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Hepatic hemangioma

Authors
Michael P Curry, MD
Sanjiv Chopra, MD, MACP
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Hepatic hemangiomas (also referred to as cavernous hemangiomas because of the cavernous vascular space seen histologically) are the most common benign mesenchymal hepatic tumors. In one series of 549 patients referred for magnetic resonance imaging for evaluation of focal hepatic lesion(s), 585 of 805 lesions (72 percent) were hemangiomas [1].

Hemangiomas are often solitary, but multiple lesions may be present in both the right and left lobe of the liver in up to 40 percent of patients [2]. They range in size from a few millimeters to over 20 cm. The majority are small (<5 cm). Those larger than 5 cm have been referred to as giant hemangiomas [3,4].

Most patients with hepatic hemangiomas are asymptomatic and have an excellent prognosis. Symptoms are more likely with large lesions. The diagnosis is often considered in patients found to have a focal liver lesion in whom hemangiomas need to be distinguished from other tumors. An approach to such patients is presented separately. (See "Solid liver lesions: Differential diagnosis and evaluation".)

EPIDEMIOLOGY AND PATHOGENESIS

Estimates of the prevalence of hepatic hemangiomas have ranged from 0.4 to 20 percent [5-8]. The highest estimates have been derived from autopsy studies, suggesting that these lesions are common in the general population [5,9]. This observation is confirmed by the increasing recognition of hemangiomas in asymptomatic patients undergoing radiologic imaging tests of the abdomen for other reasons.

Although they can be diagnosed at any age, 60 to 80 percent of cases are diagnosed in patients who are between the ages of 30 and 50 years. In adults, hemangiomas occur more frequently in women with a ratio of 3:1 [6,10]. Lesions responsible for symptoms are more likely in young women [4].

                   

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Literature review current through: Nov 2016. | This topic last updated: Fri Apr 24 00:00:00 GMT+00:00 2015.
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References
Top
  1. John TG, Greig JD, Crosbie JL, et al. Superior staging of liver tumors with laparoscopy and laparoscopic ultrasound. Ann Surg 1994; 220:711.
  2. Tait N, Richardson AJ, Muguti G, Little JM. Hepatic cavernous haemangioma: a 10 year review. Aust N Z J Surg 1992; 62:521.
  3. Adam YG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg 1970; 172:239.
  4. Grieco MB, Miscall BG. Giant hemangiomas of the liver. Surg Gynecol Obstet 1978; 147:783.
  5. Karhunen PJ. Benign hepatic tumours and tumour like conditions in men. J Clin Pathol 1986; 39:183.
  6. Gandolfi L, Leo P, Solmi L, et al. Natural history of hepatic haemangiomas: clinical and ultrasound study. Gut 1991; 32:677.
  7. Ishak KG, Rabin L. Benign tumors of the liver. Med Clin North Am 1975; 59:995.
  8. Gilon D, Slater PE, Benbassat J. Can decision analysis help in the management of giant hemangioma of the liver? J Clin Gastroenterol 1991; 13:255.
  9. Craig JR, Peters RL, Edmondson HA. Tumors of the liver and intrahepatic bile ducts. In: Atlas of tumor pathology, Armed Forces Institute of Pathology, Washington, DC 1958. Vol 25, p.19.
  10. Farges O, Daradkeh S, Bismuth H. Cavernous hemangiomas of the liver: are there any indications for resection? World J Surg 1995; 19:19.
  11. Saegusa T, Ito K, Oba N, et al. Enlargement of multiple cavernous hemangioma of the liver in association with pregnancy. Intern Med 1995; 34:207.
  12. Graham E, Cohen AW, Soulen M, Faye R. Symptomatic liver hemangioma with intra-tumor hemorrhage treated by angiography and embolization during pregnancy. Obstet Gynecol 1993; 81:813.
  13. Winkfield B, Vuillemin E, Rousselet MC, et al. [Progression of a hepatic hemangioma under progestins]. Gastroenterol Clin Biol 2001; 25:108.
