• angiogenesis
• bevacizumab
• chronic kidney disease (CKD)
• vascular endothelial growth factor (VEGF)

• Humans
• Young Adult
• Adult
• Bevacizumab/adverse effects
• Retrospective Studies
• Taiwan/epidemiology
• Vascular Endothelial Growth Factor A
• Renal Insufficiency, Chronic/epidemiology

• TTMHH-R1130011 Tungs' Taichung Metro Harbor hospital research grant
• MOST 111-2321-B-039-005 Ministry of Science and Technology

Giant hepatic cavernous hemangioma with multiple satellite nodules is a rare subtype of hepatic cavernous hemangioma, the most common vascular liver tumor. We report on a tumor with unusual histologic features: (1) Finger-like infiltration pattern; (2) lack of encapsulation; (3) blurred tumor/liver interface; and (4) massive satellitosis-referring to the article “Hepatic cavernous hemangioma: underrecognized associated histologic features”.

A 60-year-old man presented with increasing uncharacteristic abdominal discomfort and mildly elevated blood parameters of acute inflammation. Imaging revealed an unclear, giant liver tumor of the left liver lobe. A massive vascular tumor with extensive satellitosis broadly infiltrating the adjacent liver parenchyma was resected via hemihepatectomy of segments II/III. Histopathological diagnosis was giant hepatic cavernous hemangioma with multiple satellite nodules, featuring unusual characteristics hardly portrayed in the literature. Retrospectively, this particular morphology can explain the difficult pre- and perioperative diagnosis of a vascular liver tumor that is usually readily identifiable by modern imaging methods.

This case emphasizes the exact histological workup of tumor and tumor-induced parenchyma changes in radiologically unclassifiable liver tumors.

• Giant hepatic cavernous hemangioma
• Satellite nodules
• Tumour/liver interface
• Vascular liver tumours
• Preoperative imaging
• Case report

• Natural Science Foundation of Liaoning Province

Patient: Male, 41-year-old

Final Diagnosis: Autosomal dominant polycystic kidney disease

Symptoms: Pain

Medication: —

Clinical Procedure: Computed tomography • ultrasonography

Specialty: Gastroenterology and Hepatology • Medicine, General and Internal • Nephrology

Hepatic cavernous hemangioma (CH) is the most common hepatic benign tumor. Most cases are solitary, asymptomatic, and found incidentally. In symptomatic cases with rapidly growing tumors and coagulopathy, surgical treatment is considered. In rare cases, diffuse hepatic hemangiomatosis (DHH) is reported as a comorbidity. The etiology of DHH is unknown.

A 29-year-old female patient had a history of endometriosis treated with oral contraceptives. Hepatic CH was incidentally detected in the segment IVa of the liver according to the Couinaud classification. Follow-up computed tomography (CT) and ultrasound sonography showed the growth of the lesion and formation of multiple new lesions near the first. Enhanced CT and magnetic resonance imaging (MRI) revealed that the new lesions were different from CH. Although oral contraceptives were stopped, all lesions grew in size. Malignancy and possibility of rupture of these tumors were considered due to the clinical course, and we opted for surgical removal of the tumors. Left liver lobectomy and cholecystectomy were performed. Surgical findings were small red spot spreading and a mass in segment IV of the liver. Pathological examination revealed a circumscribed sponge-like tumor with diffuse irregular extension to the adjacent area. Both of the lesions consisted of blood-filled dilated vascular spaces lined by flat endothelium without atypia. The diagnosis was hepatic CH with DHH. The patient was discharged on postoperative day 12 uneventfully.

We report the successful resection of CH with DHH. The case findings suggest a relationship between oral contraceptive use and enlargement of CH and DHH. Although DHH has been poorly understood, a few previously published cases reported DHH occurrence in patients using oral contraceptives. In such cases, the decision to perform surgical resection should be made after careful examination.

• Hemangioma
• Hemangiomatosis
• Oral contraceptives

Hepatic hemangioma (HH) is the most common benign tumor of the liver. In special conditions such as rapidly growing tumors, persistent pain, hemorrhage and when pressure effect on adjacent organs exist treatment is indicated. Surgical management is the most common treatment for HH.

