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Zhou CM, Cao J, Chen SK, Tuxun T, Apaer S, Wu J, Zhao JM, Wen H. Retrospective analysis based on a clinical grading system for patients with hepatic hemangioma: A single center experience. World J Gastrointest Surg 2024; 16:2047-2053. [PMID: 39087105 PMCID: PMC11287709 DOI: 10.4240/wjgs.v16.i7.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The optimal approach for managing hepatic hemangioma is controversial. AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience. METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018. Patients were classified into four groups based on the clinical grading system and treatment: (1) Observation group with score < 4 (Obs score < 4); (2) Surgical group with score < 4 (Sur score < 4); (3) Observation group with score ≥ 4 (Obs score ≥ 4); and (4) Surgical group with score ≥ 4 (Sur score ≥ 4). The clinico-pathological index and outcomes were evaluated. RESULTS There were significantly fewer symptomatic patients in surgical groups (Sur score ≥ 4 vs Obs score ≥ 4, P < 0.001; Sur score < 4 vs Obs score < 4, χ² = 8.60, P = 0.004; Sur score ≥ 4 vs Obs score < 4, P < 0.001). The patients in Sur score ≥ 4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score ≥ 4 (P < 0.001; P < 0.001). Nevertheless, there was no significant difference in need for intervention and total patients with adverse event between the Sur score < 4 and Obs score < 4 (P > 0.05; χ² = 1.68, P > 0.05). CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma. Surgery can be suggested for patients with a score ≥ 4. For those with < 4, follow-up should be proposed.
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Affiliation(s)
- Cheng-Ming Zhou
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jun Cao
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shao-Ke Chen
- Department of Operation Management, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerhongjiang Tuxun
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shadike Apaer
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jing Wu
- Department of General Surgery, The First Teaching College, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jin-Ming Zhao
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Rabbi H, Chowdhury AQ, Arefin MS, Aman MS, Sarder MM, Siraj S. Surgical management of a 25-cm giant hepatic haemangioma: First case report from Bangladesh with literature review. Int J Surg Case Rep 2024; 120:109795. [PMID: 38843626 PMCID: PMC11214471 DOI: 10.1016/j.ijscr.2024.109795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Giant hepatic haemangioma (GHH) is defined as a hepatic haemangioma (HH) of >10 cm in diameter. Its association with thrombocytopenia and consumption coagulopathy is quite rare. CASE PRESENTATION Here, we present a case of a 39-year-old man with a rapidly enlarging 25-cm GHH arising from the entire left hemiliver. Laboratory findings suggested pancytopenia but normal liver and renal functions. He was diagnosed with Kasabach-Merritt syndrome (KMS). After three units of aphaeretic platelet transfusion, the patient underwent left hepatectomy. Postoperative recovery was uneventful, and his regular follow-up revealed no recurrence even after two years. CLINICAL DISCUSSION HH predominantly affects females, but males can also be affected, as seen in this case. With observation, it can grow over time, particularly in patients under 50 years of age. Surgical management should be considered when HH causes symptoms or is larger than 10 cm. The evolving understanding of GHH and the critical role of surgery are important, particularly when they complicate haematological or coagulation profiles and lead to thrombocytopenia. CONCLUSION Our case report highlights the significance of surgical intervention in GHH, and a disease-free outcome can be expected for patients with this condition in the future. To our knowledge, this is the first such case report from Bangladesh.
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Affiliation(s)
- Hashim Rabbi
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, BIRDEM General Hospital, Dhaka, Bangladesh.
| | - Ajmal Quader Chowdhury
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, United Hospital Limited, Dhaka, Bangladesh.
| | - Mirza Shamsul Arefin
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplant, BIRDEM General Hospital, Dhaka, Bangladesh.
| | | | - Mahmud Mohammad Sarder
- Department of Hepatobiliary, Pancreatic and Liver Transplant Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
| | - Sanjida Siraj
- National Institute of Preventive and Social Medicine, Dhaka, Bangladesh.
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Aziz H, Underwood PW, Gosse MD, Afyouni S, Kamel I, Pawlik TM. Hepatic adenoma: evolution of a more individualized treatment approach. J Gastrointest Surg 2024; 28:975-982. [PMID: 38521190 DOI: 10.1016/j.gassur.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Hepatic adenomas (HAs) are benign, solid liver lesions, which carry a risk of hemorrhage and malignant transformation. This review article highlights the advances in the diagnosis and management of HAs. METHODS A comprehensive review was performed using MEDLINE/PubMed and Web of Science databases with a search period ending on September 30, 2023. Using PubMed, the terms "hepatocellular," "hepatic," and "adenoma" were searched. RESULTS HA has been classified into at least 8 subtypes based on molecular pathology, each exhibiting unique histopathologic features, clinical considerations, and risk of malignant transformation. The most common subtype is inflammatory HA, followed by hepatocyte nuclear factor 1α-inactivated HA, β-catenin exon 3-mutated HA (βex3-HA), β-catenin exon 7- or 8-mutated HA, sonic hedgehog HA, and unclassified HA. Magnetic resonance imaging is the best imaging method for diagnosis and can distinguish among HA subtypes based on fat and telangiectasia pathologic characteristics. The risk of malignant transformation varies among molecular subtypes, ranging from <1% to approximately 50%. Up to 42% of HAs present with spontaneous intratumoral hemorrhage and peritoneal hemorrhage. In general, only 15% to 20% of patients require surgery. HA larger than 5 cm are more likely to be complicated by bleeding and malignant transformation, regardless of subtype, and should generally be resected. In particular, βex3-HA carries a high risk of malignant transformation and can be considered a true precancerous lesion. CONCLUSION The management of HAs is based on a multidisciplinary approach. Clinical decision-making should integrate information on gender, tumor size, and HA subtyping. In the future, patients with HA will benefit from novel medical therapies tailored to the individual molecular subtypes.