  14. Conter RL, Longmire WP Jr. Recurrent hepatic hemangiomas. Possible association with estrogen therapy. Ann Surg 1988; 207:115.
  15. Glinkova V, Shevah O, Boaz M, et al. Hepatic haemangiomas: possible association with female sex hormones. Gut 2004; 53:1352.
  16. Lehmann FS, Beglinger C, Schnabel K, Terracciano L. Progressive development of diffuse liver hemangiomatosis. J Hepatol 1999; 30:951.
  17. DuPre CT, Fincher RM. Case report: cavernous hemangioma of the liver. Am J Med Sci 1992; 303:241.
  18. Baer HU, Dennison AR, Mouton W, et al. Enucleation of giant hemangiomas of the liver. Technical and pathologic aspects of a neglected procedure. Ann Surg 1992; 216:673.
  19. Mathieu D, Zafrani ES, Anglade MC, Dhumeaux D. Association of focal nodular hyperplasia and hepatic hemangioma. Gastroenterology 1989; 97:154.
  20. Toshikuni N, Kawaguchi K, Miki H, et al. Focal nodular hyperplasia coexistent with hemangioma and multiple cysts of the liver. J Gastroenterol 2001; 36:206.
  21. Goodman Z. Benign Tumors of the Liver. In: Neoplasms of the liver, Okuda K, Iskah E (Eds), Springer-Verlag, Tokyo 1987. p.105.
  22. Kuo PC, Lewis WD, Jenkins RL. Treatment of giant hemangiomas of the liver by enucleation. J Am Coll Surg 1994; 178:49.
  23. Pateron D, Babany G, Belghiti J, et al. Giant hemangioma of the liver with pain, fever, and abnormal liver tests. Report of two cases. Dig Dis Sci 1991; 36:524.
  24. Kristidis P, de Silva M, Howman-Giles R, Gaskin KJ. Infantile hepatic haemangioma: investigation and treatment. J Paediatr Child Health 1991; 27:57.
  25. Bruce S, Downe L, Devonald K, Ellwood D. Noninvasive investigation of infantile hepatic hemangioma: a case study. Pediatrics 1995; 95:595.
  26. Luks FI, Yazbeck S, Brandt ML, et al. Benign liver tumors in children: a 25-year experience. J Pediatr Surg 1991; 26:1326.
  27. Huang SA, Tu HM, Harney JW, et al. Severe hypothyroidism caused by type 3 iodothyronine deiodinase in infantile hemangiomas. N Engl J Med 2000; 343:185.
  28. Canty KM, Horii KA, Ahmad H, et al. Multiple cutaneous and hepatic hemangiomas in infants. South Med J 2014; 107:159.
  29. Hughes JA, Hill V, Patel K, et al. Cutaneous haemangioma: prevalence and sonographic characteristics of associated hepatic haemangioma. Clin Radiol 2004; 59:273.
  30. Mikami T, Hirata K, Oikawa I, et al. Hemobilia caused by a giant benign hemangioma of the liver: report of a case. Surg Today 1998; 28:948.
  31. Kadry Z, Mentha G, Cereda JM. Polymyalgia rheumatica as a manifestation of a large hepatic cavernous hemangioma. J Hepatol 2000; 32:358.
  32. Moon WS, Yu HC, Lee JM, Kang MJ. Diffuse hepatic hemangiomatosis in an adult. J Korean Med Sci 2000; 15:471.
  33. Haitjema T, Westermann CJ, Overtoom TT, et al. Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu disease): new insights in pathogenesis, complications, and treatment. Arch Intern Med 1996; 156:714.
  34. Feurle GE. Arteriovenous shunting and cholestasis in hepatic hemangiomatosis associated with metoclopramide. Gastroenterology 1990; 99:258.
  35. Mungovan JA, Cronan JJ, Vacarro J. Hepatic cavernous hemangiomas: lack of enlargement over time. Radiology 1994; 191:111.
