Giant cavernous liver hemangiomas： is it the time to change the size categories？

BACKGROUND： Four different sizes （4, 5, 8 and 10 cm in diameter） can be found in the literature to categorize a liver hemangioma as giant. The present review aims to clarify the appropriateness of the size category ＂giant＂ for liver heman- gioma. DATA SOURCES： We reviewed the reports on the categoriza- tion of hemangioma published between 1970 and 2014. The number of hemangiomas, size criteria, mean and range of hemangioma sizes, and number of asymptomatic and symp- tomatic patients were investigated in patients aged over 18 years. Liver hemangiomas were divided into four groups： 〈5.0 cm, 5.0-9.9 cm, 10.0-14.9 cm and 〉15.0 cm in diameter. Inclu- sion criteria were noted in 34 articles involving 1972 （43.0%） hemangiomas （〉4.0 cm）. RESULTS： The patients were divided into the following groups： 154 patients （30.0%） with hemangiomas less than 5.0 cm in diameter （small）, 182 （35.5%） between 5.0 cm and 9.9 cm （large）, 75 （14.6%） between 10.0 and 14.9 cm （giant）, and 102 （19.9%） more than 15.0 cm （enormous）. There were 786 （39.9%） asymptomatic patients and 791 （40.1%） symptomatic patients. Indications for surgery related to symptoms were reported in only 75 （3.8%） patients. Operations including 137 non-anatomical resection （12.9%） and 469 enudeation （44.1%） were undearly related to size and symptoms.CONCLUSIONS： The term ＂giant＂ seems to be justified for liver hemangiomas with a diameter of 10 cm. Hemangiomas categorized as ＂giant＂ are not indicated for surgery. Surgery should be performed only when other symptoms are apparent.

Sclerosing cholangitis secondary to bleomycin-iodinated embolization for liver hemangioma

Sclerosing cholangitis(SC)is a rarely reported morbidity secondary to transcatheter arterial chemoembolization(TACE)with bleomycin-iodinated oil(BIO)for liver cavernous hemangioma(LCH).This report retrospectively evaluated the diagnostic and therapeutic course of a patient with LDH who presented obstructive jaundice 6 years after TACE with BIO.Preoperative imaging identified a suspected malignant biliary stricture located at the convergence of the left and right hepatic ducts.Operative exploration demonstrated a full-thickness sclerosis of the hilar bile duct with right hepatic duct stricture and right lobe atrophy.Radical hepatic hilar resection with right-side hemihepatectomy and Roux-en-Y hepaticojejunostomy was performed because hilar cancer could not be excluded on frozen biopsy.Pathological results showed chronic pyogenic inflammation of the common and right hepatic ducts with SC in the portal area.Secondary SC is a long-term complication that may occur in LCH patients after TACE with BIO and must be differentiated from hilar malignancy.Hepatic duct plasty is a definitive but technically challenging treatment modality for secondary SC.

Resection of a rapid-growing 40-cm giant liver hemangioma

Hemangiomas are the most frequent benign tumors of the liver. Most hemangiomas are asymptomatic and therefore largely diagnosed only in routine screening tests. Usually they are small and require no specific treatment. In some situations they can reach great dimensions, causing some discomfort to the patient. Resection of liver hemangioma is indicated in cases of great dimension tumors causing symptoms such as pain, nausea or bloating caused by compression of adjacent organs. We report a case of a rare giant hemangioma with rapid growth in short time:a 50 year old female reported to our institution with a 40 cm giant liver hemangioma and then underwent a left hepatectomy.