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Affiliation(s)
- Hassan Aziz
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Patrick W Underwood
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
| | - Matthew D Gosse
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States
| | - Shadi Afyouni
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Ihab Kamel
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States.
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Zhang Z, Ji J, Qiu G, Hou Z, Mi S, Jin Z, Dai Y, Xie Q, Zeng Y, Huang J. Surgical indications for solid hepatic benign tumors: An updated literature review. Biosci Trends 2023; 17:325-334. [PMID: 37599079 DOI: 10.5582/bst.2023.01152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma are the most common benign solid liver tumors. However, their surgical indications have been the subject of debate. Minimally invasive liver resection reduces the cost of surgery and may lead to overtreatment of benign liver tumors. Recently, there has been a growing understanding of the etiology, pathogenesis, and natural history of these tumors. Great progress has also been made in imaging. The use of MRI and contrast agents has improved the accuracy of non-invasive diagnosis of these tumors, and especially in the identification of specific molecular subtypes of liver adenoma. These factors have resulted in alterations of surgical indications for these tumors. This article examines recent literature and it discusses the surgical indications for hepatic hemangioma, focal nodular hyperplasia, and hepatic adenoma while summarizing modifications in clinical management.
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Affiliation(s)
- Zhihong Zhang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Ji
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guoteng Qiu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Ziqi Hou
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shizheng Mi
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaoxing Jin
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yunlong Dai
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qingyun Xie
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Zeng
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jiwei Huang
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Ghosh NK, R R, Singh A, Malage S, Sharma S, Kumar A, Singh RK, Behari A, Kumar A, Saxena R. Surgery for symptomatic hepatic hemangioma: Resection vs. enucleation, an experience over two decades. Ann Hepatobiliary Pancreat Surg 2023; 27:258-263. [PMID: 37127398 PMCID: PMC10472124 DOI: 10.14701/ahbps.22-130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 05/03/2023] Open
Abstract
Backgrounds/Aims Hemangiomas are the most common benign liver lesions; however, they are usually asymptomatic and seldom require surgery. Enucleation and resection are the most commonly performed surgical procedures for symptomatic lesions. This study aims to compare the outcomes of these two surgical techniques. Methods A retrospective analysis of symptomatic hepatic hemangiomas (HH) operated upon between 2000 and 2021. Patients were categorized into the enucleation and resection groups. Demographic profile, intraoperative bleeding, and morbidity (Clavien-Dindo Grade) were compared. Independent t-test and chi-square tests were used for continuous and categorical variables respectively. p-value of < 0.05 was considered significant. Results Sixteen symptomatic HH patients aged 30 to 66 years underwent surgery (enucleation = 8, resection = 8) and majority were females (n = 10 [62.5%]). Fifteen patients presented with abdominal pain, and one patient had an interval increase in the size of the lesion from 9 to 12 cm. The size of hemangiomas varied from 6 to 23 cm. The median blood loss (enucleation: 350 vs. resection: 600 mL), operative time (enucleation: 5.8 vs. resection: 7.5 hours), and postoperative hospital stay (enucleation: 6.5 vs. resection: 11 days) were greater in the resection group (statistically insignificant). In the resection group, morbidity was significantly higher (62.6% vs. 12.5%, p = 0.05), including one mortality. All patients remained asymptomatic during the follow-up. Conclusions Enucleation was simpler with less morbidity as compared to resection in our series. However, considering the small number of patients, further studies are needed with comparable groups to confirm the superiority of enucleation over resection.
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Affiliation(s)
- Nalini Kanta Ghosh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rahul R
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashish Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Somanath Malage
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Supriya Sharma
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Rajan Saxena
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
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Jiang T, Zhao Z, Cai Z, Shen C, Zhang B. Case Report: Giant abdominal hemangioma originating from the liver. Front Oncol 2023; 13:1165195. [PMID: 37588097 PMCID: PMC10425808 DOI: 10.3389/fonc.2023.1165195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023] Open
Abstract
Background Hepatic hemangioma is among the most common benign liver lesions. However, giant pedunculated hepatic hemangiomas are exceptionally rare and associated with additional risks, such as torsion. Case presentation We present the case of a 63-year-old female patient who presented with abdominal distension and pain. Barium meal examination and gastroscopy revealed a large, smooth-surfaced submucosal bulge located at the fundus of the stomach. Subsequent MRI examination identified a mass measuring approximately 6.4 x 7 cm in the left upper abdomen. Surgical intervention was planned for mass removal. However, intraoperative exploration revealed the origin of the mass to be the liver, and subsequent histopathological examination confirmed it as a hemangioma. Conclusion We systematically summarized the characteristics of our case along with 31 previously reported cases. Giant pedunculated hepatic hemangiomas typically occur in the left lobe of the liver. Due to their atypical presentation, a combination of imaging methods such as ultrasound, CT, and/or MRI is essential for accurate diagnosis. Furthermore, surgical intervention is recommended due to the potential risks of bleeding, rupture, and torsion.
