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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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Hu M, Chen K, Zhang X, Li C, Song D, Liu R. Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter. BMC Surg 2020; 20:93. [PMID: 32375738 PMCID: PMC7204244 DOI: 10.1186/s12893-020-00760-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 04/28/2020] [Indexed: 01/01/2023] Open
Abstract
Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas. Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria. Results There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 h of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n = 19) and the LH group (n = 13), patients in the OH group (n = 25) had a significantly longer postoperative hospital stay (P < 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 h of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P<0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P<0.05). Conclusion Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.
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Affiliation(s)
- Minggen Hu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Kuang Chen
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Xuan Zhang
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Chenggang Li
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Dongda Song
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China
| | - Rong Liu
- Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese PLA General Hospital and Chinese PLA Medical School, 28 Fuxing Road, Beijing, 100853, China.
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Wen SQ, Wan M, Len KM, Hu QH, Xie XY, Wu Q, Liao GQ. Safety and Efficacy of Laparoscopic Radiofrequency Ablation for Hepatic Hemangiomas: A Multicenter Retrospective Study. Ann Hepatol 2018; 17:268-273. [PMID: 29469049 DOI: 10.5604/01.3001.0010.8653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Radiofrequency ablation (RFA) is an effective and minimally invasive technique for the management of hepatic hemangiomas (HHs). This study aims to assess the safety and efficacy of laparoscopic RFA for HHs. MATERIAL AND METHODS Forty-four patients with 50 hepatic hemangiomas (5-10 cm in diameter) undergoing laparoscopic RFA from January 2012 to May 2015 at three tertiary hospitals in China were retrospectively analyzed. RESULTS Thirty-three patients with subcapsular hemangiomas were treated with a laparoscopic approach, and 11 patients with lesions in the liver parenchyma were treated with a combined laparoscopy and an ultrasound-guided percutaneous approach. No conversion to open surgery or two-step surgery occurred during the study period. Patients with small hemangiomas (< 7 cm) required a significantly shorter operating time (71.1 ± 20.18 min vs. 106 ± 23.55 min, p = 0.000) and fewer punctures compared with patients with large hemangiomas (> 7 cm) (4.61 ± 1.09 vs. 6.73 ±1.01, P < 0.05). According to the Dindo-Clavien classification, 15 patients experienced 34 Grade 1 complications, and two had complications of Grade 3a. All complications were resolved by conservative treatment. Forty-three (86.0%) HHs in 38 patients were completely ablated after RFA, and 7 (14.0%) HHs in 6 patients were incompletely ablated. All patients were followed up for 6-24 months (mean 15 ± 6 months). CONCLUSION The data showed that laparoscopic RFA is an effective treatment for small (< 10 cm) HHs. While the incidence of postoperative complications remains high, the majority of complications are minor. Patients undergoing laparoscopic RFA for HHs, even for the small ones, should be carefully selected.
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Affiliation(s)
- Shun-Qian Wen
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
| | - Ming Wan
- Department of General Surgery, the Second Hospital affiliated to Harbin Medical University, Harbin 150000, China
| | - Kai-Ming Len
- Department of General Surgery, the Second Hospital affiliated to Harbin Medical University, Harbin 150000, China
| | - Qiu-Hui Hu
- the Second Cancer Hospital of Heilongjiang Province, Harbin 150000, China. Department of Hepatobiliary Surgery
| | - Xue-Yi Xie
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
| | - Qing Wu
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
| | - Guan-Qun Liao
- Foshan Hospital affiliated to Southern Medical University, Foshan 528000, China. Department of Hepatobiliary Surgery
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Abstract
RATIONALE Hepatic hemangioma, a benign liver tumor, can rarely spontaneously rupture and hemorrhage, which is then associated with significant mortality. The diagnosis of internal hemorrhage is challenging and the management is disputed. PATIENT CONCERNS We describe the case of a 52-year-old female patient with chief complaints of fever and anemia, with no history of recent trauma. DIAGNOSES Ultrasound suggested the possibility of a liver abscess and computed tomography (CT) examination revealed a giant space occupying lesion (SOL) (approximately 16 cm) in the right hepatic lobe, indicating a hepatic tumor or abscess. The patient did not respond to antibiotics and blood transfusion. Liver needle biopsy revealed blood clots suggestive of intratumoral hemorrhage, possibly of a hepatic hemangioma. INTERVENTIONS Interventional radiologic approach revealed active bleeding at the phrenic artery that supplied the liver SOL. Thus, embolization was performed and re-angiography showed no active bleeding from the embolized vessel. The patient became afebrile, but fever recurred the next day. Hence, an exploratory open right hemihepatectomy was undertaken and the intraoperative frozen biopsy confirmed hepatic hemangioma with internal hemorrhage, but malignancy could not be excluded for some focal tissues. Postoperative pathology report confirmed the diagnosis of hepatic hemangioma with internal hemorrhage and excluded malignancy. OUTCOMES The fever subsided and the patient was discharged in good health. A follow-up CT performed three months, postoperatively, indicated compensatory growth of the left hepatic lobe. LESSONS This case demonstrates that the diagnosis of hepatic hemangioma with internal hemorrhage can be confirmed by needle biopsy and surgical resection is the optimal treatment for such a lesion.
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Affiliation(s)
- Fulong Hao
- Department of Hepatobiliary Surgery, Suining Central Hospital
| | - Xiaoli Yang
- Department of Hepatobiliary Surgery, Suining Central Hospital
| | - Yinsheng Tian
- Department of Hepatobiliary Surgery, Suining Central Hospital
| | - Wenping Wang
- Department of Infectious Diseases, Suining Central Hospital, Suining, Sichuan, China
| | - Minggang Ge
- Department of Hepatobiliary Surgery, Suining Central Hospital
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Cheng WL, Qi YQ, Wang B, Tian L, Huang W, Chen Y. Enucleation versus hepatectomy for giant hepatic haemangiomas: a meta-analysis. Ann R Coll Surg Engl 2017; 99:237-241. [PMID: 27869486 PMCID: PMC5450283 DOI: 10.1308/rcsann.2016.0349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Hepatic haemangiomas are the most common benign liver tumours. They can be treated with surgical resection such as enucleation or hepatectomy if necessary. However, controversy remains over the clinical outcome and safety of these two methods. In this study, we performed a comprehensive meta-analysis to compare the efficacy of liver resection with enucleation for giant haemangiomas. METHODS The online databases PubMed, Embase and CNKI (China National Knowledge Infrastructure) were searched for relevant original articles. We compared operation time, blood loss, transfusion requirements, inflow occlusion time and postoperative complications between enucleation and hepatectomy. RESULTS Seven controlled clinical trials met the predefined inclusion criteria. Analysis indicated that the enucleation group had significantly shorter operation time (weighted mean difference, WMD -28.22, 95% confidence interval, CI, -54.82 to -1.62), less blood loss (WMD -395.92, 95% CI -521.25 to -270.58) and fewer complications (odds ratio, OR, 0.47, 95 % CI 0.34 to 0.65). There were no significant differences between enucleation and hepatectomy with regard to transfusion requirements (OR 0.61, 95% CI 0.22 to 1.68) and inflow occlusion time (WMD 7.91, 95% CI -5.62 to 21.44). CONCLUSIONS Enucleation has advantages over hepatectomy in relation to operation time, blood loss and complications. Enucleation is a safe and effective treatment for giant hepatic haemangioma.