Misdiagnosis of hemangioma of left triangular ligament of the liver as gastric submucosal stromal tumor:Two case reports

BACKGROUND Extragastric lesions are typically not misdiagnosed as gastric submucosal tumor(SMT).However,we encountered two rare cases where extrinsic lesions were misdiagnosed as gastric SMTs.CASE SUMMARY We describe two cases of gastric SMT-like protrusions initially misdiagnosed as gastric SMTs by the abdominal contrast-enhanced computed tomography(CT)and endoscopic ultrasound(EUS).Based on the CT and EUS findings,the patients underwent gastroscopy;however,no tumor was identified after incising the gastric wall.Subsequent surgical exploration revealed no gastric lesions in both patients,but a mass was found in the left triangular ligament of the liver.The patients underwent laparoscopic tumor resection,and the postoperative diagnosis was hepatic hemangiomas.CONCLUSION During EUS procedures,scanning across different layers and at varying degrees of gastric cavity distension,coupled with meticulous image analysis,has the potential to mitigate the likelihood of such misdiagnoses.

Differentiation of atypical hepatic hemangioma from liver metastases: Diagnostic performance of a novel type of color contrast enhanced ultrasound

BACKGROUND In clinical practice,the diagnosis is sometimes difficult with contrast-enhanced ultrasound(CEUS)when the case has an atypical perfusion pattern.Color parametric imaging(CPI)is an analysis software for CEUS with better detection of temporal differences in CEUS imaging using arbitrary colors.It measures the differences in arrival time of the contrast agent in lesions so that the perfusion features of atypical hemangioma and colorectal cancer(CRC)liver metastasis can be distinguished.AIM To evaluate the role of a novel type of CPI of CEUS in the differential diagnosis of atypical hemangioma from liver metastases in patients with a history of CRC.METHODS From January 2016 to July 2018,42 patients including 20 cases of atypical hemangioma and 22 cases of liver metastases from CRC were enrolled.These patients had a mean age of 60.5±9.3 years(range:39-75 years).All patients received ultrasound,CEUS and CPI examinations.Resident and staff radiologists independently and retrospectively reviewed CEUS and CPI images.Two sets of criteria were assigned:(1)Routine CEUS alone;and(2)CEUS and CPI.The diagnostic sensitivity,specificity,accuracy and receiver operating characteristic(ROC)curve of resident and staff radiologists were analyzed.RESULTS The following CPI features were significantly different between liver hemangioma and liver metastases analyzed by staff and resident radiologists:Peripheral nodular enhancement(65%-70.0%vs 4.5%-13.6%,P<0.001,P=0.001),mosaic/chaotic enhancement(5%-10%vs 68.2%-63.6%,P<0.001,P<0.001)and feeding artery(20%vs 59.1%-54.5%,P=0.010,P=0.021).CPI imaging offered significant improvements in detection rates compared with routine CEUS in both resident and staff groups.By resident radiologists,the specificity and accuracy of CEUS+CPI were significantly increased compared with that of CEUS(77.3%vs 45.5%,P=0.030;78.6%vs 50.0%,P=0.006).In addition,the area under the curve(AUC)of CEUS+CPI was significantly higher than that of CEUS(0.803 vs 0.757,P=0.036).By staff radiologists,accuracy was improved in CEUS+CPI(81.0%vs 54.8%,P=0.010),whereas no significant differences in specificity and sensitivity were found(P=0.144,P=0.112).The AUC of CEUS+CPI was significantly higher than that of CEUS(0.890 vs 0.825,P=0.013)by staff radiologists.CONCLUSION Compared with routine CEUS,CPI could provide specific information on the hemodynamic features of liver lesions and help to differentiate atypical hemangioma from liver metastases in patients with CRC,even for senior radiologists.

