Surgical approach to symptomatic giant cavernous hemangioma of the liver

BACKGROUND/AIMS: Surgical treatment of giant cavernous hemangioma of the liver is still controversial. In this study, indications and results of surgical therapy were evaluated. METHODOLOGY: Fifteen patients with symptomatic giant cavernous hemangioma of the liver were treated by enucleation or liver resection. RESULTS: The surgical indications were abdominal pain in 11 patients, uncertain diagnosis in 3 patients and tumor enlargement in one patient. The median tumor size was 12.5cm (range, 6-30cm). Eleven patients underwent enucleation procedure while the other 4 patients underwent resection procedures. Complications occurred in 2 (13.4%) patients. The patient with the largest tumor underwent right extended lobectomy and died of bleeding and coagulopathy (6.7%). The postoperative hospital stay was 7 days (range, 4-16 days). Thirteen patients were followed-up for an average period of 32.8 months (range, 6-88 months). It was found that the symptoms for 12 of 13 patients disappeared. During the postoperative controls carried out by imaging procedures, no recurrences were observed. CONCLUSIONS: Abdominal pain, uncertain diagnosis and enlargement are major surgical indications of symptomatic giant cavernous hemangiomas. Most of the symptoms disappear after the surgical treatment. Enucleation can be successively performed with low morbidity rates in most of the patients and recurrences are rare. If the tumor location precludes safe enucleation, anatomic resections are preferred.     

Giant cavernous hemangioma of liver.

An abscess forming in a giant cavernous hemangioma of the left lobe of the liver is reported. It was treated by lateral segmentectomy.     

Hepatic resection for primary giant leiomyoma of the liver

Background

Smooth muscle tumours are common in the genito-urinary and gastro-intestinal tracts, but primary leiomyoma of the liver is extremely rare. Only a few cases have been reported to date.

Case outline

We report a case of giant leiomyoma of the liver in a 67-year-old woman that was treated by an extended right hepatectomy. There was no evidence of leiomyoma elsewhere in the abdomen (including the uterus).

Discussion

This appears to be the largest hepatic leiomyoma reported in the literature.     

Hepatic cavernous hemangioma: underrecognized associated histologic features.

BACKGROUND/AIMS: Cavernous hemangiomas (CH) are typically described as solitary, well-circumscribed lesions and are reported to have a distinct fibrous interface. This study describes underrecognized histological changes of large hepatic hemangiomas that contradict this long-standing view. METHODS: Nineteen cases of hepatic resections for CH were reviewed. Stains for estrogen and progesterone receptors (ER/PR), MIB-1, alpha-smooth muscle actin, collagen IV, and elastic Van Gieson stains were applied to the lesions. RESULTS: The CHs measured 5-31 cm (mean 16.6 cm). Sixteen (84%) CHs had an irregular interface with the liver parenchyma while only three had the well-defined fibrous capsule typically described for CH. Fifteen (79%) CHs had dilated vascular spaces filled with blood 0.1-2.0 cm beyond the confines of the main CH, which we have designated hemangioma-like vessels (HLVs). The histochemical and immunohistochemical stains in both CH and HLVs were similar, with the walls of the vessels composed predominantly of collagen with some faint elastic fibers and smooth muscle, endothelium underlined by collagen IV, negative ER/PR in all components, and a proliferation rate of <5/100 endothelial cells. CONCLUSION: Irregular edges of CH and HLVs in the liver parenchyma adjacent to CH have been underrecognized. No significant differences in staining or proliferative rate were present between CHs and HLVs, suggesting the HLVs are within the spectrum of CH.     

Cystic cavernous hemangioma of the liver

We report an unusual case of multilocular cystic cavernous hemangioma of the liver. The patient was a 61-year-old woman without liver disfunction but who had multicystic mass lesions in the liver. Although cavernous hemangiomas are usually accurately diagnosed by the various imaging modalities, our case showed atypical features.     

Case report: cavernous hemangioma of the liver.

