Giant Haemangioma of the Liver: Observation or Resection?

Abstract

Background: Haemangiomata are the most frequent benign solid liver lesion. The management of giant (≧5 cm) haemangiomata of the liver remains controversial. Methods: A search of relevant peer-reviewed literature was conducted using PubMed and original articles were reviewed. Results and Conclusions: The vast majority of giant haemangiomata remain asymptomatic and have a benign and uncomplicated natural history. Decisions regarding the optimal management of giant haemangiomata depend on a high level of confidence in diagnostic imaging. Diagnostic biopsy to differentiate giant haemangiomata from malignant lesions should be discouraged. Despite limitations and alternative modalities, surgery remains the only consistently effective curative treatment for giant haemangiomata. Surgery is not generally justified to prevent complications in asymptomatic patients. Principal indications for the surgical management of giant haemangiomata include established complications, incapacitating symptoms and uncertainty of diagnosis. Patients should only be selected for surgery based on a careful assessment of risks and benefits of intervention.

Successful liver resection in a giant hemangioma with intestinal obstruction after embolization

“…Considering the benign and non-progressive nature of the dis- ease, it is currently accepted that a giant hemangioma is not necessarily an indication for surgery just because of its size, and continued observation in asymptomatic patients or patients with minimal abdominal symptoms seems to be justified [19,20] . Surgery remains the only consistently effective curative treatment for giant hemangiomas and should be considered for patients with established complications, diagnostic uncertainty and incapacitating symptoms, where operative risk is acceptable, or where the diagnosis remains uncertain despite appropriate specialist investigation [21] . Various other treatment methods have been reported but their long-term results have been poor [20] .…”

Giant Hepatic Hemangioma Presenting as Gastric Outlet Obstruction

“…They are most often seen in the liver. [9][10][11] The incidence of hemangiomas varies from 0.4% to 20%. [1][2][3]6 Hemangioma are often seen between the ages of 30 and 50 years and 5 to 6 times more often in women than in men.…”

“…[1][2][3]6 Hemangioma are often seen between the ages of 30 and 50 years and 5 to 6 times more often in women than in men. 4,6,7,9,10 Therefore, it has been suggested that there may be a relationship between the disease and the use of exogenous steroids or female-specific hormones, although the relationship has not been clearly shown. 2,3,10 Because most hepatic hemangioma are asymptomatic, they are often recognized incidentally during radiologic tests for other reasons.…”

“…4,6,7,9,10 Therefore, it has been suggested that there may be a relationship between the disease and the use of exogenous steroids or female-specific hormones, although the relationship has not been clearly shown. 2,3,10 Because most hepatic hemangioma are asymptomatic, they are often recognized incidentally during radiologic tests for other reasons. However, in some patients the location and size of the lesion can cause various signs and findings.…”

“…Pain results from the stretching of the Glisson capsule, the development of thrombus within the hemangioma, increased pulsating blood flow toward the lesion, and the development of necrosis in the lesion. 10 Gastric outlet obstruction findings, such as nausea, vomiting, and bloating, result from pressure on the stomach and the duodenum by giant hemangioma. 2,7 Congestion of various liver segments, renal insufficiency, edema of the lower extremities, and clinical findings of Budd-Chiari syndrome may develop due to the compressive effect of hemangiomas on the hepatic vein and the inferior vena cava.…”