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Affiliation(s)
- Tianxiang Jiang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhou Zhao
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Zhaolun Cai
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chaoyong Shen
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Bo Zhang
- Department of General Surgery, West China Hospital, Sichuan University, Chengdu, China
- Gastric Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part II - Solid lesions. Dig Liver Dis 2022; 54:1614-1622. [PMID: 36089523 DOI: 10.1016/j.dld.2022.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic hepatic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the second part of the guideline, concerning the diagnosis and clinical management of hemangioma, focal nodular hyperplasia, and hepatocellular adenoma.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, "Agostino Gemelli", Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, "Agostino Gemelli", Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, Università di Pavia. Unità di Malattie Infettive e Immunologia, IRCCS Fondazione Ospedale San Matteo, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Università della Campania Luigi Vanvitelli, Facoltà di Medicina e Chirurgia, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, IRCCS-ISMETT-UPMCI, Palermo, Università di Catania, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica - Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, "Agostino Gemelli", Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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Dong Z, Fang K, Sui C, Guo J, Dai B, Geng L, Yang J. The surgical outcomes and risk factors of giant hepatic haemangiomas: a single centre experience. BMC Surg 2022; 22:278. [PMID: 35843944 PMCID: PMC9290193 DOI: 10.1186/s12893-022-01721-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/05/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the safety of performing surgery on cavernous haemangiomas in the liver larger than 10 cm and establish preoperative predictors of intraoperative blood transfusion and morbidity. Methods A total of 373 patients with haemangiomas larger than 10 cm who underwent surgery in our hospital were retrospectively analysed. According to tumour diameter, the patients were divided into a giant haemangioma (GH) group (241 cases) (10 cm ≤ diameter < 15 cm) and an enormous haemangioma (EH) group (132 cases) (diameter ≥ 15 cm). Clinical parameters were then compared between the two groups. Results Compared with the GH group, the EH group had higher rates of leukopenia (10.6% vs. 4.5%), anaemia (26.5% vs. 15.7%), and thrombocytopenia (13.6% vs. 6.2%). The occlusion time in the EH group was longer than that in the GH group (26.33 ± 14.10 min vs. 31.85 ± 20.09 min, P < 0.01). The blood loss and blood transfusion in the EH group were greater than those in the GH group (P < 0.05). Moreover, the morbidity in the EH group was higher than that in the GH group (17.4% vs. 9.13%, P < 0.05). According to the results of the multivariable analysis, the operation time and size of the haemangioma may be independent risk factors for blood transfusion (P < 0.05). Additionally, the size of the haemangioma may be an independent risk factor associated with complications (P < 0.05). Conclusion Enormous haemangioma is more likely to cause haematologic abnormalities than giant hepatic haemangioma. The risks of the operation and postoperative complications of enormous haemangioma are higher than those of giant hepatic haemangioma.
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Yoshimizu C, Ariizumi S, Kogiso T, Sagawa T, Taniai M, Honda G, Egawa H, Tokushige K. Giant Hepatic Hemangioma Causing Prolonged Fever and Indicated for Resection. Intern Med 2022; 61:1849-1856. [PMID: 34803101 PMCID: PMC9259820 DOI: 10.2169/internalmedicine.8405-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hepatic hemangiomas are benign liver tumors, and most of them progress asymptomatically. We report a case of hepatic hemangioma considered the cause of fever. A 53-year-old woman had a fever of 40°C for about 3 months without infection. Hepatic hemangiomas with internal bleeding of 10 cm in size on liver S8/7 and S3/2 were observed. These were resected laparoscopically for diagnostic treatment. She was afebrile after the operation. The pathological diagnosis was hematoma inside cavernous hemangioma. It should be noted that a bleeding hepatic hemangioma may cause fever of unknown origin and be indicated for resection.
