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Zhang H, Xu H, Wen N, Li B, Chen K, Wei Y. Laparoscopic liver resection or enucleation for giant hepatic hemangioma: how to choose? Surg Endosc 2024; 38:3079-3087. [PMID: 38622227 DOI: 10.1007/s00464-024-10820-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Laparoscopic treatment has been increasingly adopted for giant hepatic hemangioma (HH), but the role of liver resection or enucleation remains uncertain. The aim of this study is to compare the laparoscopic resection (LR) with laparoscopic enucleation (LE) for HH, and to provide evidence on how to choose the most suitable approach for HH. METHODS A retrospective analysis of HH patients underwent laparoscopic treatment between March 2015 and August 2022 was performed. Perioperative outcomes were compared based on the surgical approaches, and risk factors for increased blood loss was calculated by logistic regression analysis. RESULTS A total of 127 patients in LR group and 287 patients in LE group were enrolled in this study. The median blood loss (300 vs. 200 mL, P < 0.001) was higher in LE group than that in LR group. Independent risk factors for blood loss higher than 400 mL were tumor size ≥ 10 cm, tumor adjacent to major vessels, tumor occupying right liver or caudate lobe, and the portal phase enhancement ratio (PER) ≥ 38.9%, respectively. Subgroup analysis showed that LR was associated with less blood loss (155 vs. 400 mL, P < 0.001) than LE procedure in patients with high PER value. Both LR and LE approaches exhibited similar perioperative outcomes in patients with low PER value. CONCLUSIONS Laparoscopic treatment for HH could be feasibly and safely performed by both LE and LR. For patients with PER higher than 38.9%, the LR approach is recommended.
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Affiliation(s)
- Haili Zhang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wuhou District, Chengdu, 610041, China
| | - Hongwei Xu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wuhou District, Chengdu, 610041, China
| | - Ningyuan Wen
- Division of Biliary Tract Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bo Li
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wuhou District, Chengdu, 610041, China
| | - Kefei Chen
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wuhou District, Chengdu, 610041, China
| | - Yonggang Wei
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, 37 Guo Xue Road, Wuhou District, Chengdu, 610041, China.
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2
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Thomann S, Metzler T, Tóth M, Schirmacher P, Mogler C. Immunologic landscape of human hepatic hemangiomas and epithelioid hemangioendotheliomas. Hepatol Commun 2024; 8:e0359. [PMID: 38206210 PMCID: PMC10786595 DOI: 10.1097/hc9.0000000000000359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 11/21/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The missing requirement for resection for the majority of hepatic hemangiomas (HH) and tissue scarcity for rare diseases such as hepatic epithelioid hemangioendotheliomas (HEHE) complicate the characterization of the spatial immunovascular niche of these benign and malignant vascular neoplastic diseases. METHODS Two tissue cohorts containing 98 HHs and 13 HEHEs were used to study entity-specific and disease stage-specific endothelial cell (EC) phenotype and immune cell abundance. Using semiquantitative assessment, annotation-based cell classifiers, digital cell detection on whole slides, and tissue microarrays, we quantified 23 immunologic and vascular niche-associated markers and correlated this with clinicopathologic data. RESULTS Both HH and HEHE ECs were characterized by a CD31high, CD34high, FVIII-related antigenhigh expression phenotype with entity-specific expression differences of sinusoidal EC markers Stabilin1, Stabilin2, CD32, and Lymphatic Vessel Endothelial Hyaluronan Receptor 1 (LYVE-1). Cell detection identified an HH margin-prevailing immunologic response dominated by Myeloperoxidase+ (MPO+) macrophages, CD3+ and CD8+ T cell subsets, and B cells (CD20+, CD79A+). In HEHE, increased CD68+ and CD20+ cell demarcation of lesion margins was observed, while CD3+ and CD8+ T cells were equally detectable both marginally and intralesionally. Stage-specific pairwise correlation analysis of HH and HEHE revealed disease entity-specific immunologic infiltration patterns as seen by high CD117+ cell numbers in HH, while HEHE samples showed increased CD3+ T cell infiltration. CONCLUSIONS ECs in HH and HEHE share a continuous EC expression phenotype, while the expression of sinusoidal EC markers is more highly retained in HEHE. These phenotypic differences are associated with a unique and disease-specific immunovascular landscape.
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Affiliation(s)
- Stefan Thomann
- Institute of Pathology, University Hospital Heidelberg, Germany
- Institute of Systems Immunology, University of Würzburg, Germany
| | - Thomas Metzler
- Institute of Pathology, School of Medicine & Health, Technical University of Munich, Germany
- Comparative Experimental Pathology (CEP), School of Medicine & Health, Technical University of Munich, Germany
| | - Marcell Tóth
- Institute of Pathology, University Hospital Heidelberg, Germany
| | - Peter Schirmacher
- Institute of Pathology, University Hospital Heidelberg, Germany
- Liver Cancer Center Heidelberg, National Center for Tumor Diseases (NCT) Heidelberg, Germany
| | - Carolin Mogler
- Institute of Pathology, University Hospital Heidelberg, Germany
- Institute of Pathology, School of Medicine & Health, Technical University of Munich, Germany
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3
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Wen R, Zhou ZZ, Chen WJ. Clinical and Pathological Features of Congenital Hepatic Hemangioma in Children: A Retrospective Analysis. Fetal Pediatr Pathol 2023; 42:198-206. [PMID: 36036082 DOI: 10.1080/15513815.2022.2114300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective: We reviewed our experience with congenital hepatic hemangiomas (CHH) to assess the effectiveness of our treatment strategies. Methods: Clinical and pathologic features of children with CHH were reviewed. Results: Twenty-two cases of CHH were collected, 17 were resected and 5 were followed until resolution. In 17 with alpha-feto-protein (AFP) levels, 9 were elevated with 5 decreasing to normal before surgery. In six with tumors under 3 cm, five regressed between 1 and 13 months, one required removal 5 years after initial diagnosis. Postoperative histopathology of 17 cases showed abnormal vascular hyperplasia without lobular architecture. CD34 was expressed in all tumors, glucose transporter 1(Glut1) was negative. Conclusion: If the tumor is less than 3 cm, AFP is normal and there are no obvious complications, the lesion can be followed with regular assessment imaging. Surgical resection is an option in tumors less than 3 cm which have not regressed over time.
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Affiliation(s)
- Rong Wen
- Department of Pathology, Hunan Children's Hospital, Changsha, China
| | - Zheng-Zhen Zhou
- Department of Pathology, Hunan Children's Hospital, Changsha, China
| | - Wei-Jian Chen
- Department of Pathology, Hunan Children's Hospital, Changsha, China
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4
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Rónaszéki AD, Dudás I, Zsély B, Budai BK, Stollmayer R, Hahn O, Csongrády B, Park BS, Maurovich-Horvat P, Győri G, Kaposi PN. Microvascular flow imaging to differentiate focal hepatic lesions: the spoke-wheel pattern as a specific sign of focal nodular hyperplasia. Ultrasonography 2023; 42:172-181. [PMID: 36420572 PMCID: PMC9816699 DOI: 10.14366/usg.22028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/09/2022] [Indexed: 11/25/2022] Open
Abstract
Microvascular flow imaging (MVFI) is an advanced Doppler ultrasound technique designed to detect slow-velocity blood flow in small-caliber microvessels. This technique is capable of realtime, highly detailed visualization of tumor vessels without using a contrast agent. MVFI has been recently applied for the characterization of focal liver lesions and has revealed typical vascularity distributions in multiple types thereof. Focal nodular hyperplasia (FNH) constitutes an important differential diagnosis of malignant liver tumors. In this essay, we provide iconographic documentation of the MVFI appearance of FNH and other common solid liver lesions. Identifying the typical patterns of vascularity, including the spoke-wheel pattern with MVFI, can expedite the diagnosis, spare patients from unnecessary procedures, and save costs.
