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Zhou CM, Cao J, Chen SK, Tuxun T, Apaer S, Wu J, Zhao JM, Wen H. Retrospective analysis based on a clinical grading system for patients with hepatic hemangioma: A single center experience. World J Gastrointest Surg 2024; 16:2047-2053. [PMID: 39087105 PMCID: PMC11287709 DOI: 10.4240/wjgs.v16.i7.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 07/22/2024] Open
Abstract
BACKGROUND The optimal approach for managing hepatic hemangioma is controversial. AIM To evaluate a clinical grading system for management of hepatic hemangioma based on our 17-year of single institution experience. METHODS A clinical grading system was retrospectively applied to 1171 patients with hepatic hemangioma from January 2002 to December 2018. Patients were classified into four groups based on the clinical grading system and treatment: (1) Observation group with score < 4 (Obs score < 4); (2) Surgical group with score < 4 (Sur score < 4); (3) Observation group with score ≥ 4 (Obs score ≥ 4); and (4) Surgical group with score ≥ 4 (Sur score ≥ 4). The clinico-pathological index and outcomes were evaluated. RESULTS There were significantly fewer symptomatic patients in surgical groups (Sur score ≥ 4 vs Obs score ≥ 4, P < 0.001; Sur score < 4 vs Obs score < 4, χ² = 8.60, P = 0.004; Sur score ≥ 4 vs Obs score < 4, P < 0.001). The patients in Sur score ≥ 4 had a lower rate of in need for intervention and total patients with adverse event than in Obs score ≥ 4 (P < 0.001; P < 0.001). Nevertheless, there was no significant difference in need for intervention and total patients with adverse event between the Sur score < 4 and Obs score < 4 (P > 0.05; χ² = 1.68, P > 0.05). CONCLUSION This clinical grading system appeared as a practical tool for hepatic hemangioma. Surgery can be suggested for patients with a score ≥ 4. For those with < 4, follow-up should be proposed.
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Affiliation(s)
- Cheng-Ming Zhou
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jun Cao
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shao-Ke Chen
- Department of Operation Management, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerhongjiang Tuxun
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Shadike Apaer
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jing Wu
- Department of General Surgery, The First Teaching College, Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Jin-Ming Zhao
- Department of Liver and Laparoscopic Surgery, Digestive and Vascular Surgery Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Hao Wen
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Cmarková K, Nosáková L, Pindura M, Vojtko M, Bánovčin P, Miklušica J. Rare Benign Focal Lesions of the Liver: Report of 2 Cases and Literature Review. Case Rep Gastroenterol 2024; 18:90-97. [PMID: 38439817 PMCID: PMC10911787 DOI: 10.1159/000536111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/12/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction Benign lesions of the liver are very common findings, usually randomly discovered, especially during examinations for other indications. The frequent use of imaging modalities may be responsible for the statistical increase in the incidence of these findings. Case Presentation In this publication, we present the cases of 2 female patients with benign liver lesions, the occurrence of which is considered rare, and only a few dozen cases have been described worldwide. In both cases, clinical symptoms, diagnostic approach, and surgical treatment are presented. Conclusion Due to increasing availability of imaging methods, the occurrence of previously considered rare benign liver lesions increases as well. In many cases, the malignant potential of these findings remains unclear. Decision-making process should include a multidisciplinary board.
