Giant cavernous hepatic hemangioma shrunk by use of sorafenib

Abstract

Here we report a case of a 76-year-old man with a giant cavernous hepatic hemangioma of more than 20 cm in diameter. Since the hepatic hemangioma was actually growing and might possibly rupture and he complained of abdominal symptoms, we decided to perform interventional therapy. First we performed transcatheter arterial embolization (TAE) of the hepatic arteries. However, since this was not sufficiently effective, we added sorafenib (600 mg/day). As a result, the tumor shrank with symptomatic improvement. Subsequently, an adverse event occurred, and we suspended the sorafenib therapy. Then, the tumor began to grow, and we resumed administering sorafenib at 400 mg/day. The tumor shrank again, and we continued the sorafenib therapy thereafter. The tumor shrinkage, although possibly induced by the effect of TAE, is considered primarily due to the effect of treatment with sorafenib, because (1) TAE did not sufficiently reduce the blood supply to the inside of the tumor; (2) other tumors shrank in the area not targeted by TAE; and (3) the tumor grew during suspension of sorafenib therapy and shrank again after resuming the treatment.

Benign Liver Tumors

“…Recently, it has been shown that an increase in vascular endothelial growth factor (VEGF) plays an essential role in the development of hemangioma [16]. This concept was supported by case reports showing hemangioma shrinkage following anti-VEGF treatment [17]. However, Lee et al [18] found no effect in 21 anti-VEGF-treated patients.…”

Liver Transplantation for Hemoperitoneum Secondary to Huge Multiple Hemangiomatosis: A Case Report of a Tele-intensive Care Unit in Deceased-Donor Management

“…9 Transcatheter arterial embolization of the hepatic arteries has been adopted for tumor shrinkage, with or without the association of sorafenib administration. 10 Transcatheter arterial embolization has also been proposed for the sequential management of ruptured, bleeding liver tumors and for nonsurgical treatment of symptomatic giant liver hemangiomas. 9,11 Conversely, very recently, a study by Kneuertz et al 2 analyzed which factors most impacted quality of life to determine which patients derived the most benefit from surgery for benign liver lesions.…”

Hemorrhagic hemangioma in the liver: A case report

“…Liver transplantation is an option for treating giant hemangioma for which surgical resection is impossible [19] . In a recent report, a hemangioma was shrunk using monoclonal antibodies such as bevacizumab [14] or sorafenib [20] . While the pathophysiology of hemangioma is not clearly defined, it is known that abnormal vasculogenesis and angiogenesis may be involved [21] .…”