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Affiliation(s)
- Chihiro Yoshimizu
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Shunichi Ariizumi
- Institute of Gastroenterology, Department of Surgery, Tokyo Women's Medical University, Japan
| | - Tomomi Kogiso
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Takaomi Sagawa
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Makiko Taniai
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
| | - Goro Honda
- Institute of Gastroenterology, Department of Surgery, Tokyo Women's Medical University, Japan
| | - Hiroto Egawa
- Institute of Gastroenterology, Department of Surgery, Tokyo Women's Medical University, Japan
| | - Katsutoshi Tokushige
- Institute of Gastroenterology, Department of Internal Medicine, Tokyo Women's Medical University, Japan
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10
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Wang S, Gao R, Zhao S, Zhu H, Zhang W, Kong X, Li P, Ma D, Gao J, Sun W. Safety and effectiveness of laparoscopic intratumoral resection facilitated by coagulation of giant hepatic hemangioma: a matched case-control study and literature review. Surg Endosc 2021; 36:5149-5159. [PMID: 34845546 DOI: 10.1007/s00464-021-08891-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To report the safety and effectiveness of laparoscopic intratumoral resection facilitated by coagulation (LIRC) compared with laparoscopic hepatectomy (LH) in treating giant hepatic hemangioma. METHODS From 2017 to 2020, 19 consecutive patients with giant hepatic hemangioma (≥ 10 cm) received LIRC in one center. We selected a subgroup of 103 patients treated by LH in other four centers who well matched the 19 consecutive patients treated with LIRC, in a 1:1 fashion based on the tumor location, tumor size, and body mass index. Furthermore, the differences in technical success, operative time, operative blood loss, change of laboratory indexes, hospital stays, complication and clinical responds are compared between the two groups. RESULTS Technical success was achieved in all 38 patients. Patients in the LIRC group had a relative shorter operative time (P < 0.001) and less operative blood loss (P = 0.003). The serum levels of C-reactive protein (CRP), total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate transaminase (AST) were elevated significantly (P < 0.05) 1 day after the resection and returned to normal within 7 days in both groups; however, relatively lower serum levels of those indexes were observed in the LIRC group (P < 0.05). The total complication rate was relatively lower in the LIRC group compared with the LH group (P = 0.029). Patients in the LIRC group had shorter hospital stays than those in the LH group (P = 0.010). The clinical response was similar in the two groups. CONCLUSIONS LIRC is safe and effective for treating giant hepatic hemangioma.
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Affiliation(s)
- Shaohong Wang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China
| | - Ruize Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China
| | - Shuchao Zhao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, China
| | - Wenxuan Zhang
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China
| | - Xinliang Kong
- Department of Hepatobiliary Surgery, Rizhao Central Hospital, Rizhao, 276801, Shandong Province, China
| | - Peng Li
- Department of General Surgery, Binzhou Second People's Hospital, Binzhou, 256800, Shandong Province, China
| | - Demin Ma
- Department of Hepatobiliary Surgery, Dezhou People's Hospital, Dezhou, 253000, Shandong Province, China
| | - Jun Gao
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China.
| | - Wenbing Sun
- Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing, 100043, China.
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11
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Tang T, Wang X, Mao Y, Li J, Wen T, Jia W, Chen Y, Peng T, Liu L, Fan R, Ma K, Xia F. Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1067. [PMID: 34422979 PMCID: PMC8339840 DOI: 10.21037/atm-20-4684] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 03/28/2021] [Indexed: 02/05/2023]
Abstract
Background There is currently a lack of consensus regarding the clinical features, diagnosis, treatment indications and options, and risk assessment of hepatic hemangioma patients. Methods This was a multicenter, real-world study that analyzed a large number of hepatic hemangioma cases in China and included patient data on epidemiology, diagnosis, treatment methods, and outcomes. Results A total of 5,143 patients hospitalized for hepatic hemangioma were included, of whom 34.42% were male and 65.58% were female. The age distribution was concentrated between 30 and 60 years old, accounting for 87.41% of the patients. Among the hepatic hemangioma patients, 60.8% had only one tumor, with the most common pathological type being cavernous hemangioma (96.07% of cases). The treatment motivations and indications included anxiety, obvious clinical symptoms, rapid tumor growth, unclear diagnoses and acute emergencies. Overall, 41.4% of the patients were treated for psychological reasons, while 30.59% were treated because they presented obvious (primarily nonspecific) clinical symptoms. Hepatic resection was the main therapeutic method and was based on various indications. There were a small number of patients with Kasabach-Merritt syndrome, according to its generally recognized definition. Conclusions Most patients in this study who were hospitalized for hepatic hemangioma did not meet the indications for requiring treatment. Surveillance is the recommended course of action for definitively diagnosed hepatic hemangioma, and a new classification system is needed to standardize the diagnosis of this condition.
