Hepatic hemangioma natural history, complications and prognosis
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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
Hepatic hemangioma natural history
- Hepatic hemangioma is the most common benign liver tumor and typically remains stable in size.[1]
- These are usually diagnosed as asymptomatic incidental findings.
- Hemangiomas also (rarely) rupture spontaneously or by trauma and then lead to acute hemorrhagic shock with upper abdominal pain.[2][3]
- In the worldwide literature a total of only 97 cases with a rupture of a hemangioma have been published, whereas a spontaneous rupture only happened in 47.4% of cases.[4][3]
- Further investigation showed that these spontaneously ruptured hemangiomas had a mean size of 11.2 cm.[3][4]
- Despite therapy, in these situations the mortality rate is 30-40%.[3]
- Hemangiomas generally have no growth tendency. In the literature, however, cases of hemangioma growth during pregnancy or after estrogen administration are described.[2][3]
- Hemangiomas less than 10 cm should generally not be treated, even before a pregnancy. In case of a planned pregnancy and a size more than 10 cm, due to the risk of a possible rupture, a definitive treatment should be discussed.[3][2]
Several studies have concluded that a spontaneous rupture of a hemangioma (even while pregnancy) [10, 19] occurs only very rarely, and therefore a prophylactic resection should only be conducted under special conditions and especially with a size of the hemangioma >11 cm [10]. In case of hemangiomas with high growth trend (>3 cm in 12 months), with symptomatic compression symptoms or recurrent pain, which may correlate with hemorrhage into the lesion, surgical intervention should be indicated [18, 19]. Because of hypotension, unexplained anemia, or diagnosis difficulties of the liver lesion, surgical intervention can be rarely necessary.[3]
Complications
In rare cases, a cavernous hemangioma may rupture. Babies may develop a type of hepatic hemangioma called benign infantile hemangioendothelioma (also called multinodular hepatic hemangiomatosis). This rare, noncancerous tumor has been linked to high rates of heart failure and death in infants. Infants are usually diagnosed by the time they are 6 months old. Pregnancy and estrogen-based medications can cause cavernous hemangiomas to grow.
Prognosis
References
- ↑ Maruyama, Masaki; Isokawa, Osamu; Hoshiyama, Koki; Hoshiyama, Ayako; Hoshiyama, Mari; Hoshiyama, Yoshihiro (2013). "Diagnosis and Management of Giant Hepatic Hemangioma: The Usefulness of Contrast-Enhanced Ultrasonography". International Journal of Hepatology. 2013: 1–6. doi:10.1155/2013/802180. ISSN 2090-3448.
- ↑ 2.0 2.1 2.2 Assy, Nimer (2009). "Characteristics of common solid liver lesions and recommendations for diagnostic workup". World Journal of Gastroenterology. 15 (26): 3217. doi:10.3748/wjg.15.3217. ISSN 1007-9327.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Ehrl, Denis; Rothaug, Katharina; Herzog, Peter; Hofer, Bernhard; Rau, Horst-Günter (2012). ""Incidentaloma" of the Liver: Management of a Diagnostic and Therapeutic Dilemma". HPB Surgery. 2012: 1–14. doi:10.1155/2012/891787. ISSN 0894-8569.
- ↑ 4.0 4.1 Donati, Marcello; Stavrou, Gregor A.; Donati, Angelo; Oldhafer, Karl J. (2011). "The risk of spontaneous rupture of liver hemangiomas: a critical review of the literature". Journal of Hepato-Biliary-Pancreatic Sciences. 18 (6): 797–805. doi:10.1007/s00534-011-0420-7. ISSN 1868-6974.