Inflammatory process complicating giant hemangioma of the liver: Report of three cases

Abstract

Three cases of giant hemangioma of the liver associated with clinical and laboratory signs of inflammatory process, including low-grade fever, weight loss, abdominal pain, accelerated erythrocyte sedimentation rate, anemia, thrombocytosis, and increased fibrinogen level with normal white blood cell count are described. One patient presented with slight cholestatic jaundice because of tumor-related bile duct compression, but the other two patients had normal liver function tests, except for a slight increase in gammaglutamyl transferase. Clinical and laboratory abnormalities disappeared after surgical excision. Inflammatory manifestations have rarely been reported during giant liver hemangioma. Intratumoral inflammation necrosis or bleeding could explain the symptoms but histological signs of inflammation were not detected in two of three surgical specimens. The release of immune mediators by liver endothelial cells lining the hemangioma is an alternative explanation. The incidence of inflammatory process complicating giant hemangioma is probably underestimated because our three cases were observed within a span of only 3 years.

Giant Haemangioma of the Liver: Observation or Resection?

“…raised erythrocyte sedimentation rate, thrombocytosis and hyperfibrinogenaemia, may be detected in association with giant haemangioma and can be reversed by resection [20]. However, in a further small group of patients with giant haemangioma exhibiting inflammatory features, none displayed a leucocytosis [18]. Clinical features of polymyalgia rheumatica have also been described in association with a giant cavernous haemangioma.…”

“…Liver function tests (LFT) are generally normal in the presence of giant haemangioma, although LFT abnormalities have been reported as a consequence of biliary compression by the mass [18]. Patients with a giant haemangioma may exhibit inflammatory features, and Bornman et al [19] described a clinical triad in 4 patients, consisting of signs suggestive of an acute inflammatory process within the liver, normal white cell count and normal LFT.…”

Experience with Surgical Resection of Giant Hepatic Hemangiomas

“…Few hemangiomas cause abdominal pain, and a minority have unusual presentations, such as arteriovenous communication or inflammatory changes. 2 Traditionally, if they attain a size bigger than 4-6 cm they are called "giant" hemangiomas. When such a size is reached, the surgeon's threshold for surgical resection becomes low.…”

A liver lesion with systemic inflammatory manifestations

“…Laboratory abnormalities reported include anemia, and elevated platelets, fibrinogen, ESR, and C-reactive protein. [3] White blood cell count has been normal in majority of the reported cases. Liver function tests are usually normal, although there may be cholestasis related to biliary compression.…”