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Affiliation(s)
- Tengqian Tang
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xishu Wang
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC and Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Li
- The Institute of Hepatobiliary Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Tianfu Wen
- Department of Liver Surgery & Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, China
| | - Weidong Jia
- Department of Hepatobiliary Surgery, Anhui Provincial Hospital, Hefei, China
| | - Yongjun Chen
- Department of Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Peng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lingxiao Liu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University; Shanghai Institute of Medical Imaging, Shanghai, China
| | - Ruifang Fan
- Department of Hepatobiliary Surgery, Lanzhou General Hospital of Lanzhou Military Area Command, PLA, Lanzhou, China
| | - Kuansheng Ma
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Feng Xia
- The Institute of Hepatobiliary Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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12
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Xie QS, Chen ZX, Zhao YJ, Gu H, Geng XP, Liu FB. Outcomes of surgery for giant hepatic hemangioma. BMC Surg 2021; 21:186. [PMID: 33832476 PMCID: PMC8033692 DOI: 10.1186/s12893-021-01185-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The surgical indications for liver hemangioma remain unclear. METHODS Data from 152 patients with hepatic hemangioma who underwent hepatectomy between 2004 and 2019 were retrospectively reviewed. We analyzed characteristics including tumor size, surgical parameters, and variables associated with Kasabach-Merritt syndrome and compared the outcomes of laparoscopic and open hepatectomy. Here, we describe surgical techniques for giant hepatic hemangioma and report on two meaningful cases. RESULTS Most (63.8%) patients with hepatic hemangioma were asymptomatic. Most (86.4%) tumors from patients with Kasabach-Merritt syndrome were larger than 15 cm. Enucleation (30.9%), sectionectomy (28.9%), hemihepatectomy (25.7%), and the removal of more than half of the liver (14.5%) were performed through open (87.5%) and laparoscopic (12.5%) approaches. Laparoscopic hepatectomy is associated with an operative time, estimated blood loss, and major morbidity and mortality rate similar to those of open hepatectomy, but a shorter length of stay. 3D image reconstruction is an alternative for diagnosis and surgical planning for partial hepatectomy. CONCLUSION The main indication for surgery is giant (> 10 cm) liver hemangioma, with or without symptoms. Laparoscopic hepatectomy was an effective option for hepatic hemangioma treatment. For extremely giant hemangiomas, 3D image reconstruction was indispensable. Hepatectomy should be performed by experienced hepatic surgeons.
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Affiliation(s)
- Qing-Song Xie
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Zi-Xiang Chen
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Yi-Jun Zhao
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Heng Gu
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Xiao-Ping Geng
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China
| | - Fu-Bao Liu
- Hepatopancreatobiliary Surgery, Department of general surgery, The First Affiliated Hospital of Anhui Medical University, 120# Wanshui Road, Hefei, 230022, Anhui, China.
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13
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Desai G, Budkule D, Pande P, Wagle P. Pyrexia of Unknown Origin: An Atypical Presentation of Hepatic Hemangioma. Surg J (N Y) 2020; 6:e180-e184. [PMID: 33335986 PMCID: PMC7735872 DOI: 10.1055/s-0040-1721428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/11/2020] [Indexed: 10/28/2022] Open
Abstract
Pyrexia of unknown origin (PUO) has been a diagnostic challenge for decades. Hepatic hemangioma (HH) is not a common differential diagnosis of PUO. It is the most common benign hepatic tumor, commonly asymptomatic and incidentally detected, or can present with vague abdominal pain. PUO is a rare presenting feature. We describe a case of 38-year-old lady presenting with PUO. With no other identifiable source of fever despite exhaustive investigations, a giant hemangioma in right lobe of liver detected on abdominal ultrasonography was deemed to be the cause of PUO. The patient had sudden decrease in hemoglobin while undergoing workup, which on imaging showed a bleeding hemangioma and right hepatectomy was performed. Patient had an uneventful recovery and her PUO also resolved after surgery. HH should be considered a rare diagnosis of exclusion for PUO after a standard algorithmic approach does not reveal any other cause.
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Affiliation(s)
- Gunjan Desai
- Department of Surgical Gastroenterology, MGM New Bombay Hospital, Navi Mumbai, Maharashtra, India
| | - Dattaraj Budkule
- Department of General Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Prasad Pande
- Department of Surgical Gastroenterology, MGM New Bombay Hospital, Navi Mumbai, Maharashtra, India
| | - Prasad Wagle
- Department of Surgical Gastroenterology, Lilavati Hospital, Mumbai, Maharashtra, India
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14
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Oldhafer KJ, Habbel V, Horling K, Makridis G, Wagner KC. Benign Liver Tumors. Visc Med 2020; 36:292-303. [PMID: 33005655 DOI: 10.1159/000509145] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022] Open
Abstract
Background Due to the frequent use of medical imaging including ultrasonography, the incidence of benign liver tumors has increased. There is a large variety of different solid benign liver tumors, of which hemangioma, focal nodular hyperplasia (FNH), and hepatocellular adenoma (HCA) are the most frequent. Advanced imaging techniques allow precise diagnosis in most of the patients, which reduces the need for biopsies only to limited cases. Patients with benign liver tumors are mostly asymptomatic and do not need any kind of treatment. Symptoms can be abdominal pain and pressure effects on adjacent structures. The 2 most serious complications are bleeding and malignant transformation. Summary This review focuses on hepatic hemangioma (HH), FNH, and HCA, and provides an overview on clinical presentations, surgical and interventional treatment, as well as conservative management. Treatment options for HHs, if indicated, include liver resection, radiofrequency ablation, and transarterial catheter embolization, and should be carefully weighed against possible complications. FNH is the most frequent benign liver tumor without any risk of malignant transformation, and treatment should only be restricted to symptomatic patients. HCA is associated with the use of oral contraceptives or other steroid medications. Unlike other benign liver tumors, HCA may be complicated by malignant transformation. HCAs have been divided into 6 subtypes based on molecular and pathological features with different risk of complication. Key Message The vast majority of benign liver tumors remain asymptomatic, do not increase in size, and rarely need treatment. Biopsies are usually not needed as accurate diagnosis can be obtained using modern imaging techniques.