A 38-year-old male patient was diagnosed with HH for 7 years. The initial presentation of the mass was progressive abdominal distention causing early satiety, gastro-esophageal reflux disease, vomiting, dysphagia and weight loss. Later, the patient developed bilateral lower extremity edema. Imaging with computed tomography (CT scan) showed a large mass measuring 32.4*26*3.1 cm which was considered unresectable. The patient underwent a deceased donor liver transplantation. The excised mass was 9 kg. After nine days of hospitalization the patient was discharged in good condition. Three months later, the patient was admitted due to fever and cytomegalovirus infection for which he received intravenous ganciclovir and was discharged. In the latest follow-up the patient had no liver or kidney dysfunction eight months after the transplantation.

With appropriate patient selection, liver transplantation can be considered as a treatment option for patients with huge HHs which are life-threatening and surgically unresectable.

• Benign liver neoplasms
• Cavernous Hemangioma
• Hepatic Hemangioma
• Liver transplantation

• Hepatic hemangioma
• Liver
• Liver masses
• Vascular lesion

• Catheter Ablation/methods
• Embolization, Therapeutic/methods
• Hemangioma/pathology
• Hemangioma/therapy
• Hepatectomy/methods
• Humans
• Internal Medicine
• Liver Neoplasms/pathology
• Liver Neoplasms/therapy

To evaluate the value of a three dimension (3D)visualization operative planning system in ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs).

Fifty-eight patients with LHHs were divided into 3D and 2D groups. The therapeutic efficacy was assessed by contrast-enhanced imaging during follow-up. Hepatic and renal function were examined. The complete ablation, tumor volume shrinkage, and complication rates were analyzed.

The ablation time and energy of the 3D group were lower than those of the 2D group (1152.0 ± 403.9 s vs. 1379.7 ± 375.8 s and 87,407.2.9 ± 50,387.0 J vs. 117,775.8 ± 46,245.6 J, P = 0.031 and 0.021, respectively). The 3D group had a higher complete ablation rate than the 2D group (97.7 ± 2.4% vs. 94.5 ± 3.7%, P < 0.001). The incidence of hemoglobinuria after ablation in the 3D group was lower than that in the 2D group (32.0% vs. 57.6%, P = 0.047). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and creatinine (Cre) after ablation in the 3D group were lower than those in the 2D group (126.7 ± 56.4 U/L vs. 210.9 ± 96.2 U/L, P < 0.001; 141.0 ± 60.8 U/L vs. 211.4 ± 90.0 U/L, P = 0.001; 57.3 ± 17.6 U/L vs. 80.8 ± 41.9 U/L, P = 0.010; and 66.6 ± 16.6 mmol/L vs. 84.5 ± 39.6 mmol/L, P = 0.037, respectively). There were no significant differences in antenna insertion and the volume reduction rate between the groups. One patient developed acute kidney injury shortly after ablation in the 2D group and recovered after hemodialysis. No other severe complications occurred during the follow-up period.

The 3D visualization operative planning system has a relatively high clinical application value in providing scientific, reasonable, quantifiable, and individualized therapy for LHHs by US-PMWA.

• 3D visualization operative planning system
• Large hepatic hemangiomas
• Microwave ablation

• Megadose methylprednisone
• Kasabach-Merritt Syndrome
• VEGF

• AKT1 mutation
• Proteus syndrome
• overgrowth syndromes
• vascular malformations

• avastin
• bevacizumab
• chemotherapy
• endoscopic sinus surgery
• hemangioma
• intralesional therapy
• nasal
• septum

• Benign liver lesions
• Complications
• Computed tomography
• Magnetic resonance imaging
• Uncommon evolutions

• Bleomycin–lipiodol
• Hepatic hemangioma
• Transarterial bleomycin–lipiodol embolization (B/LE)

• Adult
• Diffuse hepatic hemangiomatosis
• Kasabach–Merritt syndrome
• Postmortem examination
• Vascular endothelial growth factor

• hemoglobinuria
• hepatic cavernous hemangioma
• microwave ablation
• risk factors
• ultrasound guidance

Background: The formation of hepatic hemangiomas (HH) is associated with VEGF and IL-7 that alter conduit arteries and small arterioles. To our knowledge, there are no studies to investigate the effects of HH on the hemodynamics in conduit arteries. The aim of the study is to perform morphometric and hemodynamic analysis in abdominal conduit arteries and bifurcations of HH patients and controls.

