and autologous transfusion (P < .001), greater rates of blood transfusion (P < .001), and greater postoperative stays (P < .001). Morbidity was greater in the extremely giant hemangioma group; however, this difference was not statistically significant (P = .076). For patients in the extremely giant hemangioma group, no differences were detected regarding autologous transfusion, blood transfusion, or morbidity between enucleation and liver resection. Extremely giant hemangiomas may cause abnormalities in the hematologic and coagulation systems. Operative treatment may be difficult and risky but can be completed safely.

Stapler hepatectomy in giant cavernous hemangioma of liver

Stapler hepatectomy in giant cavernous hemangioma of liver