Giant Liver Hemangioma Research Articles

Addendum to: Successful treatment of a therapy-resistant, giant liver hemangioma with repeated bleomycin TACE: A case report

Addendum to: Successful treatment of a therapy-resistant, giant liver hemangioma with repeated bleomycin TACE: A case report

Giant cavernous hemangioma of liver complicated by Kasabach-Merritt syndrome.

Giant cavernous hemangioma of liver complicated by Kasabach-Merritt syndrome.

Successful treatment of a therapy-resistant, giant liver hemangioma with repeated bleomycin TACE: A case report

Successful treatment of a therapy-resistant, giant liver hemangioma with repeated bleomycin TACE: A case report

Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion.

To evaluate the safety, efficacy, and long-term outcomes of transarterial chemoembolization (TACE) with bleomycin-Lipiodol for giant liver hemangiomas. Single-center retrospective study from 1998 to January 2020, including patients with giant liver hemangiomas treated with bleomycin-Lipiodol TACE and followed up >36months. The exclusion criteria were defined as patients who had been treated but had no available follow-up above 3years and patients who had previously been treated with any other treatment method. Clinical success was defined as the disappearance of symptoms and radiological success (responded vs. non-responded groups) as a more than 50% decrease in the volume of the giant hemangioma in follow-up CT or MRI compared to the baseline images. A total of 121 patients were included. The mean maximum diameter of the hemangiomas decreased from 122 (range: 40-300) to 73mm (range: 15-240), and the mean volume reduced from 984.4 (range: 30-7312) to 286.6cm3 (range: 1-3835). There were 106 patients in the responded group, while only 15 patients were in the non-responded group. No significant difference was found in size and volume change percentages across these two groups based on gender, age, lesion size, lesion volume, lesion number, and second TACE. When the follow-up period was stratified in 5-year periods, the maximum volume decrease was observed in the first 5-year period and then remained constant up to > 15years. TACE with bleomycin-Lipiodol is safe, reducing the size and volume of giant liver hemangiomas with stable results in the long-term follow-up.

Congenital hepatic hemangioma: an unusual case report of pulmonary hypertension

BackgroundPulmonary hypertension (PH) in newborns is a rare but serious condition that often requires immediate intervention and quick diagnosis of the correct etiology to prevent mortality. Congenital hepatic hemangioma (CHH) is an example of an extrathoracic etiology of PH.Case presentationHerein, we report the case of a newborn with a giant liver hemangioma, who presented with an early onset of PH and was successfully treated with intra-arterial embolization.ConclusionsThis case illustrates the importance of suspicion and prompt evaluation of CHH and related systemic arteriovenous shunts among infants with unexplained PH.

RARE PRESENTATION OF HEMANGIOMA-LIKE HEPATOCELLULAR CARCINOMA WITH INFREQUENT SYMPTOMS OF LOWER GASTROINTESTINAL BLEEDING AND ATYPICAL RADIOLOGICAL FEATURES-A CASE REPORT

Hepatocellular carcinoma can mimic benign lesions like liver haemangioma with atypical image findings and can manifest in an acute emergency where a diagnostic dilemma is encountered that can alter the phase of management. We hereby present a case of a 70-year-old male patient with multiple medical comorbidities who presented to us initially in June 2021 with a history of blunt trauma abdomen. Ultrasound abdomen imaging was suggestive of bleeding from liver hemangioma. The patient underwent emergency exploratory laparotomy and hemostasis was achieved. After being clinically better he underwent angioembolisation of the bleeding vessels; unfortunately, he presented one year later with bleeding per rectum. On re-evaluation, imaging features were again consistent with giant liver hemangioma infiltrating ascending and transverse colon. Tumour markers were negative. Being nonamenable to angioembolisation at this setting he underwent exploratory laparotomy unblock right hemicolectomy + non-anatomical liver resection (segment 6, part of 5,7) on October 2022 based on intraoperative findings. Surprisingly the histopathology report was that of hepatocellular carcinoma (HCC). Detailed searching made us able to find these sorts of discordant presentations of HCC with negative tumor markers and atypical imaging findings. The patient was referred to our medical oncology department for expert management. The incidence of direct invasion of HCC to the gastrointestinal tract is approximately 0.5–2%. Colonic metastasis is uncommon in patients with HCC. The diagnosis of HCC is generally made by radiologic hallmarks of dynamic contrast imaging. Sometimes large HCCs may have atypical radiological contrast enhancement patterns thus mimicking hemangioma.