Recurrent giant hemangiomas of liver:Report of two rare cases with literature review

Most hepatic hemangiomas(HHs) are small,asymptomatic and do not require clinical intervention.Surgical resection is only indicated for symptomatic hemangiomas.We report here cases of recurrent HHs in 2 women of 37 and 40 years old,who initially presented with abdominal pain and mass.Radiological examination of each tumor revealed a solitary tumor of 14 and 20 cm in diameter,respectively.Surgical liver segmental resections were performed in both,and the diagnosis of cavernous hemangioma was confirmed.Both patients had recurrent tumor on subsequent radiological examination 4-5 years after the initial surgery.In the first patient,a 15 cm recurrent hemangioma was resected,but multiple hemangiomas were again detected 8 years later occupying the other hepatic lobe,which was not amendable for resection.In the second patient,a 16 cm hemangioma was seen on radiogram,and because the lesion was not symptomatic,conservative observation was offered.Recurrence after liver resection of giant hemangioma is extremely rare.The pathogenesis of tumor progression and recurrence is unknown,as is the management of these patients with recurrent hemangioma,particularly when it is extensive and unresectable.

The origin of blood supply for cavernous hemangioma of the liver

OBJECTIVE: To investigate the origin of blood supply to cavernous hemangioma of the liver (CHL). METHODS: To observe the relation of cavernous hemangioma of the liver to the hepatic artery and portal vein, we performed serial selective hepatic arteriography in 22 patients. Five patients after ligation of the right hepatic arteries underwent portography and liver staining by in jection of methylene blue into the portal veins and 2 patients had hepatic specimens resected, which were made into a model cast by filling the hepatic veins (yellow) and portal venous branches (blue) with methyl methacrylate after vascular lavage. RESULTS: Serial selective hepatic arteriography showed that hepatic arteries and hemangioma were displayed simultaneously, and that hemangioma was supplied by one to numerous arterial branches. In the portal phase of portography, contrast medium failed to enter the tumor and the intrahepatic branches of the portal vein were pushed aside by the tumor; in the liver parenchymal phase, however, the tumor appeared to be a low-density area. Hepatic arteriography and portography revealed that the fistula between the artery and portal vein may not be existed. The liver stained with methylene blue showed that the normal hepatic parenchyma could be stained with deep blue; in contrast, the tumor was not stained at all. The casting specimens showed that the eroded tumor left a round vacant area because of its total shedding, and no blue stained branches of the portal vein extended into the tumor. CONCLUSION: Blood supply of CHL may originate from the hepatic artery.

An unusual case of incidental rupture of liver hemangioma during labor

Cavernous hemangiomas are the most common benign tumors of the liver and are found in about 2% of autopsy patients. The vast majority of these tumors are small and asymptomatic; however, there have been a few reported cases in which these lesions led to spontaneous fatal hemorrhage. Although liver hemangiomas occur in both sexes, most studies point to a female

Hemorrhagic hemangioma in the liver:A case report

Hemangioma is the most common type of benign tumor that arises in the liver. Although rupture and hemorrhage of hepatic hemangioma are rare complications, they can be the cause of mortality. The authors report a case of hemorrhagic hepatic hemangioma: in a 54-yearold woman who was admitted with epigastric pain.She had taken oral contraceptives several weeks prior.The results of a blood examination were normal. An abdominal computed tomography scan revealed a tumor in hepatic segment 4, and a hemorrhage inside the cystic mass was suspected. The mass was removed laparoscopically to confirm the tumor properties and control the hemorrhage. The pathologic findings of the resected mass were consistent with hepatic hemangioma with intratumoral hemorrhage. The patient was discharged 8 d after the surgery, without further complications or complaints, and the patient's condition was found to have improved during follow-up.

Source of blood supply of liver cavernous hemangioma and sclerosis and embolization treatment