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Affiliation(s)
- Aladár David Rónaszéki
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ibolyka Dudás
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Boglarka Zsély
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bettina Katalin Budai
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Stollmayer
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Oszkár Hahn
- Department of Surgery, Transplantation and Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara Csongrády
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Byung-so Park
- Medical Affairs Manager at Samsung Medison, Samsung Medison Co., Ltd., An Affiliate of Samsung Electronics, Seoul, Korea
| | - Pál Maurovich-Horvat
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Gabriella Győri
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Pal Novak Kaposi
- Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary,Correspondence to: Pál Novák Kaposi, MD, PhD, Department of Radiology, Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Korányi Sándor str. 2., H-1083 Budapest, Hungary Tel. +36-1-459-1500/61628 Fax. +36-1-459-1500/61626 E-mail:
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5
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Pompili M, Ardito F, Brunetti E, Cabibbo G, Calliada F, Cillo U, de Sio I, Golfieri R, Grova M, Gruttadauria S, Guido M, Iavarone M, Manciulli T, Pagano D, Pettinari I, Santopaolo F, Soresi M, Colli A. Benign liver lesions 2022: Guideline for clinical practice of Associazione Italiana Studio del Fegato (AISF), Società Italiana di Radiologia Medica e Interventistica (SIRM), Società Italiana di Chirurgia (SIC), Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB), Associazione Italiana di Chirurgia Epatobilio-Pancreatica (AICEP), Società Italiana Trapianti d'Organo (SITO), Società Italiana di Anatomia Patologica e Citologia Diagnostica (SIAPEC-IAP) - Part II - Solid lesions. Dig Liver Dis 2022; 54:1614-1622. [PMID: 36089523 DOI: 10.1016/j.dld.2022.08.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022]
Abstract
Benign liver lesions are increasingly diagnosed in daily clinical practice due to the growing use of imaging techniques for the study of the abdomen in patients who have non-specific symptoms and do not have an increased risk of hepatic malignancy. They include simple or parasitic hepatic cysts and solid benign tumors which differ widely in terms of prevalence, clinical relevance, symptoms and natural history and often lead to significant clinical problems relating to diagnosis and clinical management. Following the need to have updated guidelines on the management of benign focal liver lesions, the Scientific Societies mainly involved in their management have promoted the drafting of a new dedicated document. This document was drawn up according to the present Italian rules and methodologies necessary to produce clinical, diagnostic, and therapeutic guidelines based on evidence. Here we present the second part of the guideline, concerning the diagnosis and clinical management of hemangioma, focal nodular hyperplasia, and hepatocellular adenoma.
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Affiliation(s)
- Maurizio Pompili
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, "Agostino Gemelli", Largo A. Gemelli, 8, Roma 00168, Italy.
| | - Francesco Ardito
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, "Agostino Gemelli", Largo A. Gemelli, 8, Roma 00168, Italy
| | - Enrico Brunetti
- Dipartimento di Scienze Cliniche, Chirurgiche, Diagnostiche e Pediatriche, Università di Pavia. Unità di Malattie Infettive e Immunologia, IRCCS Fondazione Ospedale San Matteo, Pavia, Italy
| | - Giuseppe Cabibbo
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Fabrizio Calliada
- Dipartimento di Radiologia, Fondazione Policlinico San Matteo IRCCS, Università di Pavia, Italy
| | - Umberto Cillo
- Chirurgia Epatobiliare e Trapianto di Fegato, Ospedale Universitario di Padova, Italy
| | - Ilario de Sio
- Epatogastroenterologia, Università della Campania Luigi Vanvitelli, Facoltà di Medicina e Chirurgia, Napoli, Italy
| | - Rita Golfieri
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Mauro Grova
- Sezione di Gastroenterologia e Epatologia, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Salvatore Gruttadauria
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, Dipartimento di Chirurgia e Specialità Medico-Chirurgiche, IRCCS-ISMETT-UPMCI, Palermo, Università di Catania, Italy
| | - Maria Guido
- Dipartimento di Anatomia Patologica, Azienda ULSS2 Marca Trevigiana, Treviso, Italy; Dipartimento di Medicina - DIMED, Università di Padova, Italy
| | - Massimo Iavarone
- Divisione di Gastroenterologia ed Epatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Manciulli
- Dipartimento di Medicina Sperimentale e Clinica - Università degli Studi, Firenze, Italy
| | - Duilio Pagano
- Dipartimento per la cura e lo studio delle Patologie Addominali e dei Trapianti Addominali, IRCCS-ISMETT-UPMC, Palermo, Italy
| | - Irene Pettinari
- Dipartimento di Radiologia, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - Francesco Santopaolo
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Gemelli, Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia, "Agostino Gemelli", Largo A. Gemelli, 8, Roma 00168, Italy
| | - Maurizio Soresi
- Medicina Interna, Dipartimento di Promozione della Salute, Materno-Infantile, di Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE) Università di Palermo, Italy
| | - Agostino Colli
- Dipartimento di Medicina Trasfusionale ed Ematologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
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6
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Kobayashi N, Iijima H, Tada T, Shibata Y, Nishimura T, Kumada T, Hashimoto M, Higashiura A, Yoshida M, Nishimura J, Aizawa N, Ikeda N, Takashima T, Takata R, Nishikawa H, Iwata Y, Enomoto H, Hirota S, Hatano E. A New Ultrasonographic "Fluttering Sign" for Hepatic Hemangioma. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:941-946. [PMID: 33413966 DOI: 10.1016/j.ultrasmedbio.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/18/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
The aim of the study described here was to clarify the diagnostic value of the fluttering sign, a new sign that characterizes hepatic hemangiomas in gray-scale ultrasonography (US). It refers to a phenomenon in which the speckled echogenicity inside the hemangioma changes continuously and seems to be moving. A total of 172 hemangiomas diagnosed with contrast-enhanced US were evaluated. The fluttering sign was found in 123 of 172 hemangiomas (71.5%). Its prevalence was significantly higher than that of the marginal strong echo (89/172, 51.7%, p < 0.001), posterior acoustic enhancement (103/172, 59.9%, p = 0.031) and chameleon sign (100/172, 58.1%, p = 0.013). In addition, the fluttering sign was observed significantly more frequently in mixed or hypo-echoic tumors than in hyper-echoic tumors (p < 0.001), relatively large tumors (p < 0.001) and tumors that were less than 5 cm from the body surface (p = 0.015). The fluttering sign in gray-scale US has great potential to be a new complementary sign for the diagnosis of hemangioma.
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Affiliation(s)
- Natsuko Kobayashi
- Department of Internal Medicine, Kenwakai Hospital, Iida, Nagano, Japan; Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroko Iijima
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
| | - Toshifumi Tada
- Department of Internal Medicine, Himeji Red Cross Hospital, Himeji, Hyogo, Japan
| | - Yoko Shibata
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Nishimura
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan; Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kumada
- Faculty of Nursing, Gifu Kyoritsu University, Ogaki, Gifu, Japan
| | - Mariko Hashimoto
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Akiko Higashiura
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masahiro Yoshida
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Junko Nishimura
- Ultrasound Imaging Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobuhiro Aizawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Naoto Ikeda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoyuki Takashima
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Ryo Takata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroki Nishikawa
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshinori Iwata
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirayuki Enomoto
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Etsuro Hatano
- Division of Hepatobiliary and Pancreatic Disease, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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7
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Surgical Treatment of Giant Liver Hemangioma, Case Report and Literature Review. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2020; 53:318-321. [PMID: 32377104 PMCID: PMC7192281 DOI: 10.14744/semb.2017.09815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/08/2017] [Indexed: 11/21/2022]
Abstract
Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases, they are small, asymptomatic and often require follow up. Giant hemangiomas are known as being larger than 5 cm and mostly consists of a cavernous haemangioma, is usually asymptomatic, diagnosed incidentally. In this study, we aimed to show that giant hemangiomas would be treated safely with surgical resection without transarterial embolization before the surgery. We present a 56-year-old male patient with liver hemangioma, who was diagnosed incidentally on thorax computarised tomography and consulted to thorax disease clinic with coughing complaint for a month. A case, which is rarely mentioned in literature, of a 30 cm sized asymptomatic giant cavernous hemangioma treated by surgical resection without any complication. We suggest that some patients should go through surgical treatment even if they do not have any complaint. Not only symptoms but also size and risk of rupture by trauma should be considered in these cases. However, all possible circumstances must be taken under consideration. Transarterial embolization is not the necessary.