Magnetic resonance imaging features varying by size in giant hemangioma of the liver

Different definitions are used for giant liver hemangiomas. When liver hemangiomas are larger than 4 cm, they are called cavernous hemangiomas (CHs). 6cm or higher thresholds have also been suggested in the literature. Mastering the magnetic resonance imaging (MRI) features that change as the size of CHs increases can prevent misdiagnoses. The aim of the study was to compare MRI features of CHs between 4-6cm and >6cm. The contrast-enhanced abdominal MRIs in the hospital image archiving system was retrospectively examined in the last two years. A total of 52 patients (39 females, 13 males) with CHs were detected by screening. MRI features of 30 patients in Group 1 (between 4-6cm) and 22 patients in Group 2 (>6cm) were analyzed and the two groups were compared in terms of imaging features. The presence of a central cleft-like area was found to be more in Group 2 (54.5%) than in Group 1 (6.7%) (p<0.001). Internal hemorrhage was not detected in Group 1, but it was seen in 3 (13.6%) patients in group 2 (p=0.07). The multiloculation-like appearance was significantly higher in Group 2 (86.4%) than in Group 1 (23.3%) (p<0.001). Delayed diffuse enhancement was observed at a rate of 30% in Group 1 patients, while it was not seen at all in Group 2 (p=0.007). In Apparent diffusion coefficient (ADC) mapping, the incidence of the hypointense rim in the periphery of CH was significantly higher in Group 2 (90.9%) than in Group 1 (66.7%) (p=0.04). ADC value was higher in Group 1 (1.76±0.28) than Group 2 (1.55±0.24) (p=0.007).

Sindroma Kasabach-Merritt pada Hemangioma Hati: Laporan Kasus

Hemangioma is the most common congenital benign liver tumor. It affects mostly female, with the incidence of 0.4- 20%. Giant liver hemangioma induce the Kasabach Merritt syndome, a life threathening coagulation disorder which occur due to consumptive coagulopathy: trombocyte sequestration and agregation inside the hemangioma. The mortality rate is around 60%, with the most common cause is multiorgan complication which may end up with sepsis. The core management is hemangioma decompression by surgical measure. However, this often considered as a very risky procedure leading to massive bleeding. In most cases, conservative treatment is the preferred option. It is important to consider Kasabach Merritt syndome as one of the differential diagnosis when facing cases with enlarged abdomen in order to plan for its treatment as well as educate the patients regarding the prognosis.

S3004 Giant Hepatic Hemangioma: Dulling the Blade of Ockham’s Razor

S3004 Giant Hepatic Hemangioma: Dulling the Blade of Ockham’s Razor

The simultaneous appearance of Kasabach-Merritt syndrome and focal nodular hyperplasia: a rare case with literature review

Introduction and importance: The simultaneous development of Kasabach-Merritt syndrome (KMS) and focal nodular hyperplasia (FNH) in the same individual is rare. This study aims to report the coexistence of KMS and FNH in a 32-year-old female. Case presentation: A 32-year-old woman presented to the gastroenterology clinic complaining of heavy menses, fatigue, and hematuria. Physical examination revealed multiple ecchymoses on the skin. Abdominal computed tomography scan revealed a large hepatic lesion with features of atypical hemangioma. Complete blood count showed normochromic, normocytic red blood cells, and thrombocytopenia. Surgery was decided based on a clinical diagnosis of KMS resulting from a giant liver hemangioma. Histopathologic diagnosis of the resected lesion was FNH. Clinical discussion: KMS, which refers to a giant hemangioma associated with thrombocytopenia, was initially described by Kasabach and Merritt. It occurs in nearly 1% of hemangiomas and primarily affects infants. KMS is a life-threatening condition that could be fatal if adequate, timely treatment is not administered. FNH is a benign hepatocellular neoplasm with a predilection for females. Conclusion: KMS and FNH are 2 distinct conditions that can rarely co-exist in the same patient. Corticosteroids, radiotherapy, and surgical resection are the primary modalities of treatment.