AIM To investigate the source of blood supply of carvenous hemangioma of liver (CHL) and provide a feasibile treatment for CHL via hepatic artery. METHODS Ⅰ. Origin of blood supply of CHL: portovenography, hepatic arteriography and portal vein staining were performed in 5 patients. Two casts of hepatic blood vessels from resected specimen were observed. Ⅱ. Clinical data: Among 75 patients (30 males, 45 females, aged 25～57 years with a mean of 37 4). 56 were of solitary type (44 on the right lobe, 12 on the left with 4 having intraparenchymatoma) and 19 were of multiple type (9 on the right, 2 the left, 8 whole liver). Twenty two patients were treated by sclerosis, 50 by embolization via hepatic artery and 3 were excised. RESULTS In 5 cases with portography, the contrast medium did not enter the tumor, the tumor appeared as low denty area and the intrahepatic branches of portal vein were pushed aside. In 5 cases with portal vein staining, the normal liver parenchyma was stained deep blue, and the tumor was not stained. The tumor area appeared as a round vacant cavity in 2 specimen casts. In 72 patients treated with sclerosis a or embolization via hepatic artery or through interventional method, the tumors diminished by 10%～30% in diameter and no tumors grew larger. CONCLUSION The blood supply of CHL originates from the hepatic artery. Tumors treated with sclerosis and emblization decreased in size or got fiberized.

Collagenous nodule mixed simple cyst and hemangioma coexistence in the liver

A 20-year-old female patient presented with two masses located in the left liver.In this patient, a computed tomography(CT) scan revealed a hypodense mass and a second well-defined mass with a calcified nodule in the left hepatic lobe.No enhancements were apparent in or around the masses.A laparotomy was performed due to the patient's symptoms, namely, the atypical CT findings and a risk of rupture of the subcapsular lesion.The operation revealed two masses in the left hepatic lobe and a left liver resection was subsequently performed.One of the masses involved segment Ⅲ and the other mass was located in segment Ⅳ.The histopathologic findings supported a diagnosis of collagenous nodule mixed simple cyst and hemangioma.A diagnosis of collagenous nodule mixed simple hepatic cyst is extremely rare and radiologically mimics a teratoma, hepatolithiasis, parasitic cyst, or hemangioma.Although hepatic hemangiomas are the most common benign tumors found in the liver, the present case showed atypical radiographic features.

Orthotophic Liver Transplantation in Giant Hepatic Hemangioma: A Case Report and Literature Review

Hemangioma is the most common benign tumor affecting the liver in 7% of general population. One of the rare presentations of this pathology is gigantic liver hemangioma, reported in the literature as anecdotal cases. In selected cases, liver transplantation has been a therapeutic option. We herein describe a case of massive liver hemangioma which was submitted to liver transplant, and the main indication for liver transplant in this case was a severe psychosocial impact of the disease in the patient’s life, altogether with Kasabach-Merritt syndrome and abdominal discomfort.

肝脏硬化性血管瘤的CT和MRI表现分析

目的 探讨肝脏硬化性血管瘤(HSH)的影像表现。方法 回顾性分析2013年至2021年复旦大学附属中山医院经病理证实的10例HSH患者的影像学资料6例行MR检查,2例行CT检查,2例行MR+CT检查。图像分析包括病灶数目、部位、大小、形态、边缘、密度或信号、强化方式、相邻肝包膜等影像学特征,并测量病灶与肝实质的ADC值,两者ADC值比较采用独立样本t检验。结果 10例患者均为单发病灶,大小(35.8±44.4)mm,8例类圆形、1例类椭圆形、1例分叶状,边缘均清楚。CT平扫均为低密度,2例轻度均匀持续强化,2例向心性强化;T1WI呈低、稍低信号,T2WI呈高信号、3例病灶内见低信号,增强扫描4例向心性强化,2例轻度环形持续强化,1例延迟强化,1例类似环形“快进快出”强化,病灶与肝实质的ADC值差异有显著统计学意义(P<0.01),3例出现相邻肝包膜皱缩现象。结论HSH影像表现不典型但具有一定特点:动脉期环形强化,门脉期及延迟期强化不减退,病灶ADC值高于肝实质ADC值。