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8
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Wang A, Deng J, Qian B, Chen H, Li M, Yang D, Li Q, Lei Z, Fu W. Natural history of hepatic hemangioma: a follow-up analysis of 534 patients. FRONTIERS IN LIFE SCIENCE 2019. [DOI: 10.1080/21553769.2019.1684389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ankang Wang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Jiaqi Deng
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Baolin Qian
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Hao Chen
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Mingxing Li
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Dayin Yang
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Qiu Li
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Zhengming Lei
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
| | - Wenguang Fu
- Department of Hepatobiliary Surgery, The Affiliated Hospital of Southwest Medical University, Sichuan, People’s Republic of China
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9
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Wabitsch S, Kästner A, Haber PK, Benzing C, Krenzien F, Andreou A, Kamali C, Lenz K, Pratschke J, Schmelzle M. Laparoscopic Versus Open Liver Resection for Benign Tumors and Lesions: A Case Matched Study with Propensity Score Matching. J Laparoendosc Adv Surg Tech A 2019; 29:1518-1525. [PMID: 31670608 DOI: 10.1089/lap.2019.0427] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background and Aim: In recent years, minimally invasive surgical approaches have gained an increasingly important role in hepatobiliary surgery. The aim of this study was to investigate the safety and potential benefits of laparoscopic liver resection (LLR) compared with open liver resection (OLR) for benign liver tumors and lesions. Patients and Methods: Between January 2009 and December 2017, 182 patients underwent liver resection for benign liver tumors and lesions at our center. After exclusion of 15 patients, the remaining 167 patients were divided into LLR group (n = 54) and OLR group (n = 113) and were compared with regard to perioperative outcomes. To overcome selection bias, a 1:1 propensity score matching (PSM) was performed. In addition, patients undergoing major hepatectomy were divided into major-LLR and major-OLR groups and perioperative outcomes evaluated. Results: After PSM, 35 patients were included in the OLR group and 35 patients in the LLR group. The LLR group had a significantly shorter median intensive care unit (ICU) stay (LLR: 1 [0-4] days; OLR: 1 [0-3] days; P = .009) and median hospital stay (length of stay [LOS]) (LLR: 7 [4-14] days; OLR: 10 [5-16] days; P < .001). There were no statistically significant differences in postoperative complications graded as Clavien-Dindo ≥III (LLR: 11.4%; OLR: 2.9%; P = .375) in both groups. Postoperative 90-day mortality was 0% in both groups. When comparing major-LLR (n = 8) with major-OLR (n = 59), patients in the major-LLR group had a significantly longer median operation time (major-LLR: 403 [240-501] minutes; major-OLR: 221.5 [111-529] minutes; P < .001), but a significantly shorter median LOS (major-LLR: 7 [5-14] days; major-OLR: 9 [7-129] days; P = .013). The rate of major complications (Dindo Classification ≥III) for major-LLR was 0% and for major-OLR it was 16.9% (P = .207). Conclusion: Our case-matched study demonstrates shorter ICU and hospital stay using laparoscopic techniques while maintaining high-quality perioperative outcomes. Based on our findings, we suggest preferring the LLR over OLR for benign liver tumors and lesions regardless of the resection extent.
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Affiliation(s)
- Simon Wabitsch
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Anika Kästner
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Philipp K Haber
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Andreas Andreou
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Can Kamali
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Klaus Lenz
- Department of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany
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Zhang G, Wang M, Duan F, Yuan K, Li K, Yan J, Chang Z. Transarterial embolization with bleomycin for symptomatic hepatic focal nodular hyperplasia. Diagn Interv Radiol 2017; 23:66-70. [PMID: 27910813 DOI: 10.5152/dir.2016.16061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We aimed to evaluate the therapeutic effect and safety of transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for the treatment of symptomatic hepatic focal nodular hyperplasia (FNH). METHODS This retrospective study included 23 consecutive patients with symptomatic hepatic FNH, who underwent embolization using bleomycin-iodinated oil and polyvinyl alcohol particles between January 2005 and December 2012. Patients were followed-up with radiologic and clinical evaluation. Therapeutic effects including changes in lesion size and symptomatic improvement were evaluated after the procedure. RESULTS Embolization was performed for 27 lesions in 23 patients. Follow-up period ranged from three months to 89 months. The mean lesion diameters decreased significantly from 5.0±2.4 cm to 3.2±1.5 cm at 3-9 months after embolization (P < 0.001). Five lesions had complete resolution in the follow-up period. The clinical symptoms were significantly relieved in all patients. Contrast-enhanced scans at follow-up showed complete lack of residual arterial blood supply in the majority of lesions. Local recurrence was found in one treated lesion at the 54-month follow-up. There were no major complications associated with the procedure. CONCLUSION Transarterial embolization using bleomycin-iodinated oil and polyvinyl alcohol particles for hepatic FNH is a safe and effective alternative treatment with good long-term symptomatic control and reduction in lesion size after embolization.
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Affiliation(s)
- Guodong Zhang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, China.
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Jing L, Liang H, Caifeng L, Jianjun Y, Feng X, Mengchao W, Yiqun Y. New recognition of the natural history and growth pattern of hepatic hemangioma in adults. Hepatol Res 2016; 46:727-33. [PMID: 26492419 DOI: 10.1111/hepr.12610] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Revised: 10/11/2015] [Accepted: 10/14/2015] [Indexed: 12/12/2022]
Abstract
AIM Surgical indications for hepatic hemangiomas are still not clearly defined due to limited data on their natural history. This study aimed to investigate the natural history and growth pattern of hepatic hemangiomas in adults. METHODS From April 2010 to March 2013, adult patients with hepatic hemangioma who had no prior treatment were enrolled. A routine follow up was performed to observe the natural history of the lesions and their tendency to cause complications. RESULTS A total of 236 patients were enrolled in the study. The median size of hemangiomas was 4.5 cm (range, 0.6-19.2). During a median follow-up period of 48 months (range, 3-266), 61.0% patients had hemangiomas that increased in size, 23.7% patients had stable lesions and 8.5% patients had hemangiomas that decreased in size. The peak growth period of hemangiomas was in patients of less than 30 years of age (0.46 ± 0.41 cm/year) and the growth rate decreased significantly after 50 years of age (0.21 ± 0.40 cm/year). Hemangiomas of less than 2 cm had the lowest growth rate (0.16 ± 0.42 cm/year). The peak growth rate of hemangioma size was 8-10 cm (0.80 ± 0.62 cm/year), then decreased rapidly to 0.47 ± 0.91 cm/year while the hemangiomas were of more than 10 cm. Only nine patients had severe symptoms caused by hemangioma. No patients presented with hemangioma-related complications. CONCLUSION The majority of hepatic hemangiomas have the tendency to increase in size but rarely cause complications. All the hemangiomas can be safely managed by observation, and surgery is only considered for patients with severe complications.