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Affiliation(s)
- Kristína Cmarková
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Lenka Nosáková
- Clinic of Internal Medicine – Gastroenterology, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Miroslav Pindura
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Martin Vojtko
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Peter Bánovčin
- Clinic of Internal Medicine – Gastroenterology, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
| | - Juraj Miklušica
- Clinic of General, Visceral and Transplant Surgery, JFM CU, Jessenius Faculty of Medicine in Martin (JFM CU), Comenius University in Bratislava, Bratislava, Slovakia
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Naumchik B, Weigel BJ, Murati MA, Rudzinski E, Paulson V, Lockwood CM, Dolan M, Flanagan S, Luquette M. Congenital Infantile Fibrosarcoma Involving Pelvic Wall and Thigh Soft Tissues and Placenta, Presenting with Coagulopathy. Pediatr Dev Pathol 2022; 25:656-660. [PMID: 35834223 DOI: 10.1177/10935266221114017] [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: 12/14/2022]
Abstract
Infantile fibrosarcoma (IF) is a well characterized pediatric malignancy marked by gene rearrangements involving members of the NTRK family. In this report, we present a case of IF that presented in the inguinal region-proximal thigh and was initially thought to be a kaposiform hemangioendothelioma (KHE) because it presented with a bleeding diathesis thought to be Kasabach-Merritt phenomenon (KMP). Subsequently, the placental examination showed a neoplasm in the perivascular-subendothelial space of stem villi, initially thought to be myofibromatosis. Ultimately, a biopsy of the thigh mass showed IF with an NTRK3-ETV6 fusion. Subsequent FISH analysis of the placenta showed an ETV6 rearrangement confirming that it was also IF. Review of the laboratory studies suggests that disseminated intravascular coagulation may have been more likely than KMP, highlighting the difficulty in making this distinction in some cases. We believe this to be the first report of an IF presenting in a soft tissue site and the placenta, and discuss the possible mechanisms that could have allowed the IF in the leg to spread to the placenta.
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Affiliation(s)
- Brianna Naumchik
- Pathology, 5635University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Brenda J Weigel
- Pediatrics, Division of Pediatric Hematology and Oncology, 5635University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Michael A Murati
- Radiology, 5635University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Erin Rudzinski
- Pathology, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Vera Paulson
- Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Christina M Lockwood
- Laboratory Medicine and Pathology, 7284University of Washington, Seattle, WA, USA
| | - Michelle Dolan
- Pathology, 5635University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Siobhan Flanagan
- Interventional Radiology, 5635University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Mark Luquette
- Pediatric and Perinatal Pathology, 5635University of Minnesota Twin Cities, Minneapolis, MN, USA
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4
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Cutaneous and giant hepatic haemangioma associated with Kasabach-Merritt syndrome in an adult patient with discoid lupus erythematosus. Postepy Dermatol Alergol 2021; 38:909-911. [PMID: 34849144 PMCID: PMC8610044 DOI: 10.5114/ada.2021.110150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 03/03/2020] [Indexed: 11/17/2022] Open
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Dane B, Shanbhogue K, Menias CO, Taffel MT. The humbling hemangioma: uncommon CT and MRI imaging features and mimickers of hepatic hemangiomas. Clin Imaging 2021; 74:55-63. [PMID: 33434867 DOI: 10.1016/j.clinimag.2020.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, Department of Radiology, United States of America.
| | | | - Christine O Menias
- Mayo Clinic, Department of Radiology, Scottsdale, AZ, United States of America
| | - Myles T Taffel
- NYU Langone Health, Department of Radiology, United States of America
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Tangled Up in Red Cells: A Large Liver Mass with Intravascular Hemolysis. Dig Dis Sci 2020; 65:1960-1963. [PMID: 32394332 DOI: 10.1007/s10620-020-06311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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7
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Giant Liver Hemangiomas: A Plea for Early Surgical Referral and Resection. Case Rep Surg 2020; 2020:5923787. [PMID: 32607273 PMCID: PMC7315262 DOI: 10.1155/2020/5923787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/23/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022] Open
Abstract
Hepatic hemangiomas are the most common benign hepatic tumor. Current guidelines recommend surveillance imaging and reserving surgical intervention for symptomatic patients with giant liver hemangiomas (>5 cm). We present the case of a patient with a rapidly enlarging giant hepatic hemangioma initially managed by surveillance. During her observation period, she developed weight loss, constipation, and pancytopenia concerning for Kasabach-Merritt Syndrome. Resection of the hemangioma was complicated by its large size (28.0×18.0×11.4 cm). Patients with rapidly growing giant liver hemangiomas, even when asymptomatic, should be promptly referred to specialized surgical centers for evaluation and management.
