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