  36. Yamagata M, Kanematsu T, Matsumata T, et al. Management of haemangioma of the liver: comparison of results between surgery and observation. Br J Surg 1991; 78:1223.
  37. Giuliante F, Ardito F, Vellone M, et al. Reappraisal of surgical indications and approach for liver hemangioma: single-center experience on 74 patients. Am J Surg 2011; 201:741.
  38. Gibney RG, Hendin AP, Cooperberg PL. Sonographically detected hepatic hemangiomas: absence of change over time. AJR Am J Roentgenol 1987; 149:953.
  39. Hasan HY, Hinshaw JL, Borman EJ, et al. Assessing normal growth of hepatic hemangiomas during long-term follow-up. JAMA Surg 2014; 149:1266.
  40. Nghiem HV, Bogost GA, Ryan JA, et al. Cavernous hemangiomas of the liver: enlargement over time. AJR Am J Roentgenol 1997; 169:137.
  41. Yoshida J, Yamasaki S, Yamamoto J, et al. Growing cavernous haemangioma of the liver: 11-fold increase in volume in a decade. J Gastroenterol Hepatol 1991; 6:414.
  42. Scribano E, Loria G, Ascenti G, et al. Spontaneous hemoperitoneum from a giant multicystic hemangioma of the liver: a case report. Abdom Imaging 1996; 21:418.
  43. Yamamoto T, Kawarada Y, Yano T, et al. Spontaneous rupture of hemangioma of the liver: treatment with transcatheter hepatic arterial embolization. Am J Gastroenterol 1991; 86:1645.
  44. Mazziotti A, Jovine E, Grazi GL, et al. Spontaneous subcapsular rupture of hepatic haemangioma. Eur J Surg 1995; 161:687.
  45. Trastek VF, van Heerden JA, Sheedy PF 2nd, Adson MA. Cavernous hemangiomas of the liver: resect or observe? Am J Surg 1983; 145:49.
  46. Pietrabissa A, Giulianotti P, Campatelli A, et al. Management and follow-up of 78 giant haemangiomas of the liver. Br J Surg 1996; 83:915.
  47. Hotokezaka M, Kojima M, Nakamura K, et al. Traumatic rupture of hepatic hemangioma. J Clin Gastroenterol 1996; 23:69.
  48. Perkins AB, Imam K, Smith WJ, Cronan JJ. Color and power Doppler sonography of liver hemangiomas: a dream unfulfilled? J Clin Ultrasound 2000; 28:159.
  49. Tanaka S, Kitamura T, Fujita M, et al. Color Doppler flow imaging of liver tumors. AJR Am J Roentgenol 1990; 154:509.
  50. Yasuhara K, Kimura K, Ohto M, et al. Pulsed Doppler in the diagnosis of small liver tumours. Br J Radiol 1988; 61:898.
  51. Ohnishi K, Nomura F. Ultrasonic Doppler studies of hepatocellular carcinoma and comparison with other hepatic focal lesions. Gastroenterology 1989; 97:1489.
  52. Leifer DM, Middleton WD, Teefey SA, et al. Follow-up of patients at low risk for hepatic malignancy with a characteristic hemangioma at US. Radiology 2000; 214:167.
  53. Dietrich CF, Mertens JC, Braden B, et al. Contrast-enhanced ultrasound of histologically proven liver hemangiomas. Hepatology 2007; 45:1139.
  54. Yamashita Y, Ogata I, Urata J, Takahashi M. Cavernous hemangioma of the liver: pathologic correlation with dynamic CT findings. Radiology 1997; 203:121.
  55. McFarland EG, Mayo-Smith WW, Saini S, et al. Hepatic hemangiomas and malignant tumors: improved differentiation with heavily T2-weighted conventional spin-echo MR imaging. Radiology 1994; 193:43.