Comparison of efficacy and safety of laparoscopic and open enucleation for liver hemangioma in the right hemi liver: a retrospective cohort study.

BackgroundOpen enucleation (OE) is often performed for giant liver hemangioma (LH) because of its advantage in maximum preservation of functional liver parenchyma. Laparoscopic enucleation (LE) has been applied to LHs more frequently for its potential advantages in postoperative recovery and blood loss. However, to date, LE is still a difficult and complex surgical technique especially when the hemangioma is located in the right hemi liver. The aim of this study was to analyze whether LE is superior to OE for LH in the right hemi liver.MethodsDemographics and perioperative data of patients who underwent LE or OE for LH in the right hemi liver between May 2013 and July 2020 were collected. To decrease the selection bias, patients who underwent OE in first 2 years and those underwent LE in next 5 years by a same operation team were included. The data of sex, age, body mass index (BMI), American Society of Anesthesiologists (ASA) score, largest tumor size, and removed tumor number were enrolled in the propensity score matching (PSM) method to compensate for differences in the baseline characteristics between LE and OE groups. The perioperative outcomes were compared between 2 matched groups after PSM method.ResultsA total of 110 patients (36 LE vs. 74 OE) were matched by age, sex, BMI, ASA grade score, largest tumor size, removed tumor number and tumor location. Finally, 34 patients in each group were retained after PSM. There were no significant differences in operative time, estimated blood loss, amount of autologous transfusion, morbidity grade and the levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) on postoperative day 1 or 3 or 5. LE was associated with a significantly higher rate of use of the Pringle maneuver (P<0.001), shorter time to oral feeding (P<0.001) and shorter postoperative length of stay (P<0.001).ConclusionsFor LHs in the right hemi liver, the perioperative safety of LE is not inferior to OE, and LE seems to achieves a faster recovery from surgery compared with OE.

Abstract No. 182 Transarterial bleomycin–Lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma: interim analysis

Abstract No. 182 Transarterial bleomycin–Lipiodol embolization (B/LE) for symptomatic giant hepatic hemangioma: interim analysis

Right Hepatectomy for Giant Liver Hemangioma Guided with Intraoperative Ultrasound and Indocyanine Green

Background: Hepatic hemangiomas are benign vascular tumors of the liver, most of them asymptomatic. Surgical management includes enucleation, embolization, and liver resection. We present a case with symptomatic hepatic hemangioma susceptible to surgical treatment. Case Presentation: A 73-year-old man with chronic obstructive pulmonary disease and a history of two small hemangiomas started with pain in the right upper quadrant. Computerized tomography showed multiple hypodense lesions highly suggestive of hepatic hemangioma. Tumor markers were found at normal levels. A right hepatectomy guided with indocyanine green and intraoperative ultrasound was performed minimal bleeding and pulmonary complications. Conclusion: Hepatectomy for giant hemangiomas combined with ultrasound and indocyanine green is a feasible option in patients with comorbidities, decreasing bleeding risk, and allowing complete and surgical resection.

Percutaneous Sclerotherapy with Bleomycin and Ethiodized Oil: A Promising Treatment in Symptomatic Giant Liver Hemangioma.