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Affiliation(s)
- Li Jing
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Huang Liang
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Liu Caifeng
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan Jianjun
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xu Feng
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wu Mengchao
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yan Yiqun
- Department of Hepatic Surgery I, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
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Mocchegiani F, Vincenzi P, Coletta M, Agostini A, Marzioni M, Baroni GS, Giovagnoni A, Guerrieri M, Marmorale C, Risaliti A, Vivarelli M. Prevalence and clinical outcome of hepatic haemangioma with specific reference to the risk of rupture: A large retrospective cross-sectional study. Dig Liver Dis 2016; 48:309-14. [PMID: 26514738 DOI: 10.1016/j.dld.2015.09.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/15/2015] [Accepted: 09/24/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prevalence and incidence of hepatic haemangioma are estimated from autopsy series only. Although benign and generally asymptomatic, hepatic haemangioma can cause serious complications. AIMS The aim of the study was to assess the prevalence of hepatic haemangioma and to attempt to quantify the risk of major complications such as spontaneous rupture. METHODS We retrospectively analyzed the radiology database of a Regional University Hospital over a 7-year period: the radiological records of 83,181 patients who had an abdominal computed tomography or magnetic resonance scan were reviewed. Diagnoses made at imaging were reviewed and related to clinical course. RESULTS Hepatic haemangioma was diagnosed in 2071 patients (2.5% prevalence). In 226 patients (10.9%), haemangioma had diameter of 4 cm or more (giant haemangioma). The risk of bleeding was assessed on patients without concomitant malignancies. Spontaneous bleeding occurred in 5/1067 patients (0.47%). All 5 patients had giant haemangioma: 4 had exophytic lesions and presented with haemoperitoneum; 1 with centrally located tumour experienced intrahepatic bleeding. CONCLUSION Giant haemangiomas have a low but relevant risk of rupture (3.2% in this series), particularly when peripherally located and exophytic. Surgery might be considered in these cases.
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Affiliation(s)
- Federico Mocchegiani
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Paolo Vincenzi
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Martina Coletta
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Andrea Agostini
- Radiology, Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Italy.
| | - Marco Marzioni
- Clinic of Gastroenterology, Department of Clinic and Molecular Sciences, Polytechnic University of Marche, Italy.
| | - Gianluca Svegliati Baroni
- Clinic of Gastroenterology, Department of Clinic and Molecular Sciences, Polytechnic University of Marche, Italy.
| | - Andrea Giovagnoni
- Radiology, Department of Specialistic Clinical and Odontostomatological Sciences, Polytechnic University of Marche, Italy.
| | - Mario Guerrieri
- Clinic of Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Cristina Marmorale
- Clinic of Surgical Training, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
| | - Andrea Risaliti
- Clinic of Surgery, Department of Medical and Biological Sciences, University of Udine, Italy.
| | - Marco Vivarelli
- Hepatobiliary and Transplantation Surgery, Department of Clinical and Experimental Medicine, Polytechnic University of Marche, Italy.
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Stankiewicz R, Kobryń K, Patkowski W, Krawczyk M. Management of Giant Hepatic Hemangioma in Atypical Localization; Report of a Case and Literature Review. POLISH JOURNAL OF SURGERY 2015; 87:139-42. [PMID: 26146110 DOI: 10.1515/pjs-2015-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Indexed: 11/15/2022]
Abstract
Hemangiomas are the most common benign primary hepatic neoplasms, often being incidentally discovered. In most of the cases they are small and asymptomatic. It is widely accepted that clinical intervention is indicated only for symptomatic hemangiomas. We present a case of an asymptomatic giant hemangioma managed by enucleation due to its atypical localization. The hemangioma, originally located in segment 5, was now described in Computer Tomography (CT) Imaging as separating the gallbladder from the liver parenchyma. A careful evaluation of images revealed proximity to the portal vein (PV), right hepatic artery (RHA), right hepatic duct (RHD) and right branch of the portal vein (RBPV). Thus, in the case of an emergent operation, surgical maneuvers in the area of the altered hepatic anatomy and proximity to the hemangioma itself, would in fact increase the risk endangering the patient's life. After patient's consent, a surgical enucleation en block with the gall-bladder was performed. It is of great importance that specifically selected, asymptomatic patients diagnosed with a giant hemangioma, with the above mentioned or similar localization should be considered for surgical treatment.
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Darai N, Shu R, Gurung R, Zhang X, Teng G. Atypical CT and MRI Features of Focal Nodular Hyperplasia of Liver: A Study with Radiologic-Pathologic Correlation. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ojrad.2015.53020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Belghiti J, Cauchy F, Paradis V, Vilgrain V. Diagnosis and management of solid benign liver lesions. Nat Rev Gastroenterol Hepatol 2014; 11:737-49. [PMID: 25178878 DOI: 10.1038/nrgastro.2014.151] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
More and more asymptomatic benign liver tumours are discovered incidentally and can be divided into regenerative lesions and true neoplastic lesions. The most common regenerative lesions include hemangioma, focal nodular hyperplasia and inflammatory pseudotumours of the liver. Neoplastic lesions include hepatocellular adenomas and angiomyolipomas. Regenerative lesions rarely increase in volume, do not yield a higher risk of complications and usually do not require treatment. By contrast, hepatocellular adenomas and angiomyolipomas can increase in volume and are associated with a risk of complications. Large hepatocellular adenomas (>5 cm in diameter) are undoubtedly associated with a risk of bleeding and malignant transformation, particularly the inflammatory (also known as telangiectatic) and β-catenin mutated subtypes. Accurate diagnosis needs to be obtained to select patients eligible for surgical resection. MRI has markedly improved diagnosis and can identify the major hepatocellular adenomas subtypes. The use of biopsy results to inform the indication for resection remains questionable. However, when diagnosis remains uncertain after imaging, percutaneous biopsy could help improve diagnostic accuracy.
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Affiliation(s)
- Jacques Belghiti
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, University Paris-Diderot, 100 Boulevard du General Leclerc, 92110 Clichy, France
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ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol 2014; 109:1328-47; quiz 1348. [PMID: 25135008 DOI: 10.1038/ajg.2014.213] [Citation(s) in RCA: 249] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/22/2014] [Indexed: 12/11/2022]
Abstract
Focal liver lesions (FLL) have been a common reason for consultation faced by gastroenterologists and hepatologists. The increasing and widespread use of imaging studies has led to an increase in detection of incidental FLL. It is important to consider not only malignant liver lesions, but also benign solid and cystic liver lesions such as hemangioma, focal nodular hyperplasia, hepatocellular adenoma, and hepatic cysts, in the differential diagnosis. In this ACG practice guideline, the authors provide an evidence-based approach to the diagnosis and management of FLL.
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Badea R, Meszaros M, Al Hajjar N, Rusu I, Chiorean L. Benign nodular hyperplasia of the liver-pedunculated form: diagnostic contributions of ultrasonography and consideration of exophytic liver tumors. J Med Ultrason (2001) 2014; 42:97-102. [PMID: 26578496 DOI: 10.1007/s10396-014-0564-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/03/2014] [Indexed: 12/12/2022]
Abstract
Focal nodular hyperplasia (FNH) is an asymptomatic benign liver tumor that may be detected accidentally during an abdominal ultrasound examination; it is associated with unspecific complaints, sometimes painful. Diagnosis can be precise using imaging techniques like ultrasonography. The diagnostic criteria are represented by the spatial display of the tumoral vessels and their hemodynamic characteristics. Sometimes differential diagnostic issues occur with other benign or malignant liver tumors. We present the case of a young female patient without a personal pathological history, who complained of intense, diffuse, intermittent, non-systematic abdominal pain and who underwent ultrasound examination, followed by contrast-enhanced ultrasound. With this technique, we evidenced a solid extrahepatic tumor, which was mobile at the patient's change of position and had the hemodynamic features of FNH. The article also tackles the problem of intra-abdominal pedunculated tumors.
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Affiliation(s)
- Radu Badea
- Department of Ultrasonography, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
| | - Magdalena Meszaros
- Department of Gastroenterology, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, Cluj Napoca, Romania.
| | - Nadim Al Hajjar
- Department of Surgery, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Str. Croitorilor 19-21, 400 162, Cluj Napoca, Romania
| | - Ioana Rusu
- Department of Pathology, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, Cluj Napoca, Romania
| | - Liliana Chiorean
- Department of Ultrasonography, Medical Clinic 3, "Octavian Fodor" Regional Gastroenterology and Hepatology Institute, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj Napoca, Romania
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Navarro AP, Gomez D, Lamb CM, Brooks A, Cameron IC. Focal nodular hyperplasia: a review of current indications for and outcomes of hepatic resection. HPB (Oxford) 2014; 16:503-11. [PMID: 24127684 PMCID: PMC4048071 DOI: 10.1111/hpb.12169] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/28/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) is a common benign disease of the liver with no recognized potential for malignant transformation. The term describes an entity of lobular proliferation of normally differentiated hepatocytes, frequently around a central fibrous scar. Two key issues influence surgical decision making in FNH: diagnostic certainty, and symptomatic assessment. METHODS A systematic review of studies reporting hepatic resections of FNH was performed. Indications and outcomes in adult populations were examined with a focus on diagnostic workup, patient selection and operative mortality and morbidity. RESULTS Diagnostic modalities in the majority of studies involved ultrasound and computed tomography. Fewer than half employed magnetic resonance imaging (MRI). In instances in which MRI was not available, diagnostic accuracy was inferior. CONCLUSIONS Percutaneous biopsy should be avoided to prevent the risk for tumour seeding. Patients presenting with asymptomatic definitive FNH can be safely managed conservatively. In symptomatic patients surgical resection is a safe and effective treatment for which acceptable rates of morbidity (14%) and zero mortality are reported. However, evidence of symptom resolution is reported with conservative strategies. Diagnostic uncertainty remains the principal valid indication for FNH resection, but only in patients in whom contrast-enhanced MRI forms part of preoperative assessment.