  56. Lee MG, Baker ME, Sostman HD, et al. The diagnostic accuracy/efficacy of MRI in differentiating hepatic hemangiomas from metastatic colorectal/breast carcinoma: a multiple reader ROC analysis using a jackknife technique. J Comput Assist Tomogr 1996; 20:905.
  57. Goshima S, Kanematsu M, Kondo H, et al. Hepatic hemangioma: correlation of enhancement types with diffusion-weighted MR findings and apparent diffusion coefficients. Eur J Radiol 2009; 70:325.
  58. Semelka RC, Brown ED, Ascher SM, et al. Hepatic hemangiomas: a multi-institutional study of appearance on T2-weighted and serial gadolinium-enhanced gradient-echo MR images. Radiology 1994; 192:401.
  59. Kim T, Federle MP, Baron RL, et al. Discrimination of small hepatic hemangiomas from hypervascular malignant tumors smaller than 3 cm with three-phase helical CT. Radiology 2001; 219:699.
  60. Tamm EP, Rabushka LS, Fishman EK, et al. Intrahepatic, extramedullary hematopoiesis mimicking hemangioma on technetium-99m red blood cell SPECT examination. Clin Imaging 1995; 19:88.
  61. Isla C, Ceballos C, Córdoba E, et al. Cavernous hemangioma of the liver. Diagnostic value of 99mTc-labeled red cell scintigraphy: results in 28 patients. Rev Esp Enferm Dig 1997; 89:29.
  62. Moinuddin M, Allison JR, Montgomery JH, et al. Scintigraphic diagnosis of hepatic hemangioma: its role in the management of hepatic mass lesions. AJR Am J Roentgenol 1985; 145:223.
  63. Farlow DC, Chapman PR, Gruenewald SM, et al. Investigation of focal hepatic lesions: is tomographic red blood cell imaging useful? World J Surg 1990; 14:463.
  64. Salvatori M, Meduri G, Manfredi R, et al. [A false negative scintigram in hepatic cavernous hemangioma with extensive thrombotic fibrosis. A case report]. Radiol Med 1994; 88:337.
  65. el-Desouki M, Mohamadiyeh M, al-Rashed R, et al. Features of hepatic cavernous hemangioma on planar and SPECT Tc-99m-labeled red blood cell scintigraphy. Clin Nucl Med 1999; 24:583.
  66. Belli L, De Carlis L, Beati C, et al. Surgical treatment of symptomatic giant hemangiomas of the liver. Surg Gynecol Obstet 1992; 174:474.
  67. Caturelli E, Pompili M, Bartolucci F, et al. Hemangioma-like lesions in chronic liver disease: diagnostic evaluation in patients. Radiology 2001; 220:337.
  68. Brancatelli G, Federle MP, Blachar A, Grazioli L. Hemangioma in the cirrhotic liver: diagnosis and natural history. Radiology 2001; 219:69.
  69. Soyer P, Bluemke DA, Vissuzaine C, et al. CT of hepatic tumors: prevalence and specificity of retraction of the adjacent liver capsule. AJR Am J Roentgenol 1994; 162:1119.
  70. Terriff BA, Gibney RG, Scudamore CH. Fatality from fine-needle aspiration biopsy of a hepatic hemangioma. AJR Am J Roentgenol 1990; 154:203.
  71. Davies R. Haemorrhage after fine-needle aspiration biopsy of an hepatic haemangioma. Med J Aust 1993; 158:364.
  72. Caturelli E, Rapaccini GL, Sabelli C, et al. Ultrasound-guided fine-needle aspiration biopsy in the diagnosis of hepatic hemangioma. Liver 1986; 6:326.
  73. Heilo A, Stenwig AE. Liver hemangioma: US-guided 18-gauge core-needle biopsy. Radiology 1997; 204:719.
  74. Solbiati L, Livraghi T, De Pra L, et al. Fine-needle biopsy of hepatic hemangioma with sonographic guidance. AJR Am J Roentgenol 1985; 144:471.
