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Onishi Y, Ohno T, Shimizu H, Shimada K, Isoda H, Ishii T, Takai A, Nakamoto Y. Natural History of Hepatic Hemangiomas Larger Than 10 cm: Imaging Findings and Clinical Course of 22 Cases. Cureus 2023; 15:e50563. [PMID: 38226088 PMCID: PMC10788688 DOI: 10.7759/cureus.50563] [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] [Accepted: 12/10/2023] [Indexed: 01/17/2024] Open
Abstract
INTRODUCTION The natural history of a large hepatic hemangioma is important in determining the treatment strategy. Although several studies have assessed the natural history of hepatic hemangiomas, no study has focused on hepatic hemangiomas measuring >10 cm. The aim of this study was to assess the natural history of hepatic hemangiomas measuring >10 cm by evaluating imaging findings and clinical course. METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) reports at Kyoto University Hospital, Kyoto, Japan, between January 2001 and March 2023 were retrospectively searched to find adult patients with hepatic hemangiomas >10 cm. Patients who were followed up without treatment for over six months were included. The maximum diameter of the hepatic hemangioma was compared between the baseline and the final CT or MRI. The clinical course of the patients was evaluated. RESULTS Twenty-two patients (17 women, five men; median age, 51 years) were identified. The median diameter of hepatic hemangiomas in the baseline study was 114 mm. Two patients had abdominal distention at the time of the baseline imaging, whereas the others were asymptomatic. After follow-up without treatment (the median; 95.5 months), enlargement, no change, shrinkage of hepatic hemangioma was observed in six, 11, and five patients, respectively. The median growth rate of hepatic hemangiomas was 2.5 mm/year. Two patients underwent liver resection for hepatic hemangioma, while the others were followed up without treatment. In four patients, symptoms appeared or worsened. Two patients died: one patient died from prostate cancer progression; the cause of death for the other was not confirmed. CONCLUSION Hepatic hemangiomas show a slow growth rate during follow-up, and shrinkage is occasionally observed. Some patients experience new symptoms or aggravation of symptoms; however, deaths associated with hepatic hemangiomas are uncommon.
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Affiliation(s)
- Yasuyuki Onishi
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Tsuyoshi Ohno
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hironori Shimizu
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Kotaro Shimada
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | - Hiroyoshi Isoda
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
| | | | - Atsushi Takai
- Gastroenterology and Hepatology, Kyoto University, Kyoto, JPN
| | - Yuji Nakamoto
- Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto, JPN
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Spontaneous regression of liver hemangiomas: a single-institution analysis of 46 patients. Eur J Gastroenterol Hepatol 2021; 33:1436-1440. [PMID: 33731584 DOI: 10.1097/meg.0000000000002069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to determine the nature of spontaneous regression of liver hemangiomas. PATIENTS AND METHODS The records of the liver hemangioma patients who attended the out-patient clinic between 1988 and 2018 were evaluated. The data of the 716 adult patients who were followed for at least 3 years with cross-sectional imaging were analyzed. RESULTS Spontaneous regression was documented in 46 patients (6.4%). Twenty-eight patients had a single hemangioma (61%), eight (17%) had two hemangiomas; the other 10 patients had 3-6 hemangiomas. Of the 87 lesions in 46 patients, 69 actually regressed during the study. Twelve patients with more than one lesion exhibited discordant courses - one of the hemangiomas of a patient with multiple lesions regressed, whereas the other enlarged or remained stable. Eleven of the regressed hemangiomas exhibited enlargement first, followed by spontaneous regression. Fourteen (20%) of the regressed hemangiomas acquired atypical characteristics that would have suggested a malignancy had the original films been unavailable. CONCLUSION Spontaneous regression of liver hemangiomas is an underrecognized phenomenon. Enlargement should not be a straightforward indication for intervention because it may be followed by regression. A regressed hemangioma should be considered in the differential diagnosis of liver lesions suspicious for malignancy.
