Hepatic hemangioma

Hepatic hemangioma
Heptatic hemangioma. Image courtesy of RadsWiki

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun M.D., PhD.

Overview

A hepatic hemangioma is a noncancerous liver tumor made of widened (dilated) blood vessels and is the most common primary liver tumor.

Pathophysiology

• 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.
• They may be associated with focal nodular hyperplasia.
• May be associated with Kasabach-Merritt syndrome: Hemolytic anemia and consumptive coagulopathy

Epidemiology and Demographics

Incidence

The incidence ranges from 0.4-20% of the population.

Age

Hepatic hemangiomas can occur at any time, but are most common in people in their 30s - 50s.

Gender

Women are affected more often than men (5:1), and usually have bigger tumors than men.

Natural History, Complications, Prognosis

In rare cases, a cavernous hemangioma may rupture.

Diagnosis

They are frequently asymptomatic and incidentally discovered at imaging, surgery, or autopsy. Hepatic hemangioma is usually not discovered until medical pictures are taken of the liver for some other reason. If a cavernous hemangioma ruptures, the only sign may be an enlarged liver.

Physical Examination

Babies with benign infantile hemangioendothelioma may have:

Cardiac

• Signs of heart failure

Abdomen

• A growth in the abdomen

Laboratory Findings

• Anemia

Ultrasonography

• Echogenic
• Homogenous

Computed Tomography

• Noncontrast: Hypointense to liver
• Portal venous enhancement: Peripheral nodular enhancement
• Delayed enhancement: Lesion fills in the contrast

MRI

• T2 hyperintense
• Portal venous enhancement: Peripheral nodular enhancement
• Delayed enhancement: Lesion fills in the contrast

Images courtesy of RadsWiki

• 

  T2 FrFSE

• 

  T1

• 

  T1 post Gad

• 

  T1 post Gad

• 

  T1 post Gad

• 

  T1 post Gad coronal

• File:===Scintigraphy===
• File:* Tc99-labeled red blood cells show decreased activity on early dynamic images and increased activity on delayed images (i.e. 1-2 hours).
• File:* Only sensitive for larger lesions.

Treatment

Most cavernous hepatic hemangiomas are treated only if there is persistent pain.

Treatment for infantile hemangioendothelioma depends on the child's growth and development. The following treatments may be needed:

• Inserting a material in a blood vessel of the liver to block it (embolization)
• Tying off (ligation) a liver artery
• Medications for heart failure
• Surgery to remove the tumor

Related Chapters

• Infantile hemangioendothelioma

References & Additional Resources

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• Giannitrapani L, Soresi M, La Spada E, et al. Sex hormones and risk of liver tumor. Ann N Y Acad Sci. Nov 2006;1089:228-36.

• Glinkova V, Shevah O, Boaz M, et al. Hepatic haemangiomas: possible association with female sex hormones. Gut. Sep 2004;53(9):1352-5.

• Spitzer D, Krainz R, Graf AH, et al. Pregnancy after ovarian stimulation and intrauterine insemination in a woman with cavernous macrohemangioma of the liver. A case report. J Reprod Med. Dec 1997;42(12):809-12.

• Dreyfus M, Baldauf JJ, Dadoun K, et al. Prenatal diagnosis of hepatic hemangioma. Fetal Diagn Ther. Jan-Feb 1996;11(1):57-60.

• Suzuki T, Tsuchiya N, Ito K. Multiple cavernous hemangiomas of the liver in patients with systemic lupus erythematosus. J Rheumatol. Apr 1997;24(4):810-1.

• Goodman Z. Benign tumors of the liver. In: Okuda K, Ishak KG. Neoplasms of the liver. Tokyo: Springer-Verlag; 1987:105-125.

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• Huang SA, Tu HM, Harney JW, et al. Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas. N Engl J Med. Jul 20 2000;343(3):185-9.

• Lorette G, Georgesco G, Sirinelli D, et al. [Cutaneous immature hemangioma and hepatic angioma: there is no frequent association]. Ann Dermatol Venereol. 1996;123(12):789-90.

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• De Franco A, Monteforte MG, Maresca G, et al. [Integrated diagnosis of liver angioma: comparison of Doppler color ultrasonography, computerized tomography, and magnetic resonance]. Radiol Med. Jan-Feb 1997;93(1-2):87-94.

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• Bruix J, Sherman M, Llovet JM, et al. Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver. J Hepatol. Sep 2001;35(3):421-30.

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• Ishak KG, Markin RS. Liver. In: Damjanov I, Linder J, eds. Anderson's Pathology. 10th ed. Mosby: St. Louis, Mo; 1996:1834.

• Gibney RG, Hendin AP, Cooperberg PL. Sonographically detected hepatic hemangiomas: absence of change over time. AJR Am J Roentgenol. Nov 1987;149(5):953-7.

• Corigliano N, Mercantini P, Amodio PM, et al. Hemoperitoneum from a spontaneous rupture of a giant hemangioma of the liver: report of a case. Surg Today. 2003;33(6):459-63.

• Arnoletti JP, Brodsky J. Surgical treatment of benign hepatic mass lesions. Am Surg. May 1999;65(5):431-3.

• Srivastava DN, Gandhi D, Seith A, et al. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. Sep-Oct 2001;26(5):510-4.

• Zeng Q, Li Y, Chen Y, et al. Gigantic cavernous hemangioma of the liver treated by intra-arterial embolization with pingyangmycin-lipiodol emulsion: a multi-center study. Cardiovasc Intervent Radiol. Sep-Oct 2004;27(5):481-5.

• Rokitansky AM, Jakl RJ, Gopfrich H, et al. Special compression sutures: a new surgical technique to achieve a quick decrease in shunt volume caused by diffuse hemangiomatosis of the liver. Pediatr Surg Int. Nov 1998;14(1-2):119-21.

• Tak WY, Park SY, Jeon SW, et al. Ultrasonography-guided percutaneous radiofrequency ablation for treatment of a huge symptomatic hepatic cavernous hemangioma. J Clin Gastroenterol. Feb 2006;40(2):167-70.

• Fan RF, Chai FL, He GX, et al. Laparoscopic radiofrequency ablation of hepatic cavernous hemangioma. A preliminary experience with 27 patients. Surg Endosc. Feb 2006;20(2):281-5.

• Biswal BM, Sandhu M, Lal P, et al. Role of radiotherapy in cavernous hemangioma liver. Indian J Gastroenterol. Jul 1995;14(3):95-8.

• Tepetes K, Selby R, Webb M, et al. Orthotopic liver transplantation for benign hepatic neoplasms. Arch Surg. Feb 1995;130(2):153-6.

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