左侧卧位腹腔镜肝右叶部分切除术临床分析

目的探讨左侧卧位腹腔镜肝右叶各肝段部分切除的可行性及疗效。方法回顾性分析右江民族医学院附属医院百东院区2022年5月至2023年4月期间39例行左侧卧位腹腔镜肝右叶部分切除术的病例资料。结果39例中有腹部手术史者13例;肿瘤1个34例,肿瘤2个3例,肿瘤3个2例,肿瘤最大径37.0(24.0,58.0)mm。其中行非解剖性肝切除20例,解剖性肝切除19例;单一肝段切除术28例,两部位肝部分切除术10例,三部位肝部分切除术1例;联合腹腔镜胆囊切除24例;无血流阻断9例,行Pringle法血流阻断30例。平均手术时间(143.5±56.8)min;中位术中出血量100.0(50.0,300.0)mL,4例术中输血(合计29.50 U),无中转开腹。35例放置引流管,引流管留置时间(6.3±3.7)d;术后平均住院时间(10.1±4.0)d,住院总费用(41121.8±18978.3)元。术后23例患者出现少量胸腔积液;1例患者并发急性呼吸窘迫综合征(ARDS)及肝功能不全,经ICU复苏治愈;1例出现少量气胸;无感染、出血、胆漏等并发症发生;无非计划性再次手术发生。所有患者均通过门诊或电话的方式获得随访,所有病例近期无复发。结论左侧卧位行腹腔镜肝右叶部分切除术操作简单,暴露好,手术时间相对较短,出血少。

肝癌患者剪切波弹性成像参数与病灶病理组织学的关系及肝脏硬度的重复性分析

目的 探讨肝癌患者剪切波弹性成像(SWE)参数与病灶病理组织学的关系及肝脏硬度的重复性分析。方法 收集2019年11月至2023年1月116例肝脏肿瘤患者的临床病理资料。116例患者中,55例肝血管瘤,61例肝癌。使用SWE超声诊断仪获取并记录患者的肝硬度值(LSM)。采用Spearman等级相关分析LSM与肝癌的肝纤维化分期、肝脏炎症活动度、肝功能Child-Pugh分级的相关性。采用受试者工作特征(ROC)曲线评估SWE技术对肝血管瘤和肝癌的区分度及对肝癌不同临床病理特征的诊断效能。采用组内相关系数(ICC)分析不同操作者及同一操作者测量的一致性。结果 肝血管瘤的LSM为(19.49±7.54)kPa,肝癌的LSM为(39.17±14.35)kPa,差异有统计学意义(P<0.001)。不同肝功能Child-Pugh分级、肝功能炎症分级、肝功能硬化分级患者的LSM比较,差异有统计学意义(P<0.05)。LSM诊断肝癌和肝血管瘤的临界值为23.54 kPa,灵敏度为79.85%,特异度为91.16%,ROC曲线下面积(AUC)为0.900(95%CI:0.825~0.966)。LSM与肝纤维化分期(r=0.850,P<0.001)、肝脏炎症活动度(r=0.633,P<0.001)、肝功能Child-Pugh分级(r=0.367,P<0.001)呈明显正相关。SWE技术鉴别肝纤维化(≥F2期)、肝硬化(F4期)的AUC分别为0.621(95%CI:0.573~0.824)、0.773(95%CI:0.621~0.864);SWE技术鉴别肝脏炎症活动度≥A2期、A3期的AUC分别为0.605(95%CI:0.583~0.864)、0.759(95%CI:0.573~0.872);SWE技术鉴别肝功能Child-Pugh分级为C级的AUC为0.722(95%CI:0.615~0.906)。不同操作者测量肝血管瘤患者和肝癌患者LSM的组内和组间ICC均大于0.75。结论 SWE技术是一种操作简便、重复性好的肝脏硬度检测方法,可较好地区分肝癌和肝血管瘤,也可对肝癌患者的肝纤维程度、肝脏炎症活动度及Child-Pugh分级进行评估。操作者的经验对重复性的影响不明显。

儿童肝血管瘤的诊治现状与进展

儿童肝血管瘤是儿童婴幼儿期最常见的肝脏良性血管源性肿瘤,部分儿童肝血管瘤与肝脏恶性肿瘤鉴别困难,且少数有恶性转化或出现危及生命并发症的可能。本文综述了儿童肝血管瘤的分型、临床特征、诊断、治疗及预后等,以期为该病的临床诊治提供参考。