Although cavernous hemangioma is the most common benign tumor of the liver, controversy persists regarding diagnosis and management of these lesions. With the development of multiple noninvasive modalities to visualize the liver, hepatic cavernous hemangiomas are recognized with increased frequency. The authors report the unusual case of a post-menopausal woman on no exogenous estrogen therapy who had a cavernous hemangioma that remained stable for approximately 10 years before dramatically increasing in size. This patient illustrates the vague symptoms associated with cavernous hemangiomas and the unpredictability of growth. Although estrogens have been reported trophic, this patient had no exogenous or endogenous estrogen supply, yet her lesion reached massive proportions. Modalities necessary to assure accurate diagnosis and factors influential in management are discussed.     

Hepatic angiosarcoma mimicking cavernous hemangioma on angiography

A 60-year-old woman was admitted to our department for evaluation of a hepatic mass. The mass was diagnosed as a hemangioma of the liver by abdominal angiography because of typical cotton wool appearance and stretched arterial vessels and no peripheral staining. However, one month later, the mass was surgically removed because of extravasation. Histological findings of a specimen of the mass revealed that it entirely contained abundant necrotic tissue, and a small residual part after transcatheter arterial embolization was consistent with hemangioma. However, she complained of hemoptysis and thigh pain after several weeks. Computed tomography revealed multiple lung masses and a mass of right musculus gluteus medius. Reexamined histological findings of the liver tumor showed hemangiosarcoma. We should pay attention to the fact that it is sometimes difficult to differentiate cavernous hemangioma from angiosarcoma by angiography.     

Two giant cavernous hemangioma caused cavernous transformation of the portal vein in a pregnant woman.

We report a case with two giant hemangiomas of the liver that caused cavernous transformation of the portal vein in a 45-yr-old full term pregnant woman. The patient had no serious complaints other than a mass and slight pain in the right upper quadrant and there were no abnormalities in laboratory values. Delivery was performed without complication. In the six month follow-up period, no changes were seen in the lesions.     

Risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma of the liver.

BACKGROUND/AIMS: The aim of this study was to clarify risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma (GCH) of the liver. METHODOLOGY: Twenty patients with GCH of the liver were treated by hepatectomy. Eleven patients with intra-operative blood loss > 2000 ml (mean: 7145 +/- 7080 m; Group 1) were reviewed retrospectively and compared to 9 patients with intra-operative hemorrhage < 2000 ml (mean: 918 +/- 429 ml; Group 2). RESULTS: Although there were no significant differences in pre-operative AST, ALT, and ICG-15 or fibrinogen and platelets between the two groups, pre-operative total bilirubin and fibrin degradation product (FDP) in Group 1 was significantly higher than in Group 2. Mean operation time and intra-operative blood transfusion in Group 1 versus Group 2 were 433 min vs. 213 min (p < 0.0001) and 3036 ml vs. 422 ml (p = 0.0072), respectively. The weight of resected liver (r = 0.821, p < 0.0001), maximum diameter of tumor (r = 0.782, p < 0.0001) and operation time (r = 0.748, p < 0.0001) were the most highly correlated with intra-operative blood loss, followed by pre-operative total bilirubin (r = 0.605, p = 0.0038), FDP level (r = 0.576, p = 0.0068) and intra-operative blood transfusion (r = 0.561, p = 0.0089). CONCLUSIONS: These findings suggest that pre-operative management to reduce the tumor size, total bilirubin and FDP levels may be essential to minimize intra-operative hemorrhage and blood transfusion.     