Background Percutaneous sclerotherapy with bleomycin has been proven to have a potential benefit in the management of low-flow venous malformations. Liver hemangiomas are considered low-flow venous malformations. Thus, percutaneous sclerotherapy could potentially have a promising result in their management. Purpose To investigate the feasibility, efficacy, and safety of percutaneous sclerotherapy with bleomycin in the management of symptomatic giant liver hemangioma (GLH). Materials and Methods This single-institute prospective study was conducted between September 2018 and July 2020. Percutaneous sclerotherapy was performed using a mixture of bleomycin and ethiodized oil under guidance of US and fluoroscopy in participants with GLH who were experiencing related abdominal pain or fullness. Technical success was recorded. Change in symptom severity, according to visual analog scale (VAS), was considered the primary outcome of the study. Volume change, based on the lesion volume at CT, and complications, based on the classification of the Society of Interventional Radiology, were regarded as secondary outcomes. The primary and secondary outcomes were recorded 6 and 12 months after the procedure. Comparison was performed by using the Wilcoxon signed-rank test or paired t test. Results Twenty-eight participants (mean age, 45 years ± 9; 25 women) were evaluated. Technical success was 100%. The mean VAS score was 8.3 before the procedure, which decreased to 1.4 (84.7% reduction) and 1.5 (83.5% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). All participants reported relief of symptoms (17 of 28 participants [61%] with complete relief; 11 [39%] with partial relief) at 12-month follow-up. Mean GLH volumes dropped from 856.3 cm3 to 309.8 cm3 (65.7% reduction) and 206.0 cm3 (76% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). No major complications were detected. Conclusion Percutaneous sclerotherapy is a safe and feasible method with promising results in the treatment of patients with symptomatic giant liver hemangioma. Clinical trial registration no. NCT03649113 © RSNA, 2021 See also the editorial by McGahan and Goldman in this issue.

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

Hepatic hemangiomas (HH) are benign tumors of the liver with an incidence of 0.4%–20%. Most of the HH are asymptomatic with incidental discovery and shows female preponderance. They range from small hemangiomas to large cavernous hemangiomas involving the entire liver. Large hemangiomas will develop symptoms and complications that require prompt surgical intervention or other treatment modalities. Most large liver hemangiomas require hepatic resection which is a complex procedure involving vascular structures and physiological derangements. Hepatic resection requires meticulous anesthetic and surgical management with proper blood replacement therapy. Coagulopathy, hepatic and renal failure and bile leak are some of the important complications of hepatic resection. We present successful management of a case of hepatic hemangioma who underwent right hepatectomy.

Giant hepatic capillary hemangioma, a diagnostic dilemma: case report

Hepatic Hemangiomas (HH) are benign tumors of the liver consisting of a blood-filled cavity supplied by the hepatic artery. Most of the HH are asymptomatic and are discovered incidentally during radiological imaging of various unrelated pathology. Typical capillary hemangiomas range from a few millimeters to three centimeters and are unlikely to generate any future symptomatology. However, giant liver hemangiomas (more than 10 cm) are a very rare entity and might become symptomatic, hence requiring prompt intervention. We are reporting this case to make the readers aware of the pitfalls and radiological uncertainties while interpreting vascular lesions of the liver. We reported a case of a 21-year-old female with complaint of awareness of a mass over the right upper abdomen since a period of one year which has been gradually increasing in size. On pre-operative Contrast-Enhanced Computed Tomography, features suggestive of Fibrolamellar variant of Hepatocellular Carcinoma was found which was substantiated by biochemical investigations. However, post-operative histopathological examination revealed a capillary hemangioma.

Outcomes of surgery for giant hepatic hemangioma

BackgroundThe surgical indications for liver hemangioma remain unclear.MethodsData from 152 patients with hepatic hemangioma who underwent hepatectomy between 2004 and 2019 were retrospectively reviewed. We analyzed characteristics including tumor size, surgical parameters, and variables associated with Kasabach–Merritt syndrome and compared the outcomes of laparoscopic and open hepatectomy. Here, we describe surgical techniques for giant hepatic hemangioma and report on two meaningful cases.ResultsMost (63.8%) patients with hepatic hemangioma were asymptomatic. Most (86.4%) tumors from patients with Kasabach–Merritt syndrome were larger than 15 cm. Enucleation (30.9%), sectionectomy (28.9%), hemihepatectomy (25.7%), and the removal of more than half of the liver (14.5%) were performed through open (87.5%) and laparoscopic (12.5%) approaches. Laparoscopic hepatectomy is associated with an operative time, estimated blood loss, and major morbidity and mortality rate similar to those of open hepatectomy, but a shorter length of stay. 3D image reconstruction is an alternative for diagnosis and surgical planning for partial hepatectomy.ConclusionThe main indication for surgery is giant (> 10 cm) liver hemangioma, with or without symptoms. Laparoscopic hepatectomy was an effective option for hepatic hemangioma treatment. For extremely giant hemangiomas, 3D image reconstruction was indispensable. Hepatectomy should be performed by experienced hepatic surgeons.