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Affiliation(s)
- W L Cheng
- Department of Vascular Surgery, Wuxi People's Hospital, Nanjing Medical University , Wuxi, Jiangsu Province , China
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, Hubei Province , China
| | - Y Q Qi
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, Hubei Province , China
| | - B Wang
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, Hubei Province , China
| | - L Tian
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, Hubei Province , China
| | - W Huang
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, Hubei Province , China
| | - Y Chen
- Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, Hubei Province , China
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Zhang W, Huang ZY, Ke CS, Wu C, Zhang ZW, Zhang BX, Chen YF, Zhang WG, Zhu P, Chen XP. Surgical Treatment of Giant Liver Hemangioma Larger Than 10 cm: A Single Center's Experience With 86 Patients. Medicine (Baltimore) 2015; 94:e1420. [PMID: 26313792 PMCID: PMC4602926 DOI: 10.1097/md.0000000000001420] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/26/2015] [Accepted: 07/29/2015] [Indexed: 02/07/2023] Open
Abstract
The ideal surgical treatment of giant liver hemangioma is still controversial. This study aims to compare the outcomes of enucleation with those of resection for liver hemangioma larger than 10 cm in different locations of the liver and establish the preoperative predictors of increased intraoperative blood loss.Eighty-six patients underwent enucleation or liver resection for liver hemangioma larger than 10 cm was retrospectively reviewed. Patient demographic, tumor characteristics, surgical indications, the outcomes of both surgical treatment, and the clinicopathological parameters influencing intraoperative blood loss were analyzed.Forty-six patients received enucleation and 40 patients received liver resection. Mean tumor size was 14.1 cm with a range of 10-35 cm. Blood loss, blood product usage, operative time, hepatic vascular occlusion time and frequency, complications and postsurgical hospital stay were similar between liver resections and enucleation for right-liver and left-liver hemangiomas. There was no surgery-related mortality in either group. Bleeding was more related to adjacency of major vascular structures than the size of hemangioma. Adjacency to major vascular structures and right or bilateral liver hemangiomas were independently associated with blood loss >550 mL (P = 0.000 and 0.042, respectively).Both enucleation and liver resection are safe and effective surgical treatments for liver hemangiomas larger than 10 cm. The risk of intraoperative blood loss is related to adjacency to major vascular structures and the location of hemangioma.
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Affiliation(s)
- Wei Zhang
- From the Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China (WZ, Z-YH, CW, Z-WZ, B-XZ, Y-FC, W-GZ, PZ, X-PC); Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China (C-SK); and Key Laboratory of Organ Transplantation, Ministry of Education, China, and Key Laboratory of Organ Transplantation, Ministry of Public Health, People's Republic of China (X-PC)
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Giant hepatocellular adenoma in a previously obese thirteen-year-old boy. Ann Hepatol 2015. [DOI: 10.1016/s1665-2681(19)31180-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, Bertino G, Di Carlo I. What is changing in indications and treatment of hepatic hemangiomas. A review. Ann Hepatol 2014. [PMID: 24927603 DOI: 10.1016/s1665-2681(19)30839-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. Patients affected by hemangioma usually have their tumor diagnosed by ultrasound abdominal examination for a not well defined pain, but pain persist after treatment of the hemangioma. The causes of pain can be various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease.The malignant trasformation is practically inexistent. Different imaging modalities are used to diagnosis liver hemangioma including ultrasonography, computed tomography (CT), magnetic resonance (MR) imaging, and less frequently scintigraphy, positronemission tomography combined with CT (PET/CT) and angiography. Imaging-guided biopsy of hemangioma is usually not resorted to except in extremely atypical cases. The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself. The size of the tumor do not represent a valid indication for treatment. Liver hemangiomas, when indication exist, have to be treated firstly by surgery (hepatic resection or enucleation, open, laproscopic or robotic), but in the recent years other therapies like liver transplantation, radiofrequency ablation, radiotherapy, trans-arterial embolization, and chemotherapy have been applied.
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Affiliation(s)
- Adriana Toro
- Department of Surgery, Taormina Hospital, Messina, Italy
| | | | - Annalisa Ardiri
- Hepatology Unit. Department of Medical and Pediatric Science, University of Catania, Italy
| | | | - Giulia Malaguarnera
- University of Catania; Research Center "The Great Senescence". Cannizzaro Hospital, Italy
| | | | - Gaetano Bertino
- Hepatology Unit. Department of Medical and Pediatric Science, University of Catania, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, University of Catania. Catania, Italy; Department of Radiology, Hamad General Hospital, Doha Qatar
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Rao AM, Ahmed I. Laparoscopic versus open liver resection for benign and malignant hepatic lesions in adults. Cochrane Database Syst Rev 2013:CD010162. [PMID: 23728700 DOI: 10.1002/14651858.cd010162.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver (hepatic) resection refers to removal of the whole liver, or one or more of its vascular segments. Elective liver resection is mainly performed for benign and malignant liver tumours. The operation can be performed as an open procedure or with a laparoscopic approach. With the advancement of laparoscopic skills and equipment, liver resection is selectively being carried out with this approach. A laparoscopic procedure is intended to be less severe, allowing for quicker healing, fewer complications, and a shorter hospital stay as the insult to the body is minimised. However, evidence about the efficacy of this approach when compared to an open procedure is still scattered. Current practice at different hepato-pancreato-biliary centres is based on the clinical judgement of experts in their field, which is highly insufficient in terms of evidence. OBJECTIVES To assess the benefits and harms of laparoscopic versus open liver resection for benign or malignant lesions on the liver in adult patients. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2013. We also conducted searches of reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases. SELECTION CRITERIA We searched for randomised clinical trials of participants undergoing liver resection for benign or malignant lesions which reported on benefits and harms. We searched for quasi-randomised or observational studies for reports of harm. DATA COLLECTION AND ANALYSIS No data from randomised clinical trials could be collected. MAIN RESULTS Two authors performed study selection independently. We were not able to identify any randomised clinical trials that met the inclusion criteria of our review protocol. We identified two ongoing randomised clinical trials performed in Europe with data yet to be published. We retrieved a few observational studies (prospective and retrospective) with the searches for randomised clinical trials. They included a limited number of participants in whom laparoscopic and open liver resection was compared. Since these studies were non-randomised observational studies, the results for any adverse events are not included in the review as the risk of bias in such studies is high. AUTHORS' CONCLUSIONS No conclusions can be made at this time as no randomised clinical trials are available. In addition to the two ongoing randomised clinical trials for which results are expected to be published in the near future, well-designed, prospective, randomised clinical trials are needed in order to evaluate the benefits and harms of the laparoscopic procedure versus open liver resection.