Autologous transfusion with modified total hepatic vascular exclusion for extracapsular resection of giant hepatic cavernous hemangioma

Introduction Hemangioma is the most common benign tumor affecting the liver. Although the majority of hepatic hemangiomas never cause symptoms, some may do so because of capsule tension, local necrosis, or compression of adjacent tissues or organs, and even severe complications such as spontaneous rupture, abscess, or consumptive coagulopathy (Kasabach-Merrit syndrome).[1] Inter- ventional therapy for hepatic hemangioma is dangerous,[2] so surgery is still the most effective treatment. Howeve…     

Curious manifestations in cavernous hemangioma of the liver

We report a cavernous hemangioma of the liver with some curious findings. Angiography showed a hypervascular lesion and the arterioportal shunt which commonly is regarded as a pathognomonic sign of malignancy. Laparoscopy showed a well-defined, reddish-purple elevated lesion with a central umbilication. As the patient was a painter and dealing with vinyl chloride monomer, we suspected the possibility of hemangiosarcoma. The lesion proved to be a cavernous hemangioma with central fibrous replacement probably in consequence of thrombosis of some cavernous spaces.     

Successful liver resection in a giant hemangioma with intestinal obstruction after embolization

Hepatic hemangiomas are the most common benign tumor of the liver.Most hepatic hemangiomas remain asymptomatic and require no treatment.Giant hepatic hemangiomas with established complications,diagnostic uncertainty and incapacitating symptoms,however,are generally considered an absolute indication for surgical resection.We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization,by which the volume of the hemangioma was significantly reduced,and it was completely resected by a left hepatectomy.A 21-yearold Asian man visited our hospital for left upper quadrant pain.Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity,with a maximum diameter of 31.5 cm.Embolization of the left hepatic artery was performed and confirmed a decrease in its size.However,the patient was readmitted to our hospital one month after embolization for intestinal obstruction.A left hepatectomy was completed through a herringbone incision,and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight.Pre-operative arterial embolization is effective for reducing tumor size,but a close follow-up to decide the time for hepatectomy is important.     

Cardiac cavernous hemangioma.

Among primary cardiac tumors, hemangiomas are relatively rare with a reported incidence of 2.8%. To date, less than 100 cases are reported in literature. We present a 40-year-old woman with atypical chest discomfort of 1 month duration, previous history of glomus tumor of hand and a large cavernous hemangioma of right atrium.     

Scanning electron microscopy of a liver cavernous hemangioma

A 39-year-old female with a large cavernous hemangioma of the liver was successfully treated by ligation of the left hepatic artery. A wedge biopsy specimen of the hemangioma was obtained after the ligation and was examined by scanning electron microscopy. The hemangioma was demarcated from the surrounding normal liver parenchyma and had a labyrinth of caves 50-150 microns in diameter. The caves were separated by fibrous septa 20-40 microns in width. Endothelial cells of the caves were spindle-shaped and arranged in parallel. The surface property of the caves resembled that of the hepatic artery and differed from that of the portal vein or hepatic vein. These findings support that the cavernous hemangioma of the liver was supplied by the hepatic artery. The labyrinthine structure of the cavernous hemangioma may explain the long standing contrast enhancement of the hemangioma after hepatic arteriography.     

双侧肝叶巨大海绵状血管瘤分期切除1例

目的:探讨双侧肝叶巨大血管瘤的外科手术方式并总结治疗经验.方法:对1例罕见的特大双侧肝叶血管瘤患者的临床资料进行完整详细的回顾性分析及术后随访.结果:1例罕见的特大双侧肝叶血管瘤患者因正常肝组织较少无法同时施行左、右侧肝叶血管瘤切除术.该患者接受了二期血管瘤切除术治疗:一期手术切除左侧肝叶巨大血管瘤,术后恢复顺利,残余正常肝组织向左侧增生,但同时右侧肝血管瘤也继续增大;术后3.5年时接受了二期手术切除了右侧肝叶巨大血管瘤,该患者术后逐渐康复.至今已经健康存活4年余.结论:双侧肝叶巨大血管瘤可先切除左侧肝叶巨大血管瘤,使正常肝组织解除压迫,获得生长空间,从而逐渐增生,随后择期二期切除右侧肝叶巨大血管瘤.     

Large cavernous hemangioma in the cecum treated by laparoscopic ileocecal resection

A cavernous hemangioma of the cecum is a rare vascular malformation but is clinically important because of the possibility of massive bleeding. We report a case of a large cavernous hemangioma with pericolic infiltration in the cecum which was removed successfully using minimally invasive surgery.