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Serrano F, Bisdorff-Bresson A, Sroussi J, Aymard A, Wassef M, Civelli V, Boujlel S, Houdart E, Drouet L. Giant intrahepatic venous malformation with localized intravascular coagulopathy. Follow-up and treatment during pregnancy. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:309-315. [PMID: 33248533 DOI: 10.1016/j.jdmv.2020.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/30/2020] [Indexed: 11/28/2022]
Abstract
Intrahepatic lesions in adults, commonly named hepatic hemangioma, should be called Intrahepatic Venous Malformations (IHVM), or Giant Intrahepatic Venous Malformations (GIHVM) when larger than 10 cm according to the ISSVA classification (International society study group for vascular anomalies). Localized coagulation disorders (LIC) in patients with venous malformations are quite commonly associated in venous malformations, they result in decreased fibrinogen (< 2g/l) and elevated d-dimers (> 1500 ng/ml) and might be responsible of intralesional thrombotic, pain or bleeding episodes.We report a case report of a 41 y/o patient that presented with right hypochondrium pain episodes discovering an unknown GIHVM on ultrasound imaging with a prior history of uterine bleeding episodes and multiples miscarriages.On laboratory work up the patient presented an associated localized Intravascular Coagulation (LIC) with the GIHVM. As the patient desire to become pregnant was important our multidisciplinary clinic allowed a pregnancy with close clinical, biological and imaging monitoring and follow up. Early initiation of low molecular weighted heparin (LMWH) successfully allowed an uncomplicated term pregnancy and delivery. Intrahepatic lesion stability was achieved and prevented progression from LIC to diffuse intravascular coagulation disorder (DIC)..
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Affiliation(s)
- Fabiola Serrano
- Assistance Publique-Hôpitaux de Paris, Multi-disciplinary Vascular Anomalies Clinic, Lariboisière Hospital, Paris, France.
| | - Annouk Bisdorff-Bresson
- Assistance Publique-Hôpitaux de Paris, Multi-disciplinary Vascular Anomalies Clinic, Lariboisière Hospital, Paris, France
| | - Jérémy Sroussi
- Assistance Publique-Hôpitaux de Paris, Department of Gynecology-Obstetrics, Lariboisière Hospital, Paris, France
| | - Armand Aymard
- Assistance Publique-Hôpitaux de Paris, Multi-disciplinary Vascular Anomalies Clinic, Lariboisière Hospital, Paris, France
| | - Michel Wassef
- Assistance Publique-Hôpitaux de Paris, Department of Pathology, Lariboisière Hospital, Paris, France
| | - Vittorio Civelli
- Assistance Publique-Hôpitaux de Paris, Multi-disciplinary Vascular Anomalies Clinic, Lariboisière Hospital, Paris, France
| | - Sihem Boujlel
- Assistance Publique-Hôpitaux de Paris, Intensive Care Unit, Lariboisière Hospital, Paris, France
| | - Emmanuel Houdart
- Assistance Publique-Hôpitaux de Paris, Multi-disciplinary Vascular Anomalies Clinic, Lariboisière Hospital, Paris, France
| | - Ludovic Drouet
- Assistance Publique-Hôpitaux de Paris, Department of Hematology, Lariboisière Hospital, Paris, France
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Shin N, Choi JA, Choi JM, Cho ES, Kim JH, Chung JJ, Yu JS. Sclerotic changes of cavernous hemangioma in the cirrhotic liver: long-term follow-up using dynamic contrast-enhanced computed tomography. Radiol Med 2020; 125:1225-1232. [PMID: 32415477 DOI: 10.1007/s11547-020-01221-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/27/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE To determine the intra- and extralesional factors that predict sclerotic degeneration of hepatic hemangiomas in the cirrhotic liver on long-term follow-up computed tomography (CT) examinations. MATERIALS AND METHODS Fifty-seven hepatic hemangiomas (> 5 mm in diameter) in 41 cirrhotic patients, recruited over a 5-year period (January 2005-December 2009), were subjected to CT to determine which factors predict sclerotic contraction or degeneration in hemangiomas. Prior and follow-up CT examinations (from 2000 to 2018) were included to observe time-related changes. The patients' gender, age, cause of cirrhosis, progression of background liver cirrhosis, lesion size/location/contrast enhancement pattern, and serum aspartate transaminase to platelet ratio index were correlated with sclerotic changes of each lesion. RESULTS According to the dynamic CT features, 36 of 57 (63%) hemangiomas were determined to have sclerotic changes during the follow-up period (1.1-14.4 years, median: 7.8 years), including 28 lesions (49%) reduced by ≥ 20% in diameter. In univariate analysis, age (p = 0.047) and morphological progression of background cirrhosis (p = 0.013) were significantly related to sclerotic change of hemangiomas. In the logistic regression analysis, only morphological progression of background liver cirrhosis independently predicted sclerotic change (odds ratio: 4.88, p = 0.007). With the exception of exophytic location free from size reduction (p = 0.023 in multivariate analysis), no other analyzed factors were significantly correlated with sclerotic changes. CONCLUSION Overall, sclerotic changes of hepatic cavernous hemangioma followed the morphological progression of background liver cirrhosis, while exophytic lesions tended to be free of size reduction.
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Affiliation(s)
- Nari Shin
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Ji Ae Choi
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Jeong Min Choi
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Eun-Suk Cho
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Joo Hee Kim
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Jae-Joon Chung
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea
| | - Jeong-Sik Yu
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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