Therapeutic Options of Giant Liver Hemangioma

Abstract

Liver hemangiomas are commonly the most frequent benign lesion of the liver. They are generally smaller, asymptomatic and diagnosed incidentally in imaging studies. A liverhemangioma is qualified giant when it has a size larger than 5cm. Asymptomatic and non-complicated giant liver are managed conservatively by observation. However, lesion with incapacitating symptoms or complications is managed surgically. Surgery remains the most effective and radical therapeutic modality to treat liver hemangioma. Thus both enucleation and liver resection can be performed to remove the lesion. However recent studies demonstrated that enucleation was a safer, Quaker surgical procedure and associated with lower complication and less blood loss. Non-surgical treatment options have been described to be used alone or in combination with surgery. This mini-review provides a general view of the therapeutic options employed to treat giant liver hemangioma.

Giant Sclerosing Hepatic Hemangioma Presenting as Bornman-Terblanche-Blumgart Syndrome: a Case Report and Review of the Literature

“…At the same time, surgical intervention is indicated for symptomatic patients or those who develop complications during follow-ups, such as coagulation disorders (Kasabach-Merritt syndrome) or Bornman-Terblanche-Blumgart syndrome, as seen with our patient ( 12 ). Nevertheless, the size of the hemangioma is not an indication ( 28 ). Both transarterial embolization (TAE) and radiofrequency ablation (RFA) are used for management and preoperative preparation ( 28 ).…”

“…Nevertheless, the size of the hemangioma is not an indication ( 28 ). Both transarterial embolization (TAE) and radiofrequency ablation (RFA) are used for management and preoperative preparation ( 28 ). TEA is used to reduce symptoms, stabilize ruptured lesion preoperatively, and decrease lesional blood supply; however, recurrence is commonly observed, with no significant change in tumor size ( 3 , 29 ).…”

“…TEA is used to reduce symptoms, stabilize ruptured lesion preoperatively, and decrease lesional blood supply; however, recurrence is commonly observed, with no significant change in tumor size ( 3 , 29 ). RFA, on the other hand, was found to have the ability to reduce the size of hepatic lesions ( 13 , 28 ).…”

“…Surgery is the most effective therapeutic modality; four procedures can be applied: resection, enucleation, hepatic artery ligation, and transplantation ( 3 , 28 ). The choice of procedure depends on location, number, and size of the tumor, presence of complications, surgeon preference, and experience ( 28 ). Both resection and enucleation are widely used, keeping transplantation as a last resort for diffuse, unresectable hepatic hemangiomatosis ( 30 ).…”

Treatment and Prognosis of Hepatic Epithelioid Hemangioendothelioma: A SEER Database Analysis

“…Reported survival rates vary between studies due to dissimilarities in patient characteristics and differences in treatment strategies. As a low-grade neoplasm, prognosis of HEH is better than that of benign liver hemangioma but worse than the prognosis of malignant liver hemangiosarcoma [20,21]. Table 7 summarizes survival outcomes based on the interventions performed in different reports [8,[13][14][15][21][22][23][24][25][26][27][28].…”