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Affiliation(s)
- Alex P Navarro
- Department of Hepatobiliary and Pancreatic Surgery, Queen's Medical Centre, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, UK
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Yoon JH, Kim JY. Atypical Findings of Focal Nodular Hyperplasia with Gadoxetic Acid (Gd-EOB-DTPA)-Enhanced Magnetic Resonance Imaging. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e9269. [PMID: 24693305 PMCID: PMC3955861 DOI: 10.5812/iranjradiol.9269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/23/2013] [Accepted: 06/26/2013] [Indexed: 12/18/2022]
Abstract
We report two cases of focal nodular hyperplasia in patients following gadoxetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging confirmed with histopathology. These cases showed an atypical pattern during the delayed-hepatobiliary phase after the injection of gadoxetic acid. One case showed a total defect, and the other showed a peripheral ring-like enhancement without a visible central scar, mimicking hepatocellular carcinoma. The pathologic examination demonstrated that the two lesions were focal nodular hyperplasia.
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Affiliation(s)
- Jung-Hee Yoon
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Jwa-dong, Haeundae-gu, Busan, Korea
- Corresponding author: Jung-Hee Yoon, Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Jwa-dong, Haeundae-gu, Busan, Korea. Tel: +82-517970355, Fax: +82-517970397, E-mail:
| | - Ji-Yeon Kim
- Department of Pathology, Haeundae Paik Hospital, Inje University College of Medicine, Jwa-dong, Haeundae-gu, Busan, Korea
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Yedibela S, Alibek S, Müller V, Aydin U, Langheinrich M, Lohmüller C, Hohenberger W, Perrakis A. Management of hemangioma of the liver: surgical therapy or observation? World J Surg 2014; 37:1303-12. [PMID: 23354918 DOI: 10.1007/s00268-013-1904-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Elective surgery for liver hemangioma is controversial. We reviewed long-term outcomes following elective hepatectomy or observation only for symptomatic and asymptomatic liver hemangioma. METHODS All patients (n = 307) with liver hemangioma referred to our hospital for surgical evaluation from January 1988 to December 2009 were identified, and imaging results, tumor characteristics, surgical indication, surgical mode, outcome of observation, clinical and/or postoperative outcome, and adverse events were retrospectively evaluated. RESULTS Complete median follow-up for 246 patients was 124 months. Elective surgery was performed in 103 patients (symptomatic [n = 62] and asymptomatic [n = 41]). Postoperative morbidity occurred in 17 % of the patients and was significantly lower in asymptomatic patients (p = 0.002). No perioperative mortality was registered. Surgery relieved complaints in most (88 %) patients. In the observation group (n = 143), 56 % of patients had persistent or new onset of hemangioma-associated symptoms. Major hemangioma-related complications occurred in 12 patients (9 %) during the follow-up period, and 2 patients died after traumatic hemangioma rupture. Overall the rate of adverse events was by trend lower in the surgical group than in the observation group (35 versus 57 %; p = 0.08). CONCLUSIONS The majority of patients with liver hemangioma can be safely managed by clinical observation. In a subset of patients, especially those with giant hemangioma and/or occurrence of symptoms, surgical treatment could be considered and is justified in high-volume centers.
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Affiliation(s)
- Süleyman Yedibela
- Department of Surgery, University of Erlangen-Nuremberg, Krankenhausstr.12, 91054, Erlangen, Germany.
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Augustine MM, Fong Y. Epidemiology and risk factors of biliary tract and primary liver tumors. Surg Oncol Clin N Am 2013; 23:171-88. [PMID: 24560105 DOI: 10.1016/j.soc.2013.10.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Primary liver and biliary tract tumors encompass a range of benign and malignant neoplasms. They consist of histologically distinct types of tumors that arise from and are influenced by hepatocytes, biliary epithelial cells, and mesenchymal cells. Improvements in imaging have allowed the detection and diagnosis of these neoplasms to be refined. Investigation at the histologic, molecular, and genetic levels has allowed neoplasms to be categorized and treated. Epidemiology has improved understanding of geographic, ethnic, gender, and cultural differences that link exposures with cancer risk. This article focuses on the epidemiology of major primary adult liver and biliary tract tumors.
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Affiliation(s)
- Mathew M Augustine
- Hepatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA
| | - Yuman Fong
- Hepatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 353 East 68th Street, New York, NY 10065, USA.
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Birn J, Williams TR, Croteau D, Schwartz S, Sturza S, Getzen T. Transarterial Embolization of Symptomatic Focal Nodular Hyperplasia. J Vasc Interv Radiol 2013; 24:1647-55. [DOI: 10.1016/j.jvir.2013.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/29/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022] Open
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Zhou JX, Huang JW, Wu H, Zeng Y. Successful liver resection in a giant hemangioma with intestinal obstruction after embolization. World J Gastroenterol 2013; 19:2974-2978. [PMID: 23704832 PMCID: PMC3660824 DOI: 10.3748/wjg.v19.i19.2974] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 01/17/2013] [Accepted: 03/29/2013] [Indexed: 02/06/2023] Open
Abstract
Hepatic hemangiomas are the most common benign tumor of the liver. Most hepatic hemangiomas remain asymptomatic and require no treatment. Giant hepatic hemangiomas with established complications, diagnostic uncertainty and incapacitating symptoms, however, are generally considered an absolute indication for surgical resection. We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization, by which the volume of the hemangioma was significantly reduced, and it was completely resected by a left hepatectomy. A 21-year-old Asian man visited our hospital for left upper quadrant pain. Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity, with a maximum diameter of 31.5 cm. Embolization of the left hepatic artery was performed and confirmed a decrease in its size. However, the patient was readmitted to our hospital one month after embolization for intestinal obstruction. A left hepatectomy was completed through a herringbone incision, and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight. Pre-operative arterial embolization is effective for reducing tumor size, but a close follow-up to decide the time for hepatectomy is important.
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Mezhir JJ, Fourman LT, Do RK, Denton B, Allen PJ, D'Angelica MI, DeMatteo RP, Fong Y, Jarnagin WR. Changes in the management of benign liver tumours: an analysis of 285 patients. HPB (Oxford) 2013; 15:156-63. [PMID: 23297727 PMCID: PMC3719923 DOI: 10.1111/j.1477-2574.2012.00556.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Accepted: 07/28/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Benign liver tumours (BLTs) are common and their management remains controversial. This study assesses the safety of a selective management approach. METHODS Patients with BLT were identified from an institutional database. Patients with simple cysts or an incidental BLT in the setting of metastasis or concomitant malignancy were excluded. RESULTS A total of 285 patients presenting during the period from January 1992 to December 2009 with haemangioma (53.0%), focal nodular hyperplasia (23.9%), adenoma (10.2%) or indeterminate/other lesions (13.0%) were evaluated. Of these, 117 patients (41.1%) underwent immediate resection and 168 patients (58.9%) were followed with serial imaging (median follow-up: 30 months). During observation, eight patients (4.8%) underwent resection for tumour growth, inability to exclude malignancy or symptoms; no patients demonstrated malignant transformation or tumour-related complications. During the study period, the number of BLTs evaluated and the proportion of patients observed increased from 129 BLTs of which 36.4% were observed in 1992-2002 to 156 BLTs of which 71.2% were observed in 2003-2009 (P < 0.001). Diagnostic uncertainty led to resection in 29.5% of patients during the earlier period, but in only 13.4% during the more recent 7 years (P < 0.05). CONCLUSIONS Asymptomatic BLTs without concern for malignancy or adenoma can be safely observed with minimal risk for misdiagnosis. Patients selected for observation rarely require resection or develop tumour-related complications.