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Mamone G, Di Piazza A, Carollo V, Cannataci C, Cortis K, Bartolotta TV, Miraglia R. Imaging of hepatic hemangioma: from A to Z. Abdom Radiol (NY) 2020; 45:672-691. [PMID: 31686179 DOI: 10.1007/s00261-019-02294-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.
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Affiliation(s)
- Giuseppe Mamone
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy.
| | - Ambra Di Piazza
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | - Vincenzo Carollo
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
| | | | - Kelvin Cortis
- Department of Radiology, Mater Dei Hospital, Msida, Malta
| | - Tommaso Vincenzo Bartolotta
- Dipartimento di Biomedicina, neuroscienze e diagnostica avanzata (Bi.ND) - Università degli studi di Palermo, Palermo, Italy
| | - Roberto Miraglia
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), via Tricomi 5, 90127, Palermo, Italy
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Abstract
Hepatic hemangioma is common among benign liver tumors and usually grows slowly. About 50-70% of hepatic hemangiomas are asymptomatic, and management is not necessary; however, management should be considered in symptomatic patients. The optimal management of symptomatic hepatic hemangioma depends on multiple factors. Invasive management of symptomatic hepatic hemangioma mainly consists of surgery and interventional radiology, including transarterial embolization, ablation, percutaneous sclerotherapy, and percutaneous argon-helium cryotherapy. Although both surgery and interventional radiology are promising in the management of symptomatic hepatic hemangioma, multiple and/or giant hemangiomas represent a clinical dilemma because the complication rate and recurrence rate are relatively high, and symptom relief is not always achieved. However, a review of recent advances in treatment is lacking. We therefore summarized the current invasive management techniques for symptomatic hepatic hemangioma to potentially facilitate clinical decision-making.
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Affiliation(s)
- Wenfang Dong
- Department of Liver Surgery, Peking Union Medical College.,The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Qiu
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College
| | - Leren He
- The Seventh Department of Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Affiliation(s)
- Kolar Vishwanath Vinod
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of General Medicine, Pondicherry, India
| | - Joseph Johny
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of General Medicine, Pondicherry, India
| | - Mehalingam Vadivelan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of General Medicine, Pondicherry, India
| | - Abdoul Hamide
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Department of General Medicine, Pondicherry, India
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A case of an elderly female with diffuse hepatic hemangiomatosis complicated with multiple organic dysfunction and Kasabach-Merritt syndrome. Clin J Gastroenterol 2018; 11:411-416. [PMID: 29845554 DOI: 10.1007/s12328-018-0871-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/22/2018] [Indexed: 02/07/2023]
Abstract
Since diffuse hepatic hemangiomatosis (DHH) is an extremely rare disease especially in adults, the etiology and natural course of adult-onset DHH has not been well understood. We report a case of DHH complicated with multiple organic dysfunction and Kasabach-Merritt syndrome (KMS) in an 83-year-old female. She presented with mild abdominal distension and laboratory findings revealed thrombocytopenia and abnormal coagulation, indicating disseminated intravascular coagulation (DIC). Enhanced computed tomography revealed diffuse, hypodense hepatic nodules with delayed enhancement involving the whole liver, and multiple hypodense splenic legions. To obtain a definitive diagnosis, laparoscopic-guided biopsy was performed. Histological findings revealed irregularly dilated non-anastomotic vascular spaces, which were lined with flat endothelial cells without cellular atypia. We diagnosed this as DHH complicated with splenic lesions and KMS. Although the patient was treated with symptomatic treatment, such as anti-coagulation therapy, hemangiomatous lesions, especially in the spleen, progressed rapidly, leading to worsening of DIC. Finally, the patient died of multiple organ failure at 12 months after diagnosis. A postmortem examination demonstrated diffuse hemangiomatosis of not only the liver and spleen, but also the adrenal glands and bone marrow. Despite no malignant histologically, DHH can be fatal if it progresses rapidly within a short period of time.
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