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Affiliation(s)
- Karl J Oldhafer
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Victoria Habbel
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | | | - Georgios Makridis
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
| | - Kim Caroline Wagner
- Department für Chirurgie, Klinik für Leber-, Gallenwegs- und Pankreaschirurgie, Asklepios Klinik Barmbek, Hamburg, Germany.,Semmelweis University Budapest, Asklepios Campus Hamburg, Hamburg, Germany
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15
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Ariizumi SI, Kotera Y, Yamashita S, Omori A, Kato T, Shibuya G, Egawa H, Yamamoto M. Debulking of giant liver hemangiomas with severe symptoms: a case report. Surg Case Rep 2020; 6:195. [PMID: 32748049 PMCID: PMC7399725 DOI: 10.1186/s40792-020-00960-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/27/2020] [Indexed: 12/14/2022] Open
Abstract
Background There are no previous reports of debulking of giant liver hemangioma. This report describes our experience with debulking surgery for a patient with bilateral giant liver hemangiomas with severe symptoms. Case presentation We present a case of symptomatic giant liver hemangioma in a 41-year-old woman. She presented with abdominal pain and fullness at a local hospital and underwent trans-arterial embolization (TAE). TAE was not effective, and she was not able to walk a long distance. Giant liver hemangiomas, 30 cm and 15 cm in diameter, were located in the right liver and in the left lateral section, respectively, and normal liver parenchyma with tiny liver hemangiomas was present in segment 4. The liver function was normal. However, right hemi-hepatectomy with left lateral sectionectomy was considered to be risky according to the 3DCT volumetry. Therefore, we performed right hemi-hepatectomy in order to reduce her symptoms. The postoperative course was uneventful, and she was discharged on the 14th day after surgery. The abdominal fullness and abdominal pain disappeared immediately after surgery. The hemangiomas in the remnant liver, 15 cm in diameter, showed no change, and she is well without symptoms 7 years after surgery. Conclusions Debulking surgery is one of the options for bilateral giant liver hemangiomas with severe symptoms.
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Affiliation(s)
- Shun-Ichi Ariizumi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Yoshihito Kotera
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Shingo Yamashita
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Akiko Omori
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Takaaki Kato
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Go Shibuya
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Kawada 8-1, Shinjuku-ku, Tokyo, 162-0054, Japan.
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16
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Cai WL, Ma XM, Sun XH, Ren T, Huang CY, Li YS, Wang XA, Liu YB, Peng SY. Surgical indication and strategy for liver hemangioma in the caudate lobe: a multi-institutional retrospective analysis with 137 patients. World J Surg Oncol 2020; 18:123. [PMID: 32522218 PMCID: PMC7288691 DOI: 10.1186/s12957-020-01901-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the surgical indication and tactics for liver hemangioma in the caudate lobe Methods From January 1994 to July 2019, 137 patients, including 51 males and 86 females with the average age of 49.2 years old were diagnosed with liver hemangioma in caudate lobe and received treatment at five tertiary referral hospitals. Clinical features, correlations between tumor size and clinical manifestations, treatments, and prognosis were analyzed. Results Of the 137 patients identified, 40 (29.20%) patients were asymptomatic, whereas other 94 patients had clinical symptoms mainly presented as upper abdominal discomfort, epigastric distention, upper abdominal dull pain, nausea, and vomiting. Fifteen (93.75%), 18 (39.13%), and 7 (10.45%) patients presented no clinical symptoms among those tumor size was less than 3 cm (D ≤ 3 cm, n = 16), 3 cm < D ≤ 6 cm (n = 46), and 6 cm < D ≤ 9 cm (n = 67), respectively, while all 8 patients with tumor larger than 9 cm were symptomatic. Tumor diameter was obviously associated with the presence of clinical symptoms. In follow-up period, 7 patients in the conservative group (n = 39) received surgery because of tumor growth or symptom appearance. Totally 105 patients received operation including partial resection or isolated complete resection of caudate lobe and caudate lobe resection combined with liver segment resection, right liver resection, or left liver resection. All operations went smoothly, and no severe complications appeared. Conclusion Tumor diameter was obviously associated with the presence of clinical symptoms in patients with hemangioma in caudate lobe. Surgical therapy is not recommended for asymptomatic patients and available for patient who has symptoms. Effective surgical strategies should be put into use to reduce operative bleeding.