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Affiliation(s)
- James J Mezhir
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - Lindsay T Fourman
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - Richard K Do
- Department of Radiology, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - Brian Denton
- Department of Epidemiology and Biostatistics, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - Peter J Allen
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | | | - Ronald P DeMatteo
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - Yuman Fong
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan–Kettering Cancer CenterNew York, NY, USA
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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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Biologic and clinical features of benign solid and cystic lesions of the liver. Clin Gastroenterol Hepatol 2011; 9:547-62.e1-4. [PMID: 21397723 DOI: 10.1016/j.cgh.2011.03.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 02/07/2023]
Abstract
The widespread use of imaging analyses, either routinely or to evaluate symptomatic patients, has increased the detection of liver lesions (tumors and cysts) in otherwise healthy individuals. Although some of these incidentally discovered masses are malignant, most are benign and must be included in the differential diagnosis. The management of benign hepatic tumors ranges from conservative to aggressive, depending on the nature of the lesions. New imaging modalities, increased experience of radiologists, improved definition of radiologic characteristics, and a better understanding of the clinical features of these lesions have increased the accuracy of diagnoses and reduced the need for invasive diagnostic tests. These advances have led to constant adjustments in management approaches to benign hepatic lesions. We review the biologic and clinical features of some common hepatic lesions, to guide diagnosis and management strategies.
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Spontaneous rupture of a giant hepatic hemangioma-report of a case. Indian J Surg 2011; 74:434-6. [PMID: 24082605 DOI: 10.1007/s12262-011-0309-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2009] [Accepted: 08/28/2009] [Indexed: 12/12/2022] Open
Abstract
Hemangioma is the commonest benign hepatic neoplasm. Most cases are asymptomatic. Spontaneous rupture is rare (1-4%). Only 34 cases have been reported in adults. None had history of trauma. We report a case, the first from India of spontaneous rupture of a giant hepatic hemangioma, in a 25 year old male presenting with acute abdomen. He underwent right hepatectomy. Histopathology suggested cavernous hemangioma.
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Sugito K, Uekusa S, Kawashima H, Furuya T, Ohashi K, Inoue M, Ikeda T, Koshinaga T, Tomita R, Mugishima H, Maebayashi T. The clinical course in pediatric solid tumor patients with focal nodular hyperplasia of the liver. Int J Clin Oncol 2011; 16:482-7. [PMID: 21455626 DOI: 10.1007/s10147-011-0210-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 02/08/2011] [Indexed: 12/11/2022]
Abstract
BACKGROUND Focal nodular hyperplasia (FNH) of the liver is a rare benign lesion that may be related to the vascular and hepatic damage induced by completion of tumor therapy and a reaction to localized vascular abnormality. The aim of this study was to analyze the clinical course in pediatric solid tumor patients with FNH. METHODS We analyzed thirty-two patients with pediatric solid tumors who received multiagent chemotherapy (15 advanced neuroblastomas, 7 hepatoblastomas, 5 rhabdomyosarcomas, 2 nephroblastomas, 1 rhabdoid tumor of the kidney, 1 clear cell sarcoma of the kidney and 1 pancreatoblastoma). All of them had been previously treated at our hospital, and have been alive for over 3 years without recurrence. RESULTS FNH lesions were discovered in three (9.4%) of 32 patients, and were neuroblastoma (NB) stage 4. All 3 patients received induction chemotherapy and high-dose alkylating agents, and developed grade 3 (National Cancer Institute Common Toxicity Criteria; NCI-CTC) liver dysfunction during completion of tumor therapy without veno-occlusive disease. Two of the 3 patients received the same induction chemotherapy and high doses of alkylating agents with total body irradiation for cytoreductive agents prior to peripheral blood cell transplantation. FNH lesions in both female patients who received estrogen replacement therapy after completion of tumor therapy have expanded and are increasing. CONCLUSION FNH appears to be a late complication of iatrogenic disease in NB stage 4 patients. The therapeutic agents for NB stage 4 and estrogen replacement therapy should be considered as risk factors for the development of FNH.
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Affiliation(s)
- Kiminobu Sugito
- Department of Pediatric Surgery, Nihon University School of Medicine, 30-1, Ohyaguchi-Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
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Kang HS, Kim BK, Shim CS. Focal nodular hyperplasia: with a focus on contrast enhanced ultrasound. THE KOREAN JOURNAL OF HEPATOLOGY 2011; 16:414-7. [PMID: 21415588 PMCID: PMC3304615 DOI: 10.3350/kjhep.2010.16.4.414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ho Suk Kang
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
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31
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Nodular Regenerative Hyperplasia and Portal Hypertension in a Patient with Coeliac Disease. Case Rep Gastrointest Med 2011; 2011:938580. [PMID: 22606433 PMCID: PMC3350286 DOI: 10.1155/2011/938580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 07/04/2011] [Indexed: 11/17/2022] Open
Abstract
Nodular regenerative hyperplasia (NRH) of the liver is often associated with rheumatologic or lymphoproliferative disorders and a cause of portal hypertension in some patients. We report the case of a 71-year-old patient with celiac disease and unexplained portal hypertension. Biopsy of the liver revealed NRH as the underlying cause. The patient did not suffer from an autoimmune, rheumatologic or lymphoproliferative disease. A thrombophilic disorder that might cause NRH was ruled out. Celiac disease is often associated with mild elevation of liver enzymes and steatosis of the liver, but the association with NRH was described in only a few patients. We discuss the possible relationship of celiac disease and NRH.
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Abstract
One of the consequences of extensive use of abdominal imaging, and especially liver ultrasonography, is the detection of asymptomatic liver tumors. In the absence of underlying chronic liver disease, the vast majority of these lesions correspond to benign liver tumors including solid and cystic lesions. This article is dedicated to hepatocellular tumors and also addresses hemangiomas as the most common benign liver tumors, and angiomyolipomas as a rare tumor often misdiagnosed.
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Affiliation(s)
- Valérie Paradis
- Pathology Department, Beaujon Hospital, 100 bd du Général Leclerc, 92118 Clichy Cedex, France.
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33
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Crosnier H, Thibaud E, Duflos C, Polak M. Norethisterone-induced hepatic adenomas can cause life-threatening bleeding in girls with inherited platelet disorders. Fertil Steril 2010; 94:2329.e1-3. [DOI: 10.1016/j.fertnstert.2010.03.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 02/21/2010] [Accepted: 03/15/2010] [Indexed: 11/16/2022]
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34
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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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36
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Gadoxetate disodium-enhanced MRI of the liver: part 1, protocol optimization and lesion appearance in the noncirrhotic liver. AJR Am J Roentgenol 2010; 195:13-28. [PMID: 20566794 DOI: 10.2214/ajr.10.4392] [Citation(s) in RCA: 250] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this article is to review the pharmacokinetic and pharmacodynamic properties of gadoxetate disodium (Gd-EOB-DTPA), to describe a workflow-optimized pulse sequence protocol, and to illustrate the imaging appearance of focal lesions in the noncirrhotic liver. CONCLUSION Gd-EOB-DTPA allows a comprehensive evaluation of the liver with the acquisition of both dynamic and hepatocyte phase images. This provides potential additional information, especially for the detection and characterization of small liver lesions. However, protocol optimization is necessary for improved image quality and workflow.