Methods: Based on morphometry reconstructed from CT images, geometrical models were meshed with prismatic elements for the near wall region and tetrahedral and hexahedral elements for the core region. Simulations were performed for computation of the non-Newtonian blood flow using the Carreau-Yasuda model, based on which multiple hemodynamic parameters were determined.

Results: There was an increase of the lumen size, diameter ratio, and curvature in the abdominal arterial tree of HH patients as compared with controls. This significantly increased the surface area ratio of low time-averaged wall shear stress (i.e., SAR-TAWSS =Surface  areaTAWSS≤4 dynes·cm−2Total  surface  area× 100%) (24.1 ± 7.9 vs. 5 ± 6%, 11.6 ± 12.8 vs. < 0.1%, and 44.5 ± 9.2 vs. 21 ± 24% at hepatic bifurcations, common hepatic arteries, and abdominal aortas, respectively, between HH and control patients).

Conclusions: Morphometric changes caused by HH significantly deteriorated the hemodynamic environment in abdominal conduit arteries and bifurcations, which could be an important risk factor for the incidence and progression of vascular diseases.

• abdominal arterial tree
• computer tomography
• hemodynamics
• hepatic hemangioma
• morphology

• Bleomicina
• Bleomycin
• Chemotherapy-induced response
• Germ cell tumor
• Hemangioma hepático
• Liver hemangioma
• Respuesta quimioinducida
• Tumor de células germinales

• Angiogenesis
• Oral cancer
• Oral diseases
• Oral squamous cell carcinoma (OSCC)
• Vascular endothelial growth factor (VEGF)

• Anti-VEGF treatment
• Bevacizumab
• Hepatic hemangioma
• Sunitinib

• Adrenal Cortex Hormones/therapeutic use
• Adrenergic beta-Antagonists/therapeutic use
• Child, Preschool
• Clinical Decision-Making
• Combined Modality Therapy
• Dermatologic Surgical Procedures
• Disease Progression
• Female
• Hemangioma/complications
• Hemangioma/diagnosis
• Hemangioma/therapy
• Humans
• Infant
• Laser Therapy
• Male
• Skin Neoplasms/complications
• Skin Neoplasms/diagnosis
• Skin Neoplasms/therapy

Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm) in the right (n = 13), left (n = 1) or both (n = 13) lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the “early leaving but late returning, hanging nut on a twig” sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both P<0.05), but not total bilirubin. Six patients complained of abdominal pain, and 12 experienced transient fever. In the months after TAE, tumor size decreased (baseline: 11.24±5.08; 3 months: 8.95±4.33; 6 months: 7.60±3.90 cm; P<0.05), and the patients’ condition improved. These results indicated that TAE was effective and safe for treating giant hepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma.

• Angiography, Digital Subtraction
• Bleomycin/analogs & derivatives
• Bleomycin/therapeutic use
• Embolization, Therapeutic/methods
• Ethiodized Oil/therapeutic use
• Female
• Hemangioma, Cavernous/diagnostic imaging
• Hemangioma, Cavernous/therapy
• Humans
• Liver/blood supply
• Liver/diagnostic imaging
• Liver/pathology
• Male
• Retrospective Studies
• Tomography, X-Ray Computed

• enzyme-linked immunosorbent assay
• hemangioma
• pure alcohol
• vascular endothelial growth factor

• Hepatic haemangioma
• MRI
• Sclerosis

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.

• Hepatic hemangioma
• Sorafenib
• Transcatheter arterial embolization

• Adult
• Child
• Child, Preschool
• Cranial Irradiation/adverse effects
• Female
• Hemangioma, Cavernous/etiology
• Hemangioma, Cavernous/physiopathology
• Hemangioma, Cavernous/therapy
• Humans
• Hypopituitarism/etiology
• Male
• Neoplasms, Radiation-Induced