with this condition (HH that measure more than 10cm) are more susceptible to present symptoms and complications [2].
EpidemiologyIt is the second most common tumor in the liver after metastasis and represents 73% of all benign liver tumors, although its frequency in autopsy studies is less than 0.4% [2,3], some studies indicate that its prevalence and incidence can reach 20% and 7% of the general population, respectively [3,4].Generally, these tumors affect adult women in their third and fifth decade of life, mainly multiparous women. However, it is important to mention that it can occur at any age of life [3,5]. The female to male ratio ranging from 3: 1 to 5: 1 according to preview studies [2][3][4][5].
EtiopathogenesisThe etiopathogenesis of HH is not yet fully understood, however, it has been postulated that they are vascular malformations or hamartomas of congenital origin that are produced secondary to an intense ectasia due to hypertrophy or vascular hyperplasia [5]. There are different theories about the genetic component: Moser C et al. [6] reported the case of an Italian family, where three female members in three successive generations had symptoms related with HH and two other relatives showed asymptomatic HH on ultrasound. Likewise, Diez Redondo P et al. [7] reported a family in which six members from three successive generations presented HH, suggesting that a clear family component might exist.Women's disease preference may be explain by the expressiveness of a presumed "HH gene", proliferate factors are the condition of been a woman, increased production of female sex hormones (during puberty or pregnancy) or the use of oral contraceptives. In fact, there are reports of growth and rupture of these tumors during pregnancy or in menopausal women undergoing hormonal treatment [2,5].
Clinical FeaturesIn most cases HH do not present symptoms, they are most likely to be discovered incidentally during imaging studies for other unrelated conditions and if they present symptoms, they are nonspecific common symptoms to many other diseases of digestive origin (nausea, pain, abdominal distention, early satiety) [4]. Some authors report that there is a close relationship between tumor size and the presence of symptoms, 40% of the patients present symptoms in cases that hemangiomas measure more than 4 cm and 90% in cases that hemangiomas measure more than 10 cm denominated giant hepatic hemangiomas (HHG). Mainly symptoms are upper abdominal pain usually mild, but that can become severe in cases of thrombosis or bleeding within the lesion, which stretches and inflames Glisson's capsule [5].Physical examination is usually normal without significant findings, only rarely the hemangioma is presented as a large abdominal mass and an arterial murmur in the upper quadrant (Figure 1). Complications will depend on the location of the tumor and is generally present in cases of giant hemangiomas (HHG). It has been described circulatory shock and hemoperitoneum with
Review ArticleGastroenterol Hepatol Open Access 2017, 7...
