Background: Giant hepatic hemangiomas (GHHs) are those that are larger than 4 cm in size. Aims: The aim of this study was to describe GHH clinical findings, their risk factors, diagnostic approach and management, and to compare these data with those of conventional hemangiomas. Methods: We performed a retrospective analysis of patients diagnosed with hemangiomas, whether by imaging studies or histopathology, at our hospital within the time frame of 1990-2008. The medical records of each patient were reviewed to obtain clinical and surgical data. Results: Of the 57 patients with liver hemangioma, 41 (72%) were women and 32 (56%) had GHH. Liver hemangioma median size was 4.49 cm. In regard to the patients with GHH, 31.2% were asymptomatic and when symptoms presented, pain was the most common. Both symptoms and oral contraceptive exposure were more common in the GHH patients. Nine patients with GHH underwent surgery: 2 open biopsies due to diagnostic uncertainty, one enucleation, and 6 resections.
GHHs are more prevalent in women and when symptomatic, pain is the most frequent complaint. Diagnosis is usually made through imaging studies, but when there is diagnostic doubt, surgical exploration is sometimes needed. Oral contraceptive use is most likely more of a risk factor for GHH than for conventional hemangioma, but this association needs to be studied further.
A 70-year-old man underwent screening colonoscopy which revealed a nonspecific colitis characterized by several areas of "patchy" erythema (• " Fig. 1), congestion, and subepithelial hemorrhage of the mucosa of the left colon. Surprisingly, many dead insects resembling small cockroaches were seen (• " Fig. 2). These insects corresponded to the species Ulomoides dermestoides, colloquially known as "Chinese weevils." They were present in larval and adult stages, and some adult insects were undigested and appeared to be "alive" (• " Fig. 3). After the procedure, the patient informed us that he had consumed these bugs as part of an alternative therapy known as "coleotherapy," which consists of the consumption of live Chinese weevils over a period of 140 days. This alternative therapy is purportedly useful in combating diseases such as "any type" cancer, asthma, psoriasis, diabetes, vitiligo, chronic skin diseases, arthritis, Parkinson's disease, and depression. In a review of the subject, the word "coleotherapy" provided no results in PubMed; however there were recent publications that reported a cytotoxic effect and DNA damage to cellular components of epithelial cell line A549 human lung carcinoma by these insects, and decreased total leukocytes, polymorphonuclear leukocytes, and total proteins in an animal model for pleural damage with carrageenan after applying an "aqueous substrate" of these insects [1, 2]. At the present time, there is no firm scientific evidence to justify the use of this alternative therapy. We suspect that the mucosal colonic inflammation was the result of the presence of the dead insects.
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