Giant Liver Hemangioma Research Articles

Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report

IntroductionLiver hemangiomas are the most common benign liver tumors, usually small in size and requiring no treatment. Giant hemangiomas complicated with consumptive coagulopathy (Kasabach-Merritt syndrome) or causing severe incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. Here, we present the case of a giant hemangioma, which was, to the best of our knowledge, one of the largest ever reported.Case presentationA 38-year-old Asian man was referred to our hospital with complaints of severe abdominal distension and pancytopenia. Examinations at the first visit revealed a right liver hemangioma occupying the abdominal cavity, protruding into the right diaphragm up to the right thoracic cavity and extending down to the pelvic cavity, with a maximum diameter of 43 cm, complicated with "asymptomatic" Kasabach-Merritt syndrome. Based on the tumor size and the anatomic relationship between the tumor and hepatic vena cava, primary resection seemed difficult and dangerous, leading us to first perform transcatheter arterial embolization to reduce the tumor volume and to ensure the safety of future resection. The tumor volume was significantly decreased by two successive transcatheter arterial embolizations, and a conventional right trisectorectomy was then performed without difficulty to resect the tumor.ConclusionsTo date, there have been several reports of aggressive surgical treatments, including extra-corporeal hepatic resection and liver transplantation, for huge hemangiomas like the present case, but because of its benign nature, every effort should be made to avoid life-threatening surgical stress for patients. Our experience demonstrates that a pre-operative arterial embolization may effectively enable the resection of large hemangiomas.

Recurrent Pulmonary Embolism Due to Giant Hepatic Hamangioma Treated With Hepatectomy Under Vascular Exclusion

Giant hepatic hemangiomas are benign tumors that measure more than 4 cm and are usually asymptomatic. Pulmonary embolism (PE) is an extremely rare manifestation of giant hepatic hemangiomas. We report a case of a 44-year-old woman who suffered of recurrent pulmonary emboli that, after thorough work up, were attributed to thrombi formation inside a giant hepatic hemangioma. A right hepatectomy under vascular exclusion was performed and the hemangioma, measuring 17 cm, was resected. Two years later the patient remains asymptomatic. The report highlights the value of investigating giant liver hemangiomas in case of PE. In such cases, the hemangioma should be resected preferably under occlusion of the venous outflow of the liver to avoid PE intraoperatively.

Surgical Treatment of Giant Liver Hemangiomas: Enucleation with Continuous Occlusion of Hepatic Artery Proper and Intermittent Pringle Maneuver

The present study was designed to investigate the efficacy and safety of continuous occlusion of the hepatic artery proper combined with intermittent use of the Pringle maneuver for reduction of blood loss during enucleation of giant liver hemangiomas. A retrospective study was performed on 115 patients who underwent enucleation of giant liver hemangiomas with or without continuous occlusion of the hepatic artery proper at a tertiary care university hospital. The characteristics of patients and perioperative parameters including intraoperative blood loss, the degree of ischemia-reperfusion injury, the incidence and severity of postoperative complications, and the length of hospital stay were summarized and compared in the two groups. Seventy-three and 42 patients underwent enucleation of hepatic hemangiomas with and without continuous occlusion of the hepatic artery proper, respectively. The Pringle maneuver was routinely used in all patients in cycles of 15/5 min of clamp/unclamp times. Patient characteristics were comparable between the two groups. Intraoperative blood loss and blood transfusion in the continuous occlusion group were significantly lower than in the non-occlusion group (P < 0.001 and P = 0.012, respectively). In a comparison of the two groups, there were no significant differences in the changes of the perioperative serum aspartate transaminase and total bilirubin levels (P = 0.086, P = 0.829, respectively), and in the postoperative hospital stay and surgical complications according to Clavien's classification (P = 0.378, P = 0.227, respectively). Continuous occlusion of the hepatic artery proper when added to intermittent use of the Pringle maneuver significantly reduced intraoperative blood loss when compared with intermittent Pringle maneuver alone. Enucleation of giant hepatic hemangiomas using continuous occlusion of the hepatic artery proper in addition to intermittent application of the Pringle maneuver for up to 1 h was safe.

Resection of a rapid-growing 40-cm giant liver hemangioma

Hemangiomas are the most frequent benign tumors of the liver. Most hemangiomas are asymptomatic and therefore largely diagnosed only in routine screening tests. Usually they are small and require no specific treatment. In some situations they can reach great dimensions, causing some discomfort to the patient. Resection of liver hemangioma is indicated in cases of great dimension tumors causing symptoms such as pain, nausea or bloating caused by compression of adjacent organs. We report a case of a rare giant hemangioma with rapid growth in short time: a 50 year old female reported to our institution with a 40 cm giant liver hemangioma and then underwent a left hepatectomy.