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Abstract
BACKGROUND With the routine use of improved imaging modalities, more benign liver lesions are detected nowadays. An accurate characterization of these incidental lesions may be a challenge, and frequently a biopsy or even unnecessary surgery is being performed. However, these interventions are not always to the benefit of the patient. METHODS A Medline search of studies relevant to imaging diagnosis and management of the most common, benign, solid and non-solid liver lesions was undertaken. References from identified articles were handsearched for further relevant articles. The authors' own experiences with benign liver lesions were also taken into account. RESULTS Although atypical imaging features are the exception rather than the rule, it is sometimes difficult to differentiate between benign and malignant lesions, and knowledge of their imaging features is essential if unnecessary work-up is to be avoided. The use of tissue-specific contrast media, which has clearly improved the accuracy of highly advanced radiological techniques, may be helpful during differential diagnosis. Once having established an accurate diagnosis, surgery is rarely indicated for a benign liver lesion because of its asymptomatic nature. CONCLUSION Knowledge of imaging features and a clear management strategy during diagnostic work-up, emphasizing the indications for surgery, will minimize the number of patients who have to undergo biopsy or unnecessary surgery.
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Affiliation(s)
- Türkan Terkivatan
- Department of Surgery, Erasmus University Medical Center Rotterdam, The Netherlands
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38
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Carneros JA, Piqueras B, Tomás E, García-Durán F, Ciriza C, Bermejo F, Sánchez-Prudencio S, Valer P, Guerra I, García-Garzón S, Villa JC, Rodríguez Agulló JL. [Acute pancreatitis and space-occupying hepatic lesions in a patient with bone marrow transplant due to multiple myeloma]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:410-4. [PMID: 19500877 DOI: 10.1016/j.gastrohep.2009.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Accepted: 02/13/2009] [Indexed: 11/19/2022]
Abstract
Patients with multiple myeloma (MM) do not have a higher incidence of acute pancreatitis or pancreatitis of other etiologies than the general population. However, these patients may develop acute pancreatitis, or hyperamylasemia or isolated hyperlipasemia, due to etiologies that are highly infrequent in the absence of hematological disease. Liver involvement is found in 30-50% of patients with MM and mainly manifests as diffuse sinusoidal infiltration and less frequently in the form of nodules. We report the case of a patient who underwent bone marrow transplantation due to MM who showed clinical and laboratory findings compatible with acute pancreatitis of unknown origin, during which the presence of multiple space-occupying hepatic lesions was identified. Based on the results of biopsy, a diagnosis of extramedullary recurrence of MM was established.
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Abstract
Incidentally discovered liver masses are becoming more common with the increasing application and power of imaging techniques for the evaluation of abdominal conditions. Although such masses are often benign, conclusive diagnoses must be established in order to provide appropriate patient care. Various imaging modalities can be utilized to accurately diagnose such masses without resort to more invasive diagnostic measures.
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40
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Mahajan D, Miller C, Hirose K, McCullough A, Yerian L. Incidental reduction in the size of liver hemangioma following use of VEGF inhibitor bevacizumab. J Hepatol 2008; 49:867-70. [PMID: 18814928 DOI: 10.1016/j.jhep.2008.06.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/11/2008] [Accepted: 06/22/2008] [Indexed: 01/12/2023]
Abstract
BACKGROUND/AIMS Hepatic cavernous hemangioma is the second most common liver tumor after metastases. Vascular endothelial growth factor (VEGF) is recognized as an essential regulator of blood vessel growth. High VEGF expression leads to increased angiogenic activity in cavernous hemangioma endothelial cells. The use of specific antibodies directed against VEGF abolishes this vascular endothelial growth-promoting activity in vitro. Bevacizumab is a recombinant humanized monoclonal antibody directed against VEGF which is used for the treatment of metastatic colorectal cancer in combination with 5-fluorouracil-based regimens. METHODS We report a patient with invasive colorectal adenocarcinoma and suspected liver metastasis on radiological examination, who showed a significant decrease in the size of his liver lesions after bevacizumab treatment. Histology of the liver lesions revealed hemangioma with a strong staining for VEGF and anti-VEGFr2 antibody in the hemangioma endothelial cells. To date, surgical resection provides the only consistently effective method for treatment of hepatic hemangioma. CONCLUSIONS This is the first documented case of hepatic hemangioma responsive to antiangiogenic therapy, suggesting a possible use for these agents in treating symptomatic patients without surgery. VEGF-signaling blockade including bevacizumab use poses a potential new treatment modality for vascular neoplasms in the liver and other sites.
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Affiliation(s)
- Dipti Mahajan
- Department of Pathology and Laboratory Medicine, L25, Institute of Pathology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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41
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Wang HM, Lo GH, Hsu PI, Lin CK, Chan HH, Chen WC, Lai KH, Wang BW, Lin SL. Nodular regenerative hyperplasia of the liver. J Chin Med Assoc 2008; 71:523-7. [PMID: 18955187 DOI: 10.1016/s1726-4901(08)70161-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Nodular regenerative hyperplasia (NRH), characterized by diffuse hepatic micronodular transformation in groups without fibrous septa between the nodules, is a rare benign liver lesion that has many synonyms in previous literature. Pathologic evaluation is the mainstay of accurate diagnosis. Treatment is focused on its underlying conditions and complications of portal hypertension. A 39-year-old man visited our hospital due to right upper quadrant pain and a palpable liver mass. Magnetic resonance examination revealed a slightly hyperintense tumor on T2-weighted images, and focal nodular hyperplasia was diagnosed by the radiologists. Atypical radiologic findings could not yield an accurate diagnosis. Surgical intervention was therefore performed. Pathologic examination of the resected liver tumor confirmed the diagnosis of NRH. We conclude that NRH should be included in the differential diagnosis of benign liver tumor.
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Affiliation(s)
- Huay-Min Wang
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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42
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Moya Herráiz Á, Torres-Quevedo R, Mir Pallardó J. Trasplante hepático en pacientes con lesiones hepáticas benignas. Cir Esp 2008; 84:60-6. [DOI: 10.1016/s0009-739x(08)72135-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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43
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Vondran FWR, Katenz E, Schwartlander R, Morgul MH, Raschzok N, Gong X, Cheng X, Kehr D, Sauer IM. Isolation of primary human hepatocytes after partial hepatectomy: criteria for identification of the most promising liver specimen. Artif Organs 2008; 32:205-13. [PMID: 18201288 DOI: 10.1111/j.1525-1594.2007.00524.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Demands for primary human hepatocytes are continuously increasing, while supply is insufficient due to limited cell sources. To improve cell availability, the present study investigates the influence of donor liver characteristics on the outcome of hepatocyte isolation from surgically removed liver tissue (n = 50). Hepatocytes were isolated from liver specimens using a standardized two-step collagenase perfusion technique. The patient's sex, previous chemotherapy, or histopathology have shown no influence. Donor age significantly affected the isolation outcome, but was not found suitable for predicting cell yields. Preoperative blood parameters did not correlate with cell yield, although cell function was affected: total protein, albumin synthesis, and cell viability were significantly decreased for serum gamma-glutamyl-transferase (GGT) levels >60 U/L. Specimens from patients with benign diseases gave significantly higher cell yields than tissue removed due to secondary and primary tumors, respectively. The indication for surgery is a valuable basis for identifying the most yielding specimens. Hepatocytes from donors with high GGT levels appear to show reduced functional properties.
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Affiliation(s)
- Florian Wolfgang Rudolf Vondran
- Department of General, Visceral, and Transplantation Surgery, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany.