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Affiliation(s)
- Ahsan M Rao
- Department of Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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Shimada Y, Takahashi Y, Iguchi H, Yamazaki H, Tsunoda H, Watanabe M, Oda M, Yokomori H. A hepatic sclerosed hemangioma with significant morphological change over a period of 10 years: a case report. J Med Case Rep 2013; 7:139. [PMID: 23714181 PMCID: PMC3750244 DOI: 10.1186/1752-1947-7-139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/25/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Liver cavernous hemangioma is the most common noncystic hepatic lesion, and a hemangioma that undergoes degeneration and fibrous replacement is called a hepatic sclerosed hemangioma. CASE PRESENTATION A 63-year-old Japanese man was admitted for detailed investigation of a liver tumor. Tumor markers carcinoembryonic antigen, alpha-fetoprotein, and CA19-9 levels in the peripheral blood were not elevated at any time. Plain computed tomography showed an approximately 1.5 cm low density mass in the periphery of segment 8, which was marginally enhanced on contrast-enhanced dynamic computed tomography. On magnetic resonance imaging, the tumor was hypointense on T1-weighted image and hyperintense on T2-weighted image. The tumor was suspected to be an atypical hemangioma, metastatic, hepatocellular carcinoma, or cholangiocellular carcinoma. Segmental hepatectomy was performed. Histological examination of the resected tumor specimen revealed a sclerosed hemangioma with marked hyalinization and sparse stromal fibrosis. Immunochemically, the tumor cells were positive for CD34 and alpha smooth muscle actin. Electron microscopically, the residual hemangioma consisted of numerous caveolae and vesicles in endothelial cells in irregular shapes and sizes. Immunostaining for caveolin-1 showed decreased or no caveolin-1 reactivity in the hyalinized lesions of the sclerosed hemangioma, but abundant caveolin-1 reactivity in the residual cavernous hemangioma. Of interest, computed tomography images of the tumor obtained 10 years earlier at our hospital depicted a 3 cm typical cavernous hemangioma. CONCLUSIONS Hepatic sclerosed hemangioma is a rare condition. Comparison of radiological findings of the lesion over a period of 10 years was valuable in providing insight for the evolutional process from liver cavernous hemangioma to hepatic sclerosed hemangioma.
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Sonographic characterization of 271 hepatic hemangiomas with typical appearance on CT imaging. J Med Ultrason (2001) 2012; 39:61-8. [PMID: 27278845 DOI: 10.1007/s10396-011-0339-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 10/31/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE Hepatic hemangioma is the most frequent benign solid tumor that requires differentiation from hepatic malignancy on ultrasonography. Useful ultrasound findings are therefore required for diagnosis. SUBJECTS AND METHODS The following factors were investigated for 271 masses diagnosed as hepatic hemangioma by contrast-enhanced computed tomography (CT) in 188 patients: hepatic subsegment location, shape, maximum diameter, internal echo level, hyperechoic rim, posterior echoes, marginal hypoechoic band (halo), lateral shadow, blood flow signal in the central portion of the mass, and underlying liver disease. RESULTS Hepatic masses were classified by internal echo pattern as homogeneous hyperechoic (35.0%), homogeneous hypoechoic (22.9%), isoechoic (5.2%), mixed hyperechoic (22.1%), or mixed hypoechoic (14.8%) masses. Twelve masses were isoechoic, and could be recognized by the hyperechoic rim. Posterior echo enhancement was present in 66 masses. There were no cases of posterior echo attenuation. A halo was present in six masses, with the underlying condition being fatty infiltrated liver in two masses; a hypoechoic region with a small amount of fat deposit was present around the mass, and this resembled a halo. This finding was termed a "pseudohalo." There were no masses in which a lateral shadow was observed. In terms of blood flow signals in the central portion of the mass, pulsatile flow was present in only one mass. CONCLUSIONS Important ultrasonographic findings of hepatic hemangioma are characterized as the absence of lateral shadow (100%) and no attenuation of posterior echoes (100%), while the presence of a hyperechoic rim is useful for detecting isoechoic hemangioma.
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Kamphues C, Engel S, Denecke T, Bova R, Hippler-Benscheidt M, Puhl G, Neuhaus P, Seehofer D. Safety of liver resection and effect on quality of life in patients with benign hepatic disease: single center experience. BMC Surg 2011; 11:16. [PMID: 21791063 PMCID: PMC3163509 DOI: 10.1186/1471-2482-11-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 07/26/2011] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although liver resection has long been established for selected patients with benign hepatic disease, the success of surgical treatment of these patients cannot be evaluated exclusively through postoperative morbidity and mortality. Therefore, the aim of the study was to prove the safety of liver resection in the treatment of benign liver tumors and to evaluate the effect of surgical treatment on the patients' quality of life. METHODS A total of 146 patients who underwent liver resection because of benign liver tumors were included in this study. Postoperative outcome was assessed and patients evaluated their quality of life before surgery and at the present time using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (QLQ C-30). RESULTS The rate of serious (> grade 2) complications was 4.1% with no postoperative death. The quality of life assessment revealed an overall improvement of general health status after resection (0.7 vs. 0.56, p < 0.001) and additionally a significant reduction of 6 out of 9 symptoms. Furthermore, compelling benefits in the patients' social and emotional coping could be detected after surgery. CONCLUSIONS Liver resection for benign liver disease is a safe procedure and leads to a significant improvement of quality of life in selected patients.
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Affiliation(s)
- Carsten Kamphues
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Sabine Engel
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Timm Denecke
- Department of Radiology, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Roberta Bova
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Michael Hippler-Benscheidt
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Gero Puhl
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Peter Neuhaus
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
| | - Daniel Seehofer
- Department of General, Visceral and Transplantation Surgery, Universitätsklinikum Charité, Campus Virchow Klinikum, Humboldt-Universität, D-13353 Berlin, Germany
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14
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Association of hepatic hemangiomatosis with giant cavernous hemangioma in the adult population: prevalence, imaging appearance, and relevance. AJR Am J Roentgenol 2011; 196:809-15. [PMID: 21427329 DOI: 10.2214/ajr.09.4143] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of our study was to evaluate the association of hepatic hemangiomatosis with giant cavernous hemangioma (GCH) and describe the imaging appearances and clinical relevance. MATERIALS AND METHODS Forty-one patients who had undergone CT or MRI with reported GCH (> 8 cm) between 1997 and 2009 were identified retrospectively. Three readers interpreted 27 MRI studies, 36 CT studies, and 16 ultrasound studies of these patients. Prevalence, extent, and imaging appearance of coexistent hemangiomatosis in the surrounding liver parenchyma were evaluated. RESULTS Forty-two GCHs were identified in 41 patients and hemangiomatosis was present in 18 of 41 patients (44%) with GCH. Twelve patients had a diffuse pattern of hemangiomatosis (67%), and six patients showed a nodular pattern consisting of multiple coalescent nodules measuring < 5 mm (33%). There was no association between the size of the GCH and presence and extent of hemangiomatosis. The common hepatic artery was enlarged (> 5 mm) in 14 patients with GCH, of whom 12 had associated hemangiomatosis. There was a statistically significant association between the size of the hepatic artery and presence of hemangiomatosis (p < 0.001). CONCLUSION Hemangiomatosis is not rare in the liver parenchyma adjacent to a GCH. The presence and extent of hemangiomatosis must be specifically communicated to referring physicians. Surgical candidates have to be carefully selected to avoid complications, such as excessive blood loss and diminished risk of postoperative liver decompensation from apparent overestimation of functional residual volume due to oversight of involved liver areas by hemangiomatosis.
