Giant cavernous hemangiomas: Diagnosis and surgical strategies

Abstract

From January, 1972 to June, 1989, 51 patients with liver hemangiomas (32 females and 19 males, mean age 35 years) were evaluated for surgical treatment. Diameters of the masses were 5 cm to 20 cm (median 8.5 cm). Nine of the patients had already been treated for cancer. Twenty-two (43.1%) of the 51 patients were symptomatic and 29 (56.9%) patients were asymptomatic. In 34 patients (66.7%) a definite diagnosis of hemangioma was made by scintiscan and/or ultrasound and/or computed tomography and/or angiography while in the remaining 17 (33.3%) patients the diagnosis was uncertain. The most common indications for resection were the presence of a symptomatic angioma, a symptomatic mass with an uncertain diagnosis, and/or lack of a definite pre-operative diagnosis. Surgery was performed on 25 patients. Ten anatomic and 15 atypical resections or enucleations were performed. There were no postoperative deaths. Two further patients, operated for probable hemangioma, were found to have primary hepatic malignancies. In the 26 unresected patients, no complications were observed during follow-up. In 3 patients, hemangioma enlargement was detected by ultrasound, but there were no symptoms. As cavernous liver hemangiomas are now more reliably diagnosed and their natural history is usually uneventful, surgery can be avoided in most cases. However, when a non-resection policy is adopted, an exact diagnosis is essential in order to rule out primary or metastatic cancer. Surgical exploration and treatment should be limited to symptomatic or complicated cases as well as to patients with an uncertain diagnosis.

Late results after resection of benign hepatic tumors: clinical and radiological findings

“…Because the majority of them, such as hemangiomas and dysontogenetic cysts, usually do not require surgery, there are only few studies on the long-term outcome of liver surgery for hemangiomas, FNH, and adenomas [7,8,11,31,33,37]. Our results are supported by the study of Lise and coworkes [12] who examined 25 patients after resection of hepatic hemangiomas from 1972 to 1989. The yearly US examinations did not reveal any recurrences.…”

“…As with their primary counterparts, the tumors are often asymptomatic [11,12,33,37]. The radiological diagnostics in patients following resection of benign liver lesions poses the same problems as in diagnosis of the primary tumors.…”

“…The radiological diagnostics in patients following resection of benign liver lesions poses the same problems as in diagnosis of the primary tumors. Small hepatic tumors may be missed, and it may be difficult to define the nature of the liver tumor with a sufficiently high degree of confidence [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. In a prospective study by Lü ning and coworkers [13] US had an accuracy of 69 %, CT had an accuracy of 73 %, and MRI had an accuracy of 80 % in demonstrating the type of lesion.…”

“…Although various imaging techniques are quite accurate in identifying uncomplicated cysts and hemangiomas, other benign lesions, such as liver cell adenoma and focal nodular hyperplasia (FNH), cannot be differentiated from a malignant tumor with a high degree of confidence [1-6, 9, 10, 14-18]. Reported indications for surgical resection are palpable masses, significant symptoms, uncertain diagnosis, or the presence of complications such as rapid growth, impending rupture, or internal bleeding [7,8,12,[22][23][24]. As a rule, only a few patients with benign hepatic masses are candidates for liver surgery.…”

“…Reports on the long-term outcome after benign hepatic resections are scarce and contradictory [12,23,[28][29][30][31][32][33]. Because the total removal of a benign mass is generally considered to be curative, there are no standardized postoperative follow-up schemes comparable to the conditions in malignant disease.…”