Hemodynamic failure as an indication to urgent liver transplantation in infants with giant hepatic hemangiomas or vascular malformations – Report of four cases

The aim of this study was to present acute hemodynamic failure as a rare indication for liver transplantation in neonates and infants with liver hemangiomatosis. We report four patients aged one to six months with giant liver hemangiomas, with huge arterio-venous shunting within these malformations. In three, many skin hemangiomas were found. All children developed right ventricular failure. In two, a trial of pharmacological reduction was attempted with corticosteroids and cyclophosphamide. In one patient, the arterio-venous fistulas were embolized without any improvement in hemodynamic status. Two children underwent rescue hepatic artery surgical ligation, which did not prevent heart and then multiorgan failure including liver failure. After unsuccessful conventional therapy, all infants were considered for urgent liver transplantation; in three cases, it was performed with a living-related donor, and in one case with a deceased donor. All patients are alive and well with the follow-up between nine and 37 months after transplantation. Liver transplantation should be considered as a rescue treatment in children with hepatic vascular malformations leading to hemodynamic insufficiency when conventional therapy is unsuccessful and multiorgan failure develops.

Superextended hepatectomy for resection of multiple giant hemangiomas: Report of a case

Most liver hemangiomas are small, asymptomatic, and require no treatment. Symptoms such as right upper quadrant abdominal pain and fullness are associated only with liver hemangiomas larger than 4 cm in diameter. Serious complications such as jaundice, Kasabach-Merritt syndrome, and rupture are rare. Surgical resection is the only effective treatment, but it is advocated only for patients with incapacitating symptoms or complications. We report a case of successful superextended hepatectomy with resection of segments III-VIII for multiple, bilobar hemangiomas. A 45-year-old woman, who had undergone transcatheter arterial embolization (TAE) for inoperable multiple giant liver hemangiomas 4 years earlier, was referred to our hospital for investigation of abdominal distension and consumption coagulopathy. Because of her severe and progressive symptoms despite treatment, the other hospital had considered her as a candidate for liver transplantation, which she had refused. After careful preoperative assessment of the future liver remnant volume and function, we considered that resection was possible. Based on our review of large surgical series in the literature from 1970, this is the first report of a superextended hepatectomy for a benign liver tumor.

Dissecting giant liver hemangioma through retrohepatic tunnel: a report of 8 cases

目的 探讨肝后下腔静脉前间隙入路在特大肝血管瘤切除中的意义.方法 回顾性分析潍坊市人民医院肝胆、血管外科2004年2月至2006年9月利用肝后下腔静脉前间隙入路行8例特大肝血管瘤切除的临床资料和随访情况.结果 利用此入路手术均取得成功,术中出血少,术后恢复快,并发症少.结论 肝后下腔静脉前间隙可作为一良好的肝特大血管瘤的手术入路。

Transarterial embolization of giant liver hemangiomas associated with kasabach-merritt syndrome: a case report

Of 22 patients with symptomatic giant liver hemangiomas referred for embolization, two females (52 and 74 years) had Kasabach-Merritt syndrome (KMS). Hematocrit values were observed to be 33% and 29%, platelets 4000 and 5400/mm(3), and fibrinogen 98 and 77 mg/dl, respectively. Lesion diameters were 7 and 14 cm, respectively. Hepatic angiography revealed excessive vascular lakes typical of cavernous hemangiomas. Microspheres of 40-300 microm were superselectively injected under fluoroscopic guidance until cessation of flow. Coil packing of the feeding hepatic artery was additionally used in one patient. The procedure was uneventful in both. Partial restoration of platelet count was observed immediately; fibrinogen levels and platelets were restored completely in one patient and partially in the other, without remissions at 2-year follow-up.

An unusual cause of epigastric pain: infected giant liver hemangioma

A 64-year-old woman was admitted to our surgical emergency department suffering from epigastric pain and fever persisting for a period of 5 weeks, and, upon admission, she presented with massively elevated C-reactive protein. Computed tomography (CT) demonstrated a giant hemangioma of the liver with an intralesional central mass, which was documented by diameter progression of the central mass on follow-up CT. After liver resection, the diagnosis was an abscess in a giant liver hemangioma.