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15
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Choi J, Lee YJ, Hwang DW, Chon SH, Nagpal A, Park KM. Surgical Treatment of Giant Hepatic Hemangiomas: Technical Point of View. Am Surg 2011. [DOI: 10.1177/000313481107700120] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Hepatic hemangiomas are the most common benign tumors of the liver. Surgical treatment can be difficult as a result of the high risk of intraoperative hemorrhage. The present study reviewed clinical features of patients with hepatic hemangioma and surgical techniques used in their treatment. Eight patients with giant hepatic hemangiomas underwent hepatectomies at the Asan Medial Center between January 2006 and March 2009. Patient demographic, clinical, and surgical characteristics and outcomes were reviewed retrospectively. Seven females and one male patient underwent hepatectomies during the study period. The median age was 48.5 years (range, 33 to 58 years). Indications for surgical interventions were abdominal pain (62.5%), an abdominal mass (37.5%), Kasabach-Merritt syndrome (25%), and increased hemangioma size (25%). The hemangiomas were usually multiple (87.5%) and bilobar (75%) and had a median size of 14.5 cm (range, 7 to 29 cm). All patients underwent major hepatic resection with early vascular control using the Glissonean pedicle transection method (GPTM), the liver hanging maneuver (LHM), and preparation for total vascular exclusion (TVE). There was no major morbidity or mortality. The minor morbidity rate was 25 per cent with transfusion rate of 37.5 per cent. Early vascular control using the GPTM, the LHM, and preparation for TVE is essential for safe resection of large hepatic hemangiomas.
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Affiliation(s)
- Julian Choi
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Young-Joo Lee
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Dae Wook Hwang
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Sang-Hoon Chon
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
| | - Anish Nagpal
- Department of Surgery, Haribhakti Surgical Hospital, Ahmedabad, India
| | - Kwang-Min Park
- Division of Hepato-Biliary & Pancreas Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Korea
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16
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Giuliante F, Ardito F, Vellone M, Giordano M, Ranucci G, Piccoli M, Giovannini I, Chiarla C, Nuzzo G. Reappraisal of surgical indications and approach for liver hemangioma: single-center experience on 74 patients. Am J Surg 2010; 201:741-8. [PMID: 20937504 DOI: 10.1016/j.amjsurg.2010.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 03/03/2010] [Accepted: 03/25/2010] [Indexed: 01/02/2023]
Abstract
BACKGROUND Liver hemangiomas are rarely large, symptomatic, or presenting atypical imaging patterns. Surgery is rarely needed; indications and choice of the best technique remain not precisely defined. METHODS Features of hemangiomas and surgical indications were assessed in 74 patients (mean follow-up 63.2 months). In 40 operated patients, the results of liver resection versus enucleation were compared. RESULTS Most hemangiomas (60/74, 81.1%) showed no size increment. In 40 operated patients (40/74, 54.1%) the mean tumor size (11.9 cm, range 2.6-46.0) was larger than in nonoperated patients (11.9 vs 6.0 cm, P = .0002). Surgical indications were specific symptoms, tumor enlargement, Kasabach-Merritt syndrome, and uncertain diagnosis. Mortality (nil), morbidity (10.0%), and transfusion rate (15.0%) were similar for 28 liver resections versus 12 enucleations; bleeding was more related to large hemangioma size than to the choice of either technique. Liver ischemia techniques, autotransfusion, and intraoperative blood salvage reduced the risk of transfusion. CONCLUSIONS Surgery is rarely indicated, has a low risk, and has similar results for liver resection versus enucleation. Risk of bleeding is related more to the large size of the hemangioma than to the type of surgery (resection or enucleation). In these patients, management, the need for surgery, and the choice of technique should be carefully individualized.
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Affiliation(s)
- Felice Giuliante
- Department of Surgical Sciences, Hepatobiliary Surgery Unit, Catholic University of the Sacred Heart School of Medicine, Largo Agostino Gemelli 8, I-00168 Rome, Italy.
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17
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Sclerosing haemangiomas of the liver: two cases of mistaken identity. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2009; 2009:473591. [PMID: 20066166 PMCID: PMC2804040 DOI: 10.1155/2009/473591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 08/26/2009] [Accepted: 11/09/2009] [Indexed: 11/26/2022]
Abstract
We describe two cases where patients undergoing hepatic resection for metastatic disease of colorectal origin were found to have concomitant sclerosing haemangiomas. The typical radiological and histological appearances of these lesions are discussed.
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18
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Gutweiler JR, Yu DC, Kim HB, Kozakewich HP, Marcus KJ, Shamberger RC, Weldon CB. Hepatoblastoma presenting with focal nodular hyperplasia after treatment of neuroblastoma. J Pediatr Surg 2008; 43:2297-300. [PMID: 19040959 DOI: 10.1016/j.jpedsurg.2008.08.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2008] [Revised: 08/27/2008] [Accepted: 08/27/2008] [Indexed: 12/17/2022]
Abstract
Focal nodular hyperplasia (FNH) is a benign, poorly understood hepatic tumor that is rare in children. Although there is no evidence for malignant degeneration, FNH can occur adjacent to a malignancy. Here, the case of a 4-year-old boy with a hepatic mass and history of stage IV neuroblastoma is presented. Initial imaging and core-needle biopsy were consistent with FNH. However, after left lateral segmentectomy, pathologic examination revealed a malignant tumor most consistent with small cell undifferentiated hepatoblastoma as well as 3 foci of FNH in the surrounding parenchyma.
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Affiliation(s)
- Jordan R Gutweiler
- Department of Surgery, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA
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19
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Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular adenoma: initial experience in 10 patients. J Gastroenterol Hepatol 2008; 23:e422-7. [PMID: 17944897 DOI: 10.1111/j.1440-1746.2007.05177.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIM The purpose of this study was to assess the therapeutic efficacy and safety of percutaneous radiofrequency (RF) ablation for hepatocellular adenoma. METHODS We performed percutaneous RF ablation in 10 patients with pathologically proven hepatocellular adenomas. Eight patients were asymptomatic and two patients had a recurrent tumor after surgical resection. The size of the tumors was 2.25 +/- 0.76 cm (range: 1.5-4.5 cm) in the largest diameter. All ablation procedures were percutaneously performed with an internally cooled RF electrode system under ultrasound (US) guidance. We evaluated the therapeutic efficacy and safety of the procedure by clinical follow-up data with regular follow-up computed tomography (CT) for 2-35 months (mean, 17.5 months). RESULTS All patients well tolerated percutaneous RF ablation procedure without any incident. Contrast-enhanced CT (n = 7) or contrast-enhanced US (n = 3) obtained immediately (<24 h) after the procedure revealed complete ablation of the tumor in all cases. There was no case of local tumor progression or new recurrence during the follow-up period. We found neither procedure-related mortality nor major complication requiring specific treatment. CONCLUSION Percutaneous RF ablation of hepatocellular adenoma without overt complication can be a new potential alternative to close imaging follow-up or elective surgery.