Laparoscopic isolated caudate lobectomy of two symptomatic familiar giant liver hemangiomas, case reports and literature review

Background and objective: Liver hemangioma (LH) is the most common benign tumour of the liver, but its origin is still not clear and not much is known about a possible familiarity. Caudate lobectomy is the most effective surgical treatment for benign tumors arisen in segment I. The occurrence of giant LH within the same liver segments in different members of the same family has never been described in literature. Herein we report the first two consecutive laparoscopic caudate lobectomy for familiar giant LH in a father and his daughter.Methods: The father showed a lesion in the caudate lobe (CL) suggestive of LH steadily grown, asymptomatic for 24 years until it has caused abdominal discomfort and pain (Dmax 89 mm). The daughter showed multiple hepatic hemangiomas with the biggest one located in the CL compressing the inferior vena cava (Dmax 88 mm).Results: Despite the size of the masses, we opted for a pure laparoscopic approach and a caudate lobectomy was performed in both cases. Operation time was 140 and 180 min. Patients had an uneventful recovery and a good outcome after the scheduled follow up exams 6 months after the procedure.Conclusions: A chance of familiarity transmission for hemangiomas exists and therefore should be further investigated. Laparoscopic isolated caudate lobectomy for symptomatic GLH is feasible and safely performed on selected patients by experienced hepatobiliary surgeons. Prospective randomized studies on larger populations are needed to assess if this minimally invasive approach can be proposed as a standard of care for S-I LH.

Giant hepatic hemangiomas in newborns, review literature. Two cases of giant congenital hepatic hemangiomas

Hemangiomas are the most frequent tumors of childhood age. In the first year of life their prevalence is 1012%. Among premature children, the prevalence of hemangiomas correlates with the degree of prematurity. Liver hemangiomas are a wide range of benign vascular formations that can acquire both malignant course and capable of spontaneous regression. Small-sized hemangiomas generally do not require specific treatment and proceed asymptomally. Large-sized formations can cause life-threatening conditions such as severe thrombocytopenia with coagulopathy (KazabahMerrit syndrome), anaemia, tumor hemorrhage, spontaneous and traumatic tumor breaks, heart failure associated with intra-tumor bypass of blood flow, abdominal compression syndrome, severe hypothyroidism. Diagnosis of this pathology is carried out on the basis of a set of data of medical imaging, laboratory diagnostics and clinical picture. This review presents key points of general classification, the most characteristic diagnostic signs, as well as basic algorithms of treatment of liver hemangiomas in newborns and children of the first year of life. There are also described 2 clinical cases of newborns with giant liver hemangiomas, which were examined and treated in the pathology department of newborns and infants of Perinatal Center of St. Petersburg State Pediatric Medical University with a description of the peculiarities of the course of each of them.

Case Report: Unusual presentation of concomitant gastric outlet obstruction and jaundice complicating giant hepatic angioma

Hemangioma is the most common benign tumor affecting the liver. The vast majority of liver hemangiomas (LH) are less than 30 mm in diameter, asymptomatic, and are most often identified incidentally during radiological investigations for other reasons. Giant LH greater than 50 mm can lead to the development of symptoms and complications that require prompt surgical intervention. Herein, we report the case of a 58-year-old man who presented with gastric outlet obstruction and obstructive jaundice as a result of a giant hepatic hemangioma that was complicated with fatal spontaneous rupture.