Liver Hemangiomas

The Common Vein

Copyright 2010

Definition

hemangioma is most common benign neoplasm of the liver caused by unknown originating in connective tissue or vascular components resulting in focal mass characterised by soft, compressible and vascular nature pathogenesis new tissue growth continues but with no obvious progression structurally characterised by being space occupying functionally characterised by usually being of no significance clinical presentation usually of no clinical significance diagnostic studies include US, CT, MRI treatment is commonly by no Rx, surgery if symptomatic

Overview

hemangioma
is
most common
benign neoplasm of the liver

cause
unknown
originating in
connective tissue or vascular
components

resulting in
focal mass

characterised by
soft, compressible and
vascular nature

pathogenesis
new tissue growth
continues but with
no obvious progression

structurally characterised by being
space occupying

functionally characterised by
usually being of
no significance

clinical presentation
usually of
no clinical significance

diagnostic studies include
US, CT, MRI

treatment is commonly by
no Rx, surgery if symptomatic

Principles

benign
vasclar
gowth
tube
focal mass

General

do not usually enlarge
sometimes grow in pregnancy

Statistics

In one series of 549 patients referred for MRI for evaluation of focal hepatic lesion(s), 585 of 805 lesions (72 percent) were hemangiomas [1].

2% population (Wolf )

4% autopsy

7.4% prevalence at necropsy (Wolf )

Sex Distribution

M:F > 1

Age Distribution

adults more common

Pathogenesis

unknown
? Hamartoma

Complications

rupture – rare

giant hemangiomas may be complicated by a
consumptive coagulopaty

Natural History

natural history
most
remain unchanged

may enlarge in short time
if they bleed or undergo
proliferative change
during pregnancy

Gross Pathology

size

small <5cms (mms-20 cms)
giant hemangiomas
single or multiple
peripheral
straight borders or
scalloped border

right lobe more common

red
soft
compressible
honeycomb cut surface
centre
homogeneous or
thrombus or
fibrosis or
necrosis or
calcification

Histopathology

blood filled space
lining
single layer
flat endothelium
stroma
septa separating spaces are
thin
incomplete
myxoid
larger septa show
arteries
bile ducts

thrombus
fibrosis
calcification

Clinical Presentation

asymptomatic except giant hemangioma

Imaging

MRI
single best
CT
cotton wool peripheral puddle,
progressive fill in,
isodense 15′-30′
US – hyperechoic
NM
tagged rbc
highly specific

Treatment

? role of st

 giant hemangioma is an uncommon benign vascular growth of the liver cause unknown originating in stromal vascular elements of the liver resulting in focal mass characterised by endothelial lined blood filled cavernous spaces characterised by being greater than 10 cms asymptomatic nature lack of any significant growth pathogenesis new cell growth continues slowly? structurally characterised by being large space occupying functionally characterised by usually being of no significance clinical presentation usually of no clinical significance diagnostic studies include US, CT, MRI treatment is commonly by no Rx, surgery if symptomatic

References

Craig, J.R. Peters, R.L., Edmonson, H.A.,
Tumors of the Liver and Intrahepatic Bile Ducts
Publishers Armed Forces Institute of Pathology, 1989.

Netter, Frank H., MD. The CIBA Collection of Medical Illustrations. Volume 2. A Compilation of Paintings on the Normal and Pathologic Anatomy of the Reproductive System. CIBA Pharmaceutical Company, Rochester, NY, 1965.

Harrison’s Principles of Internal Medicine, McGraw Hill, 1995

Cotran, R.S., Kumar, V., Robbins, S.L., Robbins Pathologic Basis of Disease 5th Edition, W. B. Saunders, Philadelphia, 1994

Wolf David Raghuraman U Hemangiomas Hepatic e Medicine