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Affiliation(s)
- Wei Long Cai
- Huzhou Central Hospital, Affiliated Central Hospital of Huzhou University, 198 Hongqi Road, Huzhou, 313003, Zhejiang Province, People's Republic of China
| | - Xiao Ming Ma
- Department of General Surgery, The second affiliated hospital of Soochow University, Suzhou, 215000, Jiangsu Province, People's Republic of China
| | - Xu Heng Sun
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Tai Ren
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Cong Yun Huang
- Department of General Surgery, Yuebei People's Hospital Affiliated to Shantou University School of Medicine, Shaoguan, 512025, Guangdong Province, People's Republic of China
| | - Yong Sheng Li
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China
| | - Xu An Wang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.
| | - Ying Bin Liu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, No.1665 Kongjiang Road, Shanghai, 200092, People's Republic of China.
| | - Shu You Peng
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang Province, People's Republic of China
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Leon M, Chavez L, Surani S. Hepatic hemangioma: What internists need to know. World J Gastroenterol 2020; 26:11-20. [PMID: 31933511 PMCID: PMC6952297 DOI: 10.3748/wjg.v26.i1.11] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 11/26/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. This tumor arises from a vascular malformation; however, the pathophysiology has not been clearly elucidated. Symptoms usually correlate with the size and location of the tumor. Less commonly the presence of a large HH may cause life-threatening conditions. The diagnosis can be established by the identification of HH hallmarks in several imaging studies. In patients that present with abdominal symptoms other etiologies should be excluded first before attributing HH as the cause. In asymptomatic patient’s treatment is not required and follow up is usually reserved for HH of more than 5 cm. Symptomatic patients can be managed surgically or with other non-surgical modalities such as transcatheter arterial embolization or radiofrequency ablation. Enucleation surgery has shown to have fewer complications as compared to hepatectomy or other surgical techniques. Progression of the tumor is seen in less than 40%. Hormone stimulation may play a role in HH growth; however, there are no contraindications for hormonal therapy in patients with HH due to the lack of concrete evidence. When clinicians encounter this condition, they should discern between observation and surgical or non-surgical management based on the clinical presentation.
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Affiliation(s)
- Monica Leon
- Centro Medico ABC, Ciudad de Mexico, CDMX 01120, Mexico
| | - Luis Chavez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX 79905, United States
| | - Salim Surani
- Texas A&M University, Corpus Christi, TX 78405, United States
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18
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Impact of open and minimally invasive resection of symptomatic solid benign liver tumours on symptoms and quality of life: a systematic review. HPB (Oxford) 2019; 21:1119-1130. [PMID: 30926331 DOI: 10.1016/j.hpb.2019.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/23/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The value of open and minimally invasive liver resection for symptomatic solid benign liver tumours (BLT) such as hepatocellular adenoma, focal nodular hyperplasia and haemangioma is being debated. A systematic review on symptom relief, quality of life (QoL) and surgical outcome after both open and minimally invasive surgery for solid BLT is currently lacking. METHODS A systematic search in PubMed and EMBASE was performed according to the PRISMA guidelines (January 1985-April 2018). Articles reporting pre-and postoperative symptoms or QoL in patients undergoing open or minimally surgery for BLT were evaluated. Methodological quality was assessed using the MINORS tool. RESULTS Forty-two studies were included with 4061 patients undergoing surgery for BLT, 3536 (87%) open and 525 (13%) laparoscopic resections. Randomized and propensity-matched studies were lacking. Symptoms were the indication for resection in 56% of the patients. After a weighted mean of 28.5 months follow-up after surgery, symptoms were relieved in 82% of symptomatic patients. Validated QoL tools were used in eight studies, of which two found significant better QoL scores following laparoscopic compared to open surgery. DISCUSSION Resection of symptomatic BLT seems safe and relieves symptoms in the vast majority of selected patients. Comparative studies are needed before more firm conclusions can be drawn.
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19
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Koyama R, Minagawa N, Maeda Y, Shinohara T, Hamada T. A hepatic sclerosing hemangioma emerged in the postoperative course of multiple gastric carcinoid tumors masquerading as metachronous liver metastasis. Int J Surg Case Rep 2019; 58:1-5. [PMID: 30986640 PMCID: PMC6462798 DOI: 10.1016/j.ijscr.2019.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 03/15/2019] [Indexed: 11/29/2022] Open
Abstract
The authors present an unusual case of newly appearing hepatic sclerosing hemangioma newly emerged in the postoperative course after the resection of multiple gastric carcinoid tumors. Hepatic sclerosing hemangioma is often misdiagnosed as malignant lesion for its resemblance on the imaging studies. Although preoperative diagnosis is still difficult, hepatic sclerosing hemangioma must be included into the differential diagnosis of hepatic tumors.
Introduction Hepatic sclerosing hemangiomas are rare tumors whose appearance on imaging is similar to that of malignant tumors. The resulting difficulties in preoperative diagnosis frequently lead to surgical resection in order to accurately identify the tumor. Case presentation A 68-year-old man was diagnosed with multiple gastric carcinoid tumors (T1N1M0, pStage IIIB) after total gastrectomy with D2 lymph node dissection. Enhanced computed tomography of the abdomen 2 years after the initial surgery revealed a novel solid lesion with ring enhancement measuring 22 × 15 mm at S5 of the liver. Metachronous liver metastasis from multiple gastric carcinoid tumors was suspected, and partial hepatectomy of S5 was successfully performed. Histopathological diagnosis was sclerosing hemangioma with no malignant findings. Discussion Ours is the first reported case of a newly appearing sclerosing hemangioma excised and diagnosed histopathologically. Hepatic sclerosing hemangiomas are rarely observed, but they are often resected under a preoperative diagnosis of malignant lesion due to the similarity on imaging studies. Conclusion Surgeons must consider that a hepatic tumor may be a sclerosing hemangioma, particularly when the lesion appears to be ring enhanced.