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Affiliation(s)
- Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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20
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Scaife C. Liver. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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21
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Romano F, Messinesi G, Tana F, Uggeri F. Recurrent giant hemangioma causing severe respiratory distress. Dig Dis Sci 2007; 52:3526-9. [PMID: 17404885 DOI: 10.1007/s10620-006-9427-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Accepted: 05/01/2006] [Indexed: 01/15/2023]
Abstract
Hemangioma is a common benign tumor of the liver that is usually asymptomatic. If >4 cm (giant hemangioma), it could present symptoms related to bleeding, thrombosis, consumptive coagulopathy, or adjacent abdominal organ compression. If symptomatic surgical treatment should be considered, liver resection as well as enucleation are considered. Recurrences after surgical resection are rare. We herein present a case of woman admitted to the emergency room for acute severe respiratory distress. She had undergone 2 surgical resections of liver hemangiomas. The respiratory syndrome, as showed by chest x-ray, computed tomography scan, and nuclear magnetic resonance imaging, was related to a recurrent giant multiple hemangioma, creating a prominent compression of right lung with left mediastinal shift and left heart dislocation. It resulted in pulmonary parenchymal compression associated with reduced chest wall compliance and increased pulmonary pressure. The patient was not eligible for surgical treatment because of the disease extension and her clinical conditions. She died 6 months later from respiratory insufficiency and hypercapnic coma.
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Affiliation(s)
- Fabrizio Romano
- Department of Surgery, San Gerardo Hospital, II University of Milan, Bicocca, via Donizetti 106, 20052 Monza, Italy.
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22
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Machado MM, Rosa ACF, Lemes MS, Mota OMD, Silva OQD, Campoli PMDO, Santana Filho JB, Barreto PA, Nunes RA, Barreto MC, Milhomem PM, Milhomem LM, Oliveira GBD, Oliveira FBD, Castro FCFD, Brito AMD, Barros ND, Cerri GG. Hemangiomas hepáticos: aspectos ultra-sonográficos e clínicos. Radiol Bras 2006. [DOI: 10.1590/s0100-39842006000600013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Os hemangiomas são os tumores hepáticos benignos mais comuns, ocorrem em todos os grupos etários, sendo mais comuns nos adultos. Na grande maioria dos casos os hemangiomas são pequenos, assintomáticos e descobertos incidentalmente. Lesões maiores eventualmente podem produzir sintomas. O aspecto ultra-sonográfico desses tumores varia, sendo que o aspecto usual é o de lesão pequena hiperecogênica bem definida. Neste artigo, os autores fazem uma revisão sobre aspectos clínicos e ultra-sonográficos dos hemangiomas, ressaltando a importância desses aspectos na condução clínica dos pacientes acometidos.
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Hamaloglu E, Altun H, Ozdemir A, Ozenc A. Giant liver hemangioma: therapy by enucleation or liver resection. World J Surg 2005; 29:890-3. [PMID: 15951941 DOI: 10.1007/s00268-005-7661-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hemangioma is the most common primary tumor of the liver. The widespread use of ultrasonography (USG) and computed tomography (CT) has made the diagnosis more common. Although the vast majority of hemangiomas are diagnosed incidentally and are asymptomatic, treatment is still controversial. Surgery is the treatment of choice, especially in giant, symptomatic hemangiomas and uncertainty of diagnosis. Twenty-two patients (median age: 46 years) underwent resection (n = 12) or enucleation (n = 10) for liver hemangioma from 1989 to 2002. The primary indication for surgery was abdominal pain. Ten patients who were treated by enucleation were compared with twelve patients who were treated by liver resection. Mean tumor size was 90 mm with a range of 40-270 mm. There were no statistically significant differences in tumor size, preoperative liver function tests, hemoglobin levels, and platelet counts between the two groups. Operative time was longer in the resection group, and statistically significant the difference was (p = 0.048). Blood transfusion requirement and blood loss during intraoperative period were higher in the resection group (p = 0.025, p = 0.01, respectively). There were three postoperative complications, 1 in the enucleation group (pleural effusion), 2 in the resection group (liver abscess and wound infection). There was no surgery-related mortality in either group. Although most hemangiomas can be removed by enucleation or liver resection with low morbidity and mortality, if the location and number of hemangiomas are appropriate, enucleation is the choice of the therapy. Hospital stay, blood transfusion requirement, and blood loss can be kept minimal by the selection of enucleation.
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Affiliation(s)
- Erhan Hamaloglu
- Department of General Surgery, Hacettepe University Faculty of Medicine, Basinevleri, Yankilar Sok, Ankara, Turkey
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24
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Atwell TD, Brandhagen DJ, Charboneau JW, Nagorney DM, Callstrom MR, Farrell MA. Successful Treatment of Hepatocellular Adenoma with Percutaneous Radiofrequency Ablation. AJR Am J Roentgenol 2005; 184:828-31. [PMID: 15728604 DOI: 10.2214/ajr.184.3.01840828] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of our study was to report the safe and successful treatment of hepatocellular adenoma with percutaneous radiofrequency ablation. CONCLUSION Our limited experience indicates that percutaneous radiofrequency ablation is both safe and effective in the treatment of the small hepatocellular adenoma in carefully selected patients.
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Affiliation(s)
- Thomas D Atwell
- Department of Diagnostic Radiology, Mayo Clinic College of Medicine, 200 1 St. SW, Rochester, MN 55905, USA
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25
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Okada T, Sasaki F, Kamiyama T, Nakagawa T, Nakanishi K, Kobayashi R, Itoh T, Ota S, Todo S. Focal nodular hyperplasia of the liver: usefulness of superparamagnetic iron oxide-enhanced magnetic resonance imaging. J Pediatr Surg 2005; 40:E21-5. [PMID: 15793708 DOI: 10.1016/j.jpedsurg.2004.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This report describes the use of superparamagnetic iron oxide-enhanced magnetic resonance imaging to diagnose fibronodular hyperplasia of the liver in a 12-year-old girl.
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Affiliation(s)
- Tadao Okada
- Department of Pediatric Surgery, 1st Surgery, Pediatrics, Pathology, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan.
