Hepatic hemangioma pathophysiology

Hepatic hemangioma Microchapters
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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.

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 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.

Second theory

The second theory is that the presence of liver hemangiomas involves a genetic background of mutations [7–9]. Zhang et al. presumed that metalloproteinases accumulate in the endoplasmic reticulum of the tumor cells, causing self-digestion and vacuole formation [10]. 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

• 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.

Associated Conditions

Hepatic hemangioma may be associated with:

• Kasabach-Merritt syndrome
• Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease)
• Hepatic arterio-portal shunts
• Extra hepatic hemangiomata
• Hemolytic anemia
• Consumptive coagulopathy
• focal nodular hyperplasia

Gross Pathology

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

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.

Gallery

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  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.

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  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.