Hepatic hemangioma pathophysiology: Difference between revisions

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The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories.
The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories.
===First theory===
===First theory===
The first theory supports the notion that there is overexpression of angiogenic factors such as vascular endothelial growth factor, basic fibroblast growth factor, and metalloproteinases as well as downregulation of some inhibitors of angiogenesis, such as tissue inhibitor of metalloproteinase-I.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref>
*The first theory supports the notion that there is overexpression of angiogenic factors such as:<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref>
:*Vascular endothelial growth factor
:*Basic fibroblast growth factor
:*Metalloproteinases
*And there is downregulation of some inhibitors of angiogenesis such as:<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref>
 
:*Tissue inhibitor of metalloproteinase-I
===Second theory===
===Second theory===
The second theory is that the presence of liver hemangiomas involves a genetic background of mutations. Zhang et al. presumed that metalloproteinases accumulate in the endoplasmic reticulum of the tumor cells, causing self-digestion and vacuole formation. Additionally, Hu et al. showed the cavernous hemangioma cell to downregulate Derlin-1, a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size
*The second theory is that the presence of liver hemangiomas involves a genetic background of mutations.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref>
*They arise from the endothelial cells that line the blood vessels and consists of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls.<ref name="PapafragkakisMoehlen2011">{{cite journal|last1=Papafragkakis|first1=Haris|last2=Moehlen|first2=Martin|last3=Garcia-Buitrago|first3=Monica T.|last4=Madrazo|first4=Beatrice|last5=Island|first5=Eddie|last6=Martin|first6=Paul|title=A Case of a Ruptured Sclerosing Liver Hemangioma|journal=International Journal of Hepatology|volume=2011|year=2011|pages=1–5|issn=2090-3456|doi=10.4061/2011/942360}}</ref>
 
*Zhang et al. presumed that metalloproteinases accumulate in the endoplasmic reticulum of the tumor cells causing:
:*Self-digestion
:*Vacuole formation
*Additionally, Hu et al. showed the cavernous hemangioma cell to downregulate Derlin-1.
:*Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size.
==Associated Conditions==
==Associated Conditions==
Hepatic hemangioma may be associated with:<ref name=radiopeadia>Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015</ref>
Hepatic hemangioma may be associated with:<ref name=radiopeadia>Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015</ref>

Revision as of 22:33, 7 November 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]

Overview

They arise from the endothelial cells that line the blood vessels and consists of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls.

Pathophysiology

Pathogenesis

The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories.

First theory

  • The first theory supports the notion that there is overexpression of angiogenic factors such as:[1]
  • Vascular endothelial growth factor
  • Basic fibroblast growth factor
  • Metalloproteinases
  • And there is downregulation of some inhibitors of angiogenesis such as:[1]
  • Tissue inhibitor of metalloproteinase-I

Second theory

  • The second theory is that the presence of liver hemangiomas involves a genetic background of mutations.[1]
  • Zhang et al. presumed that metalloproteinases accumulate in the endoplasmic reticulum of the tumor cells causing:
  • Self-digestion
  • Vacuole formation
  • Additionally, Hu et al. showed the cavernous hemangioma cell to downregulate Derlin-1.
  • Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size.

Associated Conditions

Hepatic hemangioma may be associated with:[2]

Gross Pathology

On gross pathology, variable in size, well circumscribed, classically subcapsular are characteristic findings of hepatic hemangioma.[3]

Microscopic Pathology

On microscopic histopathological analysis channels lined by benign endothelium containing RBCs, surrounding (non-endothelial) cells without significant atypia are characteristic findings of hepatic hemangioma.[4]

Gallery

  • Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]

    Intermediate magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]

  • High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]

    High magnification micrograph of a cavernous hemangioma of the liver, also hepatic cavernous hemangioma, liver hemangioma,cavernous liver hemangioma. H&E stain. No liver tissue is observed.[4]

References

  1. ↑ 1.0 1.1 1.2 Papafragkakis, Haris; Moehlen, Martin; Garcia-Buitrago, Monica T.; Madrazo, Beatrice; Island, Eddie; Martin, Paul (2011). "A Case of a Ruptured Sclerosing Liver Hemangioma". International Journal of Hepatology. 2011: 1–5. doi:10.4061/2011/942360. ISSN 2090-3456.
  2. ↑ Associations of hepatic hemangioma. Dr Yuranga Weerakkody et al. Radiopaedia (2015). http://radiopaedia.org/articles/hepatic-haemangioma-3. Accessed on November 7, 2015
  3. ↑ Gross pathology of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
  4. ↑ 4.0 4.1 4.2 Microscopic features of hepatic hemangioma. Librepathology 2015. http://librepathology.org/wiki/index.php/Hemangioma_of_the_liver. Accessed on October 20, 2015
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