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26
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Kim J, Ahmad SA, Lowy AM, Buell JF, Pennington LJ, Moulton JS, Matthews JB, Hanto DW. An algorithm for the accurate identification of benign liver lesions. Am J Surg 2004; 187:274-9. [PMID: 14769319 DOI: 10.1016/j.amjsurg.2003.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Revised: 06/16/2003] [Indexed: 01/29/2023]
Abstract
BACKGROUND Benign liver lesions may be difficult to characterize preoperatively. In most instances, determination of the etiology of a hepatic mass makes its management decisions clear-cut. We present our experience using an algorithm for the management of liver masses of suspected benign or uncertain pathology and highlight this approach along with our surgical experience in benign liver lesions. METHODS Seventy-one patients underwent hepatectomy with a preoperative diagnosis of benign disease or unknown etiology from December 1992 to February 2002. Patients were preoperatively assessed with computed tomography, along with other imaging studies, as indicated. Final pathology was reviewed to confirm the preoperative diagnosis. RESULTS Ninety-two percent (65 of 71) were correctly characterized preoperatively. Diagnosis was inaccurate in 6 patients. Of these patients, final pathology revealed focal nodular hyperplasia in 4 patients. The remaining 2 patients, who had adenoma, were found to harbor malignancy within the surgical specimens. CONCLUSIONS An algorithm to manage liver lesions resulted in a high diagnostic accuracy of a preoperative evaluation. Hepatic resection for benign disease can be performed with low morbidity and mortality and is highly successful in achieving relief for symptomatic patients.
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Affiliation(s)
- Joseph Kim
- Department of Surgery, Division of Surgical Oncology, University of Cincinnati College of Medicine, OH 45219, USA
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27
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Abstract
Os hemangiomas hepáticos representam tumores hepáticos benignos, que, se corretamente identificados, não necessitariam de remoção cirúrgica na grande maioria dos casos. Usualmente apresentam-se, à ultra-sonografia (US), como lesões hiperecogênicas, entretanto, lesões com aspectos menos usuais, como as hipoecogênicas, também são descritas. Os autores avaliaram, prospectivamente, 15 casos de hemangiomas hipoecogênicos identificados num período de cerca de quatro anos. Como estes hemangiomas são atípicos em suas aparências ultra-sonográficas, o diagnóstico definitivo foi estabelecido pela análise, em conjunto, dos dados dos exames de US e tomografia computadorizada (TC) helicoidal. À TC helicoidal, todas as lesões apresentaram o aspecto característico de realce centrípeto pelo meio de contraste iodado endovenoso. Adicionalmente, em todos os pacientes foram realizadas dosagens de antígeno carcinoembrionário e alfa-fetoproteína, além de endoscopia digestiva alta e colonoscopia (ou enema opaco com duplo contraste), não tendo sido identificada qualquer alteração nestes exames. Ademais, todos os pacientes foram avaliados com US e TC-helicoidal de controle, oito meses a um ano após o exame inicial, sem qualquer alteração no aspecto e nas dimensões das lesões. De interesse foi notado que, dos 15 casos de hemangiomas hipoecogênicos, 14 foram identificados em fígados esteatóticos. Os autores concluem que, embora atípico ao ultra-som, os hemangiomas podem se apresentar hipoecogênicos. Isto ocorreria especialmente em fígados com esteatose, sendo que apenas ocasionalmente seriam identificados em fígados sem esteatose. Nestes casos atípicos à US, seria útil a realização de exames complementares de imagem e bioquímicos, além de exames de controle, para maior conforto no seu diagnóstico preciso.
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28
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Hsu CY, Chu CH, Lin SC, Yang FS, Yang TL, Chang KM. Concomitant hepatocellular adenoma and adenomatous hyperplasia in a patient without cirrhosis. World J Gastroenterol 2003; 9:627-30. [PMID: 12632534 PMCID: PMC4621598 DOI: 10.3748/wjg.v9.i3.627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Hepatocelluar adenoma (HCA) and adenomatous hyperplasia (AH) are rare benign tumors of the liver. HCA is usually found in women who use oral contraceptives. AH usually occurs in patients with liver cirrhosis. Both tumors have potential for malignant transformation.
METHODS: We described a male adult with chronic liver disease (CLD) who had been known to be a hepatitis B carrier (HBV) for years. He was found to have a space-occupying lesion with a suspicion of hepatocellular carcinoma (HCC) by abdominal ultrasonography. His α-fetoprotein (AFP) was normal. Angiographic findings were consistent with the diagnosis of HCC, he wished to avoid an operation, was treated with transcatheter hepatic arterial embolization.
RESULTS: He subsequently consented to surgery, and a right lobectomy was performed. The liver pathology disclosed HCA with nuclear dysplasia and post-embolization effects. In addition, there were multiple small foci of AH with nuclear dysplasia in the resected liver. Although he had some focal areas of cirrhosis-like change or post-embolization effect, the AH was associated only with normal liver tissue.
CONCLUSION: This case confirms that HCA and AH may resemble HCC on imaging studies, and that AH may occur in CLD in the absence of cirrhotic change.
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Affiliation(s)
- Chuan-Yuan Hsu
- Department of Hepatology and Gastroenterology, Mackay Memorial Hospital, No. 92, Chung-Shan N. Road 2 Section, 104 Chung-Shan Area, Taipei, Taiwan, China.
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29
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Porayko MK, Choudhary C. Benign Neoplasms of the Liver. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2001; 4:479-491. [PMID: 11696274 DOI: 10.1007/s11938-001-0013-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Tumors of the liver often are discovered incidentally in asymptomatic individuals during diagnostic imaging or exploratory laparotomy performed for alternative reasons. Hemangiomas are the most common benign liver tumors, followed in prevalence by focal nodular hyperplasia (FNH); other benign tumors are rare. The growth and development of hemangiomas, FNH, and hepatic adenomas especially, have been linked to hormonal (eg, estrogen) stimulation. Differentiating between benign and malignant neoplasms of the liver can be challenging. Radiologic imaging is essential for preliminary identification and classification of hepatic tumors, but tissue biopsy or surgical excision sometimes is required for a definitive diagnosis. Individuals with hemangioma or FNH usually are asymptomatic, have a benign course, and can be managed conservatively. In contrast, hepatic adenomas need to be followed more carefully and often are excised to provide symptomatic relief, remove the risk of rupture, and avoid potential malignant transformation. Liver transplantation in patients with benign hepatic neoplasms is exceedingly uncommon, and is recommended only when alternative methods of treatment are not feasible or have failed to control significant symptoms.
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Affiliation(s)
- Michael K. Porayko
- Liver Division, Department of Medicine, Thomas Jefferson University, 132 South 10th Street, Suite 4, Thompson Building, Philadelphia, PA 19107, USA.
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30
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Gorenberg M, Sopov W, Groshar D. Growing hepatic cavernous hemangioma demonstrated by Tc-99m red blood cell scintigraphy. Clin Nucl Med 2000; 25:511-3. [PMID: 10885690 DOI: 10.1097/00003072-200007000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hepatic cavernous hemangiomas rarely grow. Although a few cases have been reported in the literature, none used Tc-99m red blood cell scintigraphy. The authors describe such a case here.