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Boozari B, Lotz J, Galanski M, Gebel M. [Diagnostic imaging of liver tumours. Current status]. Internist (Berl) 2008; 48:8, 10-2, 14-6, 18-20. [PMID: 17216509 DOI: 10.1007/s00108-006-1773-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Nowadays, contrast enhanced ultrasound (CEUS) is an imaging technique equivalent to multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) for the detection and characterization of focal liver lesions. These methods have comparable sensitivity and specificity in differentiating a liver lesion as "benign" or "malignant". For benign lesions, CEUS is the recommended method of the choice. In unclear cases, or if CEUS is not available, MRI or CT are the methods of the second choice. If a benign tumor remains unclear, then a needle biopsy is recommended. In the case of a malignant tumor, it is necessary to use a second imaging technique besides CEUS. In addition to the detection and characterization of a liver tumor, CT and MRI provide information on the extrahepatic spread of a tumor, particularly into the lung or retroperitoneum. The rapid development of surgical and interventional approaches requires accurate information on the character and number of malignant liver lesions. Therefore, the combined use of CEUS and MDCT or MRI currently represents the most modern and optimal standard of imaging. The standardization of CT and MRI protocols has increased the general diagnostic level of these images. Adequate training and a certificate for the use of CEUS is recommended in order to maintain the high diagnostic level of this method (EFSUMB guide lines). An optimal interdisciplinary imaging strategy for focal liver lesions minimises unnecessary invasive or potentially harmful imaging and reduces health costs.
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Affiliation(s)
- B Boozari
- Abteilung Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, 30625, Carl-Neuberg-Str. 1, Hannover, Germany.
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45
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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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46
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Elsayes KM, Peterson CM, Menias CO. The Central Scar: Pathophysiology and Imaging Features. Curr Probl Diagn Radiol 2007; 36:247-57. [DOI: 10.1067/j.cpradiol.2007.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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47
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Hubert C, Sempoux C, Horsmans Y, Rahier J, Humblet Y, Machiels JP, Ceratti A, Canon JL, Gigot JF. Nodular regenerative hyperplasia: a deleterious consequence of chemotherapy for colorectal liver metastases? Liver Int 2007; 27:938-43. [PMID: 17696932 DOI: 10.1111/j.1478-3231.2007.01511.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
AIMS This report describes three patients suffering from nodular regenerative hyperplasia (NRH). METHODS These patients have received six, 16 and 20 cycles of neoadjuvant 5-fluorouracil and oxaliplatin-based chemotherapy before planned extended hepatectomy. Two patients underwent uneventful portal vein embolization to hypertrophy the future remnant liver. RESULTS At the end of chemotherapy, liver function tests deteriorated and portal hypertension appeared in two patients, including ascites, splenomegaly and oesophageal varices. Liver biopsy was performed through a percutaneous (two patients) or a transjugular approach (one patient) and allowed the diagnosis of NRH, which was considered to be a contraindication for major liver resection in all three patients, associated with extrahepatic disease progression in one patient. All patients died from neoplastic disease progression despite further chemotherapy at 6, 17 and 31 months following the diagnosis of NRH. One patient developed liver failure and ascites at the time of death. CONCLUSIONS Physicians should be aware of the potential occurrence and therapeutic impact of NRH in patients suffering from CRLM and treated by neoadjuvant 5FU-oxaliplatin-based chemotherapy before major liver surgery.
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Affiliation(s)
- Catherine Hubert
- Department of Abdominal Surgery and Transplantation, Division of Hepato-Biliary and Pancreatic Surgery, Saint-Luc University Hospital, Université Catholique de Louvain (UCL), Brussels, Belgium
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Abstract
A liver incidentaloma corresponds to a liver lesion detected during work-up of for unrelated pathology. The frequency of incidentalomas is directly related to the incidence of liver tumors in the general population. After detection of an incidental liver lesion, the goal is to assess if diagnosis can be made based on imaging features alone or if biopsy is required. As such, radiologists must be familiar with the imaging features of different types of liver lesions, irrespective of the imaging modality. US is useful to determine the number of lesions (single versus multiple) and the cystic or solid nature of each lesion. Cystic lesions are usually benign. Incidental solid liver lesions are typically benign, but detection of a malignant lesion, hepatocellular carcinoma and metastases, is possible. The most frequent benign incidental solid liver lesions are hemangioma, focal nodular hyperplasia and liver cell adenoma. Accurate imaging diagnosis may not always be achievable, and biopsy, percutaneous or surgical, may be required.
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Affiliation(s)
- B Gallix
- Service d'Imagerie Médicale, Hôpital Saint Eloi, CHU de Montpellier, 80, avenue Augustin Fliche, 34295 Montpellier Cedex 5.
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Dietrich CF, Mertens JC, Braden B, Schuessler G, Ott M, Ignee A. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007; 45:1139-45. [PMID: 17464990 DOI: 10.1002/hep.21615] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
UNLABELLED Differentiation of small and atypical hemangiomas from other hepatic masses using imaging methods can be difficult, especially in patients with underlying malignant disease. Therefore, contrast-enhanced ultrasound was assessed in patients with histologically confirmed hemangiomas with respect to contrast-enhancing kinetics and tumor characteristics. In 58 patients with indeterminate hepatic lesions demonstrated with at least 2 imaging methods (ultrasound/computed tomography/magnetic resonance imaging), ultrasound-guided liver biopsy revealed hemangioma. In all patients a hepatic neoplasm had been suspected because of underlying malignant disease (n=41), liver cirrhosis (n=15), or growth of the lesion (n=2). All patients underwent nonlinear, low mechanical index real-time contrast-enhanced ultrasound scanning with bolus injections of SonoVue. Peripheral nodular arterial enhancement was detected in 43 patients (74%), whereas the typical metastatic peripheral rim-like enhancement was not observed at all. Strong homogenous arterial enhancement was found in 9 of 58 (16%) patients. In 6 patients (10%), the arterial contrast enhancement pattern could not be determined because of the very small size of the lesions or fibrotic nodules. Forty-five (78%) of the hemangiomas showed homogenous centripetal filling within 180 seconds. CONCLUSION Contrast-enhanced ultrasound demonstrates typical hemangioma imaging characteristics, that is, peripheral nodular contrast enhancement and iris-diaphragm sign in a high percentage of patients with undetermined lesions. This technique may therefore improve noninvasive functional characterization and differentiation of hemangiomas.
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Affiliation(s)
- Christoph F Dietrich
- Second Department of Internal Medicine, Caritas Hospital Bad Mergentheim, Bad Mergentheim, Germany.
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50
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Colli A, Fraquelli M, Massironi S, Colucci A, Paggi S, Conte D. Elective surgery for benign liver tumours. Cochrane Database Syst Rev 2007; 2007:CD005164. [PMID: 17253542 PMCID: PMC8865609 DOI: 10.1002/14651858.cd005164.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Benign liver tumours (haemangioma, focal nodular hyperplasia, and hepatic adenoma) have different prevalence and prognosis. Spontaneous rupture and malignant transformation can complicate hepatic adenoma. Elective surgery is controversial, and indications are represented by uncertain diagnosis, presence of symptoms, and prevention of major complications. OBJECTIVES To assess the beneficial and harmful effects of elective surgery of benign liver tumours. We identified 31 cases series. These were small (with less than 60 participants) and the types of tumours mixed. These studies reported no significant mortality, but in the six studies with mortality it ranged from 1% to 17%. SEARCH STRATEGY The Cochrane Hepato-Biliary Group Controlled Trials Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (searches in Issue 1, 2006), MEDLINE, EMBASE, CancerLit, and Science Citation Index Expanded (SCI-EXPANDED) (searched December 2005). A further search included the proceedings of major hepatological and surgical congresses (Annual Meetings of the American Association for the Study of the Liver (AASLD) and European Association for the Study of the Liver (EASL)), and examination of the references of relevant papers and reference lists of the identified studies. SELECTION CRITERIA Randomised clinical trials in adult patients with benign liver tumours without indications for emergency surgery in which elective surgery (resection) versus no intervention or sham operation are compared. DATA COLLECTION AND ANALYSIS All trials identified through searches were evaluated for eligibility for inclusion. We intended to extract relevant data in order to analyse the outcomes as per our published protocol using intention-to-treat analysis. MAIN RESULTS We could not identify any randomised clinical trials. AUTHORS' CONCLUSIONS We were unable to find evidence supporting or refuting elective surgery for patients with benign liver tumours. We need large, long-term randomised clinical trials with adequate methodology to assess the benefits and harms of elective surgery.
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Affiliation(s)
- A Colli
- Ospedale "A Manzoni" Lecco, Department of Internal Medicine, Via dell'Eremo, 9/11, Lecco, Italy, 23900.
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