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Affiliation(s)
- Ryota Koyama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan.
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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20
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Okumura Y, Noda T, Eguchi H, Hanaki T, Iwagami Y, Akita H, Asaoka T, Gotoh K, Kobayashi S, Umeshita K, Mori M, Doki Y. Pure laparoscopic liver resection for giant liver hemangioma with extrahepatic growth based on preoperative 3-dimensional simulation: A case report. Surg Case Rep 2019; 5:51. [PMID: 30937826 PMCID: PMC6443745 DOI: 10.1186/s40792-019-0607-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/18/2019] [Indexed: 01/22/2023] Open
Abstract
Background Performing laparoscopic liver resection for giant hemangiomas is challenging, and careful preoperative planning is essential. Controlling intraoperative bleeding and handling surgical instruments within a limited workspace is necessary. Case presentation In the present case, the patient was a 38-year-old woman diagnosed with a 16-cm giant liver hemangioma in segment 5/6, with extrahepatic growth. Preoperative three-dimensional simulations for port placement and the laparoscopic view from the left upper abdomen were performed to complete the pure laparoscopic liver resection. The laparoscopic resection was then safely performed on the same way. Conclusions Pure laparoscopic resection could be applied to giant hemangiomas with extrahepatic growth, and the preoperative three-dimensional simulation of port placement and the laparoscopic view might be helpful when the intraabdominal workplace is restricted. Electronic supplementary material The online version of this article (10.1186/s40792-019-0607-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuichiro Okumura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.
| | - Takehiko Hanaki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
| | - Koji Umeshita
- Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka E-2, Suita, Osaka, 565-0871, Japan
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21
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Miyata T, Beppu T, Kuramoto K, Nakagawa S, Imai K, Hashimoto D, Namimoto T, Yamashita YI, Chikamoto A, Yamashita Y, Baba H. Hepatic sclerosed hemangioma with special attention to diffusion-weighted magnetic resonance imaging. Surg Case Rep 2018; 4:3. [PMID: 29299708 PMCID: PMC5752647 DOI: 10.1186/s40792-017-0414-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/26/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A hepatic sclerosed hemangioma (HSH) is a very rare benign liver tumor. The correct preoperative diagnosis of HSH is very difficult because its features of imaging are similar to those of intrahepatic cholangiocarcinoma or colorectal liver metastasis. CASE PRESENTATION We experienced five patients who were diagnosed histologically with HSH. The preoperative diagnoses were HSH in two patients, cavernous hemangioma in one, intrahepatic cholangiocarcinoma in one, and colorectal liver metastasis in one. All patients were treated with hepatectomy (one laparoscopic and four laparotomies), and the diagnosis was completed by histological investigation of the resected specimen. In particular, we investigated the apparent diffusion coefficient (ADC) mean value using diffusion-weighted sequences of magnetic resonance imaging (DW-MRI). The average of the ADC mean (ADCmean) value of HSH was 1.94 × 10-3 mm2/s (range 1.73-2.10 × 10-3 mm2/s), which was higher than the value of common malignant liver tumors. Interestingly, the ADCmean values were almost the same between the degenerate (1.90 ± 0.17 × 10-3 mm2/s) and the non-degenerate areas (1.95 ± 0.26 × 10-3 mm2/s) in HSH. CONCLUSIONS The ADCmean value seemed to be quite useful to preoperatively distinguish HSH from other malignant liver tumors.
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Affiliation(s)
- Tatsunori Miyata
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan.,Department of Surgery, Yamaga City Medical Center, 511, Yamaga, Kumamoto, 861-0593, Japan
| | - Kunitaka Kuramoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan.,Department of Surgery, Yamaga City Medical Center, 511, Yamaga, Kumamoto, 861-0593, Japan
| | - Shigeki Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Katsunori Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Daisuke Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Tomohiro Namimoto
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Akira Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Yasuyuki Yamashita
- Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1, Honjo, Chuo-ku, Kumamoto, 860-0811, Japan.
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22
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Furumaya A, van Rosmalen BV, Takkenberg RB, van Delden OM, Dejong CHC, Verheij J, van Gulik TM. [A case of thoracic empyema with broncho-pleural fistula existing for 57 years. Histological findings of squamous cell carcinoma in the resected lung]. Cardiovasc Intervent Radiol 1985; 42:800-811. [PMID: 30783780 PMCID: PMC6503075 DOI: 10.1007/s00270-019-02169-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
Background Methods Results Conclusion Electronic supplementary material
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Affiliation(s)
- Alicia Furumaya
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Belle V van Rosmalen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Room G4-108, 1105AZ, Amsterdam, The Netherlands.
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Otto M van Delden
- Department of Interventional Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis H C Dejong
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Surgery, Uniklinikum Aachen, Aachen, Germany
| | - Joanne Verheij
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Thomas M van Gulik
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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