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Affiliation(s)
- M Gorenberg
- Department of Nuclear Medicine, Rebecca Sieff Government Hospital, Safed and Bnai Zion Medical Center, and the Faculty of Medicine, Technion-Israel, Institute of Technology, Haifa, Israel
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31
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Abstract
The most frequent benign tumours of the liver include haemangioma, liver cell adenoma and focal nodular hyperplasia. Patients may undergo hepatic resection because of a preoperative diagnosis of malignancy or uncertainty in diagnosis despite an extensive work-up.
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Affiliation(s)
- M F Chen
- Department of Surgery, Chang Gung University, Chang Gung Memorial Hospital, Taipei, Taiwan.
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32
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Chicano Marín F, Torroba Carón A, Aranda García M, Ruiz Jiménez J, Giménez Abadía M. Hiperplasia nodular focal hepática. A propósito de un caso. An Pediatr (Barc) 2000. [DOI: 10.1016/s1695-4033(00)77339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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33
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Arnoletti JP, Brodsky J. Surgical Treatment of Benign Hepatic Mass Lesions. Am Surg 1999. [DOI: 10.1177/000313489906500510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Benign hepatic mass lesions may require surgical treatment for symptomatic relief or prevention of hemorrhage. The most common benign hepatic mass lesions in the United States are hemangioma, focal nodular hyperplasia, hepatic adenoma, and congenital liver cyst. We report a series of liver resections performed for benign hepatic masses at our institution. All liver resections were performed with total inflow occlusion during the parenchymal transection time. None of our patients received perioperative blood products. No postoperative complications occurred, and the average length of hospital stay was 6 days. Surgeons performing hepatic resections for benign mass lesions should be able to complete these procedures with low operative blood loss and low operative morbidity.
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Affiliation(s)
- Juan P. Arnoletti
- Department of Surgery, Allegheny University Hospitals–Hahnemann Division, Philadelphia, Pennsylvania
| | - Jeffrey Brodsky
- Department of Surgery, Allegheny University Hospitals–Hahnemann Division, Philadelphia, Pennsylvania
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Nishigaki Y, Tomita E, Matsuno Y, Goto K, Ohnishi T, Tanaka Y, Iwai H, Asano H, Yasuda I, Nagura K, Wakahara T, Yamada T. Usefulness of novel imaging modalities in diagnosis of focal nodular hyperplasia of the liver. J Gastroenterol 1997; 32:677-83. [PMID: 9349997 DOI: 10.1007/bf02934121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 17-year-old woman was admitted because of a liver tumor found incidentally by ultrasonography. Liver function was normal and there were no markers of hepatitis viruses or malignancy. Abdominal ultrasonography, computed tomography (CT), and magnetic resonance imaging revealed a mass (2 cm in diameter) in the lateral segment of the left lobe of the liver. The lesion was not detected by hepatic arteriography. However, dynamic CT with fast scanning and dynamic CO2-enhanced ultrasonography demonstrated initial central enhancement of the mass followed by centrifugal spread of enhancement to the periphery. Color Doppler flow imaging detected a central color spot, shown to be an artery by a pulsed Doppler spectrum analysis. Fine-needle biopsy confirmed a diagnosis of focal nodular hyperplasia. Dynamic CT with fast scanning, dynamic CO2-enhanced ultrasonography, and color Doppler flow imaging were useful in detecting the vascular pattern specific to focal nodular hyperplasia. Investigation of further cases with these novel imaging modalities should help to establish a comprehensive diagnostic procedure and thus avoid unnecessary surgery for focal nodular hyperplasia, which is a completely benign lesion.
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Affiliation(s)
- Y Nishigaki
- Department of Gastroenterology, Gifu Municipal Hospital, Japan
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36
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Abstract
There is uncertainty regarding the role, if any, of oral contraceptive steroids in the development of focal nodular hyperplasia of the liver. A case of focal nodular hyperplasia of the liver diagnosed by scintigraphy in a 33-year-old woman is presented. The lesion regressed in a dramatic way after oral contraceptive discontinuation. This case report suggests that oral contraceptives may influence the natural history of focal nodular hyperplasia of the liver, and that a trophic effect on the liver lesion is quite possible.
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Affiliation(s)
- C Côté
- Department of Nuclear Medicine, C. H. Beauce-Etchemin, Beauceville, Quebec, Canada
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37
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Cherqui D, Rahmouni A, Charlotte F, Boulahdour H, Métreau JM, Meignan M, Fagniez PL, Zafrani ES, Mathieu D, Dhumeaux D. Management of focal nodular hyperplasia and hepatocellular adenoma in young women: a series of 41 patients with clinical, radiological, and pathological correlations. Hepatology 1995. [PMID: 7489973 DOI: 10.1002/hep.1840220610] [Citation(s) in RCA: 232] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Preoperative distinction between focal nodular hyperplasia (FNH) that should be managed conservatively and hepatocellular adenoma (HA) that should be resected remains difficult. The result is controversial management of these patients. The aims of this study were to report the value of modern imaging procedures for noninvasive diagnosis of these lesions, to assess the value of intraoperative frozen section studies, and to propose a management strategy in those patients. Forty-one consecutive women with FNH (35 cases) or HA (6 cases) treated at our institution between 1985 and 1992 were studied. New imaging techniques, including enhanced magnetic resonance imaging (MRI) and color Doppler ultrasonography (US), were prospectively appraised in addition to usual techniques. Histological examination of surgical specimens was obtained in all cases. A sixfold increase in the number of patients with FNH was observed during this study, whereas the number of patients with HA did not change. FNHs were incidental US findings in 74% of the cases. The best imaging procedure in the diagnosis of FNH was enhanced MRI with a sensitivity of 70% and a specificity of 98%. Color Doppler US was a useful adjunct. Intraoperative frozen section studies were performed in 16 patients with 19 tumors with a sensitivity of 89% and a specificity of 100%.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- D Cherqui
- Department of Surgery, Hôpital Henri Mondor, Université Paris XII, Créteil, France
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39
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Reymond D, Plaschkes J, Lüthy AR, Leibundgut K, Hirt A, Wagner HP. Focal nodular hyperplasia of the liver in children: review of follow-up and outcome. J Pediatr Surg 1995; 30:1590-3. [PMID: 8583330 DOI: 10.1016/0022-3468(95)90162-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The authors used a conservative approach to treat focal nodular hyperplasia of the liver (FNH) and were interested in the long-term results of different therapeutic approaches in order to establish the most appropriate treatment. A review of the literature was conducted, and 31 pediatric case reports were identified in which follow-up and outcome data were noted. Tumor resection was performed in 18 cases (58%), operative biopsy alone in nine (29%), vascular ligation in two, and embolization of hepatic arteries in two. The outcome appears to be good for both groups of patients, ie, those with observation alone and those with resection. More information is to be collected regarding the new procedures (embolization and ligation). This is a retrospective analysis, and data from future international prospective studies are needed.