Case report: Non-surgical management of a giant liver hemangioma

Case report: Non-surgical management of a giant liver hemangioma

Corticothérapie et hémangiome géant du foie: Effets bénéfiques sur les symptômes et normalisation des cytokines

We report the case of a 36 year-old woman presenting with a giant liver hemangioma revealed by febrile hepatomegaly and weight loss. The patient presented an inflammatory syndrome without hyperleucytose, anemia and a moderate anicteric cholestasis. Plasma concentrations of interleukine-6 were very high whereas interleukine-1 levels were relatively low and TNF levels were normal. Eight weeks of corticosteroid treatment (prednisone 40 mg/d) resulted in disappearance of symptoms after 48 hours and biological anomalies after 6 weeks. Clinical and radiological follow-up, for respectively 36 and 24 months, did not show any relapse of symptoms or evolution of the hemangioma.

Management and follow-up of 78 giant haemangiomas of the liver.

The natural history and appropriate treatment of giant liver haemangioma remain poorly defined. The diagnostic strategy and the results of a longitudinal study of 78 such lesions are described. Sixteen resected patients and 62 with asymptomatic giant haemangiomas were entered into a follow-up programme consisting of clinical assessment and abdominal ultrasonography every 6 months. Resection was considered only for symptomatic patients (14 cases) and rapidly growing lesions (two cases). The mean follow-up was 36 months for the resected patients and 55 months for the observed group. Surgery permanently relieved symptoms. No recurrence of haemangioma was observed. Some 32 of 36 unresected lesions followed up remained stable in size. Minor changes were observed in four of 36. None ruptured or became symptomatic. It is concluded that asymptomatic large haemangiomas can be managed safely by observation. However, the occasional occurrence of rapid growth might represent a further indication for resection and justifies strict imaging follow-up. The pattern of growth, rather than absolute size, of a lesion is suggested for selection of asymptomatic patients who might benefit from preventive surgical excision. When feasible, the authors prefer enucleation to remove giant haemangiomas.

Giant Liver Hemangioma: Therapy by Enucleation or Liver Resection

Hemangioma is the most common primary tumor of the liver. The widespread use of ultrasonography (USG) and computed tomography (CT) has made the diagnosis more common. Although the vast majority of hemangiomas are diagnosed incidentally and are asymptomatic, treatment is still controversial. Surgery is the treatment of choice, especially in giant, symptomatic hemangiomas and uncertainty of diagnosis. Twenty-two patients (median age: 46 years) underwent resection (n = 12) or enucleation (n = 10) for liver hemangioma from 1989 to 2002. The primary indication for surgery was abdominal pain. Ten patients who were treated by enucleation were compared with twelve patients who were treated by liver resection. Mean tumor size was 90 mm with a range of 40-270 mm. There were no statistically significant differences in tumor size, preoperative liver function tests, hemoglobin levels, and platelet counts between the two groups. Operative time was longer in the resection group, and statistically significant the difference was (p = 0.048). Blood transfusion requirement and blood loss during intraoperative period were higher in the resection group (p = 0.025, p = 0.01, respectively). There were three postoperative complications, 1 in the enucleation group (pleural effusion), 2 in the resection group (liver abscess and wound infection). There was no surgery-related mortality in either group. Although most hemangiomas can be removed by enucleation or liver resection with low morbidity and mortality, if the location and number of hemangiomas are appropriate, enucleation is the choice of the therapy. Hospital stay, blood transfusion requirement, and blood loss can be kept minimal by the selection of enucleation.

Giant cavernous liver hemangiomas: effect of operative approach on outcome.

The choice of operative technique for resection of giant cavernous hepatic hemangiomas has an effect on outcome. Case series. Tertiary hepatobiliary surgery-liver transplantation service. Fifty-two adult patients who underwent resection of symptomatic hepatic hemangiomas (38 [73%] in the right lobe; average diameter, 10.9 cm) by means of lobectomy or enucleation, with or without Pringle inflow occlusion. Blood transfusion, morbidity, mortality, and length of hospitalization. Patient age and sex and the size of hemangiomas were similar for patients who underwent lobectomy and enucleation. Right-lobe lesions were more often treated by enucleation, and inflow occlusion was used more frequently; transfusion requirements and length of hospitalization were similar for both techniques. Complications were more frequent after lobectomy. There were no deaths. In the latter years of the series, enucleation was used in 22 (63%) and inflow occlusion in 24 (69%) of 35 patients. Outcome is related to the operative approach used for resection of giant cavernous liver hemangiomas. Although lobectomy and enucleation are curative, enucleation offers greater preservation of normal hepatic parenchyma and fewer complications and is the preferred technique for suitable lesions.