  75. Taavitsainen M, Airaksinen T, Kreula J, Päivänsalo M. Fine-needle aspiration biopsy of liver hemangioma. Acta Radiol 1990; 31:69.
  76. Brambs HJ, Spamer C, Volk B, et al. Histological diagnosis of liver hemangiomas using ultrasound-guided fine needle biopsy. Hepatogastroenterology 1985; 32:284.
  77. Gedaly R, Pomposelli JJ, Pomfret EA, et al. Cavernous hemangioma of the liver: anatomic resection vs. enucleation. Arch Surg 1999; 134:407.
  78. Ozden I, Emre A, Alper A, et al. Long-term results of surgery for liver hemangiomas. Arch Surg 2000; 135:978.
  79. Popescu I, Ciurea S, Brasoveanu V, et al. Liver hemangioma revisited: current surgical indications, technical aspects, results. Hepatogastroenterology 2001; 48:770.
  80. Lerner SM, Hiatt JR, Salamandra J, et al. Giant cavernous liver hemangiomas: effect of operative approach on outcome. Arch Surg 2004; 139:818.
  81. Fu XH, Lai EC, Yao XP, et al. Enucleation of liver hemangiomas: is there a difference in surgical outcomes for centrally or peripherally located lesions? Am J Surg 2009; 198:184.
  82. Reading NG, Forbes A, Nunnerley HB, Williams R. Hepatic haemangioma: a critical review of diagnosis and management. Q J Med 1988; 67:431.
  83. 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.
  84. Lupinacci RM, Szejnfeld D, Farah JF. Spontaneous rupture of a giant hepatic hemangioma. Sequential treatment with preoperative transcatheter arterial embolization and conservative hepatectomy. G Chir 2011; 32:469.
  85. Jangjoo A, Mehrabi Bahar M, Aliakbarian M. Ruptured giant hepatic hemangioma: report of a case. Acta Med Iran 2010; 48:419.
  86. Akamatsu N, Sugawara Y, Komagome M, et al. Giant liver hemangioma resected by trisectorectomy after efficient volume reduction by transcatheter arterial embolization: a case report. J Med Case Rep 2010; 4:283.
  87. Jain V, Ramachandran V, Garg R, et al. Spontaneous rupture of a giant hepatic hemangioma - sequential management with transcatheter arterial embolization and resection. Saudi J Gastroenterol 2010; 16:116.
  88. Seo HI, Jo HJ, Sim MS, Kim S. Right trisegmentectomy with thoracoabdominal approach after transarterial embolization for giant hepatic hemangioma. World J Gastroenterol 2009; 15:3437.
  89. Longeville JH, de la Hall P, Dolan P, et al. Treatment of a giant haemangioma of the liver with Kasabach-Merritt syndrome by orthotopic liver transplant a case report. HPB Surg 1997; 10:159.
  90. Tepetes K, Selby R, Webb M, et al. Orthotopic liver transplantation for benign hepatic neoplasms. Arch Surg 1995; 130:153.
  91. Russo MW, Johnson MW, Fair JH, Brown RS Jr. Orthotopic liver transplantation for giant hepatic hemangioma. Am J Gastroenterol 1997; 92:1940.
  92. Ezekowitz RA, Mulliken JB, Folkman J. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy. N Engl J Med 1992; 326:1456.
  93. Gaspar L, Mascarenhas F, da Costa MS, et al. Radiation therapy in the unresectable cavernous hemangioma of the liver. Radiother Oncol 1993; 29:45.
  94. Deutsch GS, Yeh KA, Bates WB 3rd, Tannehill WB. Embolization for management of hepatic hemangiomas. Am Surg 2001; 67:159.
  95. Marques R, Taborda F, Jorge CS, et al. Successful outcome in a pregnancy complicated by large hepatic hemangioma. Acta Obstet Gynecol Scand 1997; 76:606.
  96. Cobey FC, Salem RR. A review of liver masses in pregnancy and a proposed algorithm for their diagnosis and management. Am J Surg 2004; 187:181.