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Affiliation(s)
- D Reymond
- Department of Pediatrics, University Hospitals, Bern, Switzerland
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40
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Abstract
Focal nodular hyperplasia (FNH) and hepatocellular adenoma (HA) are uncommon benign hepatic tumors that continue to pose diagnostic and therapeutic challenges. An update of a recent Mayo Clinic experience is presented to highlight the management of patients harboring these neoplasms. A marked female predominance was seen. Incidental diagnosis was more prevalent with FNH, whereas symptomatic presentation was typical of HA. The frequency of oral contraceptive steroid use was similar regardless of tumor histology. Preoperative diagnosis remains difficult. Scintigraphy proved most specific, and ultrasonography and computed tomography were equally sensitive. Resection was employed in most patients. There was no mortality and minimal morbidity. Selective observation of FNH was uneventful, but resolution of HA after abstinence of oral contraceptive steroids was uncommon. These findings and data from the literature support selective management of benign liver tumors.
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Affiliation(s)
- D M Nagorney
- Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA
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41
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Schwartz JH, Ellison EC. Focal liver lesions. Postgrad Med 1994; 95:157-174. [PMID: 29219688 DOI: 10.1080/00325481.1994.11945789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Preview Solid focal lesions of the liver can present numerous diagnostic challenges, and once diagnosis is made, careful decision making is needed to assure cost-effective management. In this article, the authors consider five solid lesions: hemangioma, focal nodular hyperplasia, liver cell adenoma, primary hepatocellular carcinoma, and metastatic cancer. Cystic lesions are assessed in a companion article on page 149.
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42
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Manning MM, Murray KD, Townsend MC. The laparoscopic diagnosis and treatment of cavernous hemangioma hemorrhage following blunt trauma. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1993; 3:399-403. [PMID: 8268514 DOI: 10.1089/lps.1993.3.399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Cavernous hemangiomas are the most common benign tumor of the liver. A patient presented several hours after sustaining blunt trauma to the abdomen. A CT scan of the abdomen demonstrated blood in the peritoneal space and several cavernous hemangiomas of the liver. Laparoscopy confirmed the liver lesions as the source of bleeding, although there was no active blood loss. All intraabdominal blood was aspirated and the patient made an uneventful recovery without further blood loss. Laparoscopy allowed inspection of the abdomen which revealed cessation of intraabdominal hemorrhage from the cavernous hemangiomas. He made a successful recovery without further testing or operative intervention.
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Procacci C, Fugazzola C, Cinquino M, Mangiante G, Zonta L, Andreis IA, Nicoli N, Pistolesi GF. Contribution of CT to characterization of focal nodular hyperplasia of the liver. GASTROINTESTINAL RADIOLOGY 1992; 17:63-73. [PMID: 1312050 DOI: 10.1007/bf01888511] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Our personal series of 20 cases of focal nodular hyperplasia (FNH) of the liver is presented. All lesions were studied with computed tomography (CT), 16 of which with surgical control. Retrospective evaluation of the CT features of the identified FNH, along with those of five hepatocellular adenomas (HCA) and 30 hepatocellular carcinomas (HCC), allowed the definition of specific patterns leading to a correct characterization of FNH in 78% of cases. This greatly reduced the diagnostic errors, with the sole exception of patients with fatty liver in whom nuclear medicine may eventually provide a correct characterization. Fine-needle biopsy is thus only necessary in the dubious cases. A precise diagnostic workup of FNH is necessary, since it may avoid the surgical intervention.
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Affiliation(s)
- C Procacci
- Department of Radiology, University Hospital, Verona, Italy
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Fried RH, Wardzala A, Willson RA, Sinanan MN, Marchioro TL, Haggitt R. Benign cartilaginous tumor (chondroma) of the liver. Gastroenterology 1992; 103:678-80. [PMID: 1634084 DOI: 10.1016/0016-5085(92)90865-v] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 44-year-old woman with a large benign cartilaginous tumor (chondroma) of the liver is presented. After being followed up by computed tomography for 6 years and with imagining evidence for a recent increase in its size, this asymptomatic tumor was successfully removed at surgery. The resected tumor proved to be chondroma, a benign cartilaginous tumor. A review of the literature showed no previous reports of this type of hepatic neoplasm.
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Affiliation(s)
- R H Fried
- Department of Medicine, University of Washington, Seattle
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45
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Abstract
Although cavernous hemangioma is the most common benign tumor of the liver, controversy persists regarding diagnosis and management of these lesions. With the development of multiple noninvasive modalities to visualize the liver, hepatic cavernous hemangiomas are recognized with increased frequency. The authors report the unusual case of a post-menopausal woman on no exogenous estrogen therapy who had a cavernous hemangioma that remained stable for approximately 10 years before dramatically increasing in size. This patient illustrates the vague symptoms associated with cavernous hemangiomas and the unpredictability of growth. Although estrogens have been reported trophic, this patient had no exogenous or endogenous estrogen supply, yet her lesion reached massive proportions. Modalities necessary to assure accurate diagnosis and factors influential in management are discussed.
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Affiliation(s)
- C T DuPre
- Medical College of Georgia School of Medicine, Department of Medicine, Augusta 30912
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46
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Abstract
We discussed the proper management of patients with asymptomatic lesions incidentally found during laparotomy for other problems. For common or important lesions, information about the natural history, significance, treatment guidelines, and possible risks or complications related to operations on such incidentalomas were given. Thus, we discussed gallstones, masses of the upper and lower gastrointestinal tract, and masses in solid organs, such as liver, ovaries, and pancreas.
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Affiliation(s)
- M C Soteriou
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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47
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Pain JA, Gimson AE, Williams R, Howard ER. Focal nodular hyperplasia of the liver: results of treatment and options in management. Gut 1991; 32:524-7. [PMID: 2040476 PMCID: PMC1378930 DOI: 10.1136/gut.32.5.524] [Citation(s) in RCA: 88] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Twenty two patients (19 females) with focal nodular hyperplasia were seen between 1973 and 1989. Five were children, and all the adults were aged under 42 years (median 33 years). Fourteen patients (64%) were symptomatic on presentation. Twelve of the 14 adult women had taken the oral contraceptive pill. Twelve patients, nine of whom were symptomatic, underwent hepatic resection shortly after presentation. There were no deaths or major complications, and all remain well on follow up. Four patients underwent either hepatic artery embolisation or ligation. After an interval of six to 10 years they were asymptomatic and only one has histological evidence of residual focal nodular hyperplasia. Of five patients initially treated conservatively, two were asymptomatic and have remained so for three and 13 years. One of the three symptomatic patients became symptom free after stopping the contraceptive pill. The management of focal nodular hyperplasia requires a flexible approach. Lesions which are asymptomatic can be observed with regular ultrasound and treated if they enlarge or become symptomatic. Symptomatic patients who present while taking the contraceptive pill can also have a trial of conservative treatment. Other symptomatic patients, including those who previously took the pill, are best treated by surgical resection, and, where this is not possible, by embolisation.
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Affiliation(s)
- J A Pain
- Department of Surgery, King's College Hospital, London
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