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。

Size of lesion is not a criterion for resection during management of giant liver haemangioma.

The unknown natural history and risk of complications of large haemangiomas may pose therapeutic dilemmas. The authors describe their experience with the management of giant haemangiomas. Patients with a giant haemangioma were identified by a survey of the hospital database. Forty-nine patients with a haemangioma of at least 4 cm in diameter presented between January 1990 and December 2000. Medical records were analysed retrospectively. Eleven patients had surgical treatment and 38 were managed conservatively. The median diameter of the tumours was 8.0 cm in surgically treated patients and 6.0 cm in the group managed by observation. Surgery-related morbidity occurred in three patients, and abdominal complaints persisted in three of ten patients with a symptomatic lesion. During a median follow-up of 52 months, 12 non-operated patients had mild abdominal complaints, considered to be unrelated to the lesion. In these patients symptoms either diminished or became minimal during follow-up. Complications did not occur. Observation of giant haemangiomas can be performed safely. The authors advocate resection of cavernous liver haemangiomas only in patients with persistent severe symptoms.

Treatment of Kasabach‐Merritt syndrome by embolisation of a giant liver hemangioma

We report the case of a 14-month-old child with Kasabach-Merritt Syndrome, due to a giant liver hemangioma. The therapeutic approach consisted of peripheral transcatheter embolisation of the right hepatic artery with Ivalon microspheres without the addition of thrombogenic material. This procedure brought to a sensible permanent reduction of the size of the liver hemangioma with normalisation of the previous altered coagulation parameters after 6 years of follow-up. Am. J. Hematol. 66:140–141, 2001. © 2001 Wiley-Liss, Inc.

Rescue FK506 Therapy for Acute Rejection and Early Chronic Rejection After Liver Transplantation: Report of 14 Cases

From January 1990 to May 1996, 148 male and 99 female patients had 265 liver transplantation (LTx) and 18 (6.7%) retransplantations. The mean age was 46.6 years. A cyclosporine-based immunosuppression was used. Ninety-four patients (38%) had 116 episodes of rejection. Thirty-seven of 86 patients treated by steroid bolus were steroid resistant, requiring orthoclone therapy. In eight (3.2%) other patients, orthoclone was used without previous steroid bolus. In 14 cases (6%), refractory rejection required rescue FK506 therapy. There were seven men and seven women with a mean age of 38 years (from 14 to 56). Indications for LTx were alcoholic cirrhosis (N 5 4), post-VHC cirrhosis (N 5 2), post-VHB cirrhosis (N 5 2), fulminant liver failure (N 5 3), giant liver hemangioma (N 5 1), hemochromatosis (N 5 1), and liver metastasis of pancreatic neuroendocrine tumour (N 5 1). Rescue FK506 was done for nine patients after failure of steroid bolus and orthoclone therapy, for three patients after failure of orthoclone therapy without previous steroid bolus, and for two patients after failure of steroid bolus without orthoclone therapy. Only oral formulation of FK506 was used in association with steroids and azathioprine. There were six cases of early chronic rejection (less than 50% of bile duct loss), each had a mean of three rejection episodes, 1.8 steroid bolus therapy, and 1.4 orthoclone therapy. Eight cases of acute rejection (four early rejection , 30 days post-LTx, and four late acute rejection . 1 month post-LTx) each had a mean of two rejection episodes, 1.5 steroid bolus therapy and 1.5 orthoclone therapy.

Giant haemangioma of liver with thrombocytopenia — A case report

Giant haemangioma of liver with thrombocytopenia — A case report

Successful Arterial Embolisation of Giant Liver Haemangioma

A 28-year old man presented with a symptomatic giant haemangioma. On June 26, 1983, at laparotomy, no resection was attempted because the lesion involved the right lobe of the liver and a part of segments II and III. The patient underwent a right hepatic arterial embolisation with gelatine sponge particles. During follow-up, the patient remained asymptomatic. Five-year review by CT-scan showed a diminution of the size of the haemangioma and hypertrophy of the left lobe. On October 21, 1988, the patient was reoperated on for liver abscess and complete necrosis of the haemangioma. A right hepatectomy was performed. In conclusion, the long-term effect of hepatic arterial embolisation, as demonstrated in our case by regular CT-scans, is useful in cases of diffuse haemangioma as an alternative to hazardous major liver resection. To our knowledge, the long-term effect of hepatic arterial embolisation on symptoms and tumor size have never been reported for giant liver haemangioma.