TACE联合普萘洛尔治疗巨大婴儿肝血管瘤

目的观察TACE联合普萘洛尔治疗巨大婴儿肝血管瘤(IHH)的有效性及安全性。方法回顾性分析10例接受TACE联合普萘洛尔治疗的巨大IHH婴儿,记录技术成功率、并发症及复发情况;根据TACE前、后6个月临床症状及IHH体积变化评价治疗效果。结果对10例成功完成15次TACE,技术成功率100%;对其中3例予博莱霉素+碘化油乳剂+聚乙烯醇颗粒(PVA)+弹簧圈栓塞、7例予博莱霉素+碘化油乳剂+PVA栓塞。并发症包括1例穿刺点皮下血肿、2例TACE后24 h内一过性低热,经对症治疗后均好转;未见其他并发症。末次TACE后6个月,9例(9/10,90.00%)获得显效、1例(1/10,10.00%)有效,治疗总有效率100%。随访期间未见胆囊坏死、肝坏死、死亡等严重并发症;亦未见肝动脉瘤复发。结论TACE联合普萘洛尔治疗巨大IHH有效且安全。

周围型肝内胆管细胞癌CT误诊分析

目的分析周围型肝内胆管细胞癌(PICC)临床及CT影像特点,探讨CT误诊原因及防范误诊措施。方法回顾性分析2021年2月至2022年1月收治的曾误诊的PICC患者8例的临床资料。结果8例中3例有胆道手术史,2例有肝内胆管结石史,1例有胆囊结石史;4例伴肝硬化。8例因上腹部闷胀不适或疼痛就诊,4例因有肝硬化,甲胎蛋白升高,CT扫描见肝内肿物假包膜征,初步诊断为肝细胞癌;2例因体温轻度升高,CT增强扫描动脉期病灶强化弱,门静脉期见病灶呈蜂窝样变,远端胆管扩张并见截断征,故初步诊断为肝脓肿;2例因CT增强扫描动脉期见病灶边缘呈条索状强化,门静脉期渐进强化,邻近胆管扩张,初步诊断为肝血管瘤。8例行经皮肝穿刺细胞学检查诊断为PICC,确诊后行左半肝切除5例、右半肝切除3例。组织学分型:5例低分化腺癌、3例中分化腺癌。出院后随访2年,患者均存活,均未见转移。结论PICC术前易与肝脓肿、肝细胞癌、肝血管瘤混淆而误诊。临床医生加强对本病临床及影像学特点的认识,多方面综合分析病情,必要时及早行穿刺活检或手术病理检查,可提高诊断率。

巨大肝血管瘤切除术中两种入肝血流阻断方法对患者血流动力学及肝功能的影响比较

目的比较巨大肝血管瘤切除术中Pringle阻断法与Glisson鞘外阻断法对患者血流动力学及肝功能的影响,为优化巨大肝血管瘤切除术中入肝血流阻断方法提供参考。方法本研究为回顾性研究,收集2019年1月至2022年12月医院收治的108例行腹腔镜巨大肝血管瘤切除术患者的临床资料。依据术中入肝血流阻断方法的不同,将其中50例行Pringle阻断法患者的临床资料纳入A组,将其余58例行Glisson鞘外阻断法患者的临床资料纳入B组。统计2组患者围手术期指标(手术时间、血流阻断时间、术中出血量、住院时间),比较2组患者入肝血流阻断前(T_(0))、血流阻断后15 min(T_(1))、术毕时(T_(2))的血流动力学指标[心率(HR)、平均动脉压(MAP)];术前及术后d3、d7时肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)]。分析2组患者术后并发症发生情况。结果2组手术时间、血流阻断时间比较,差异无统计学意义(P>0.05);B组术中出血量少于A组,住院时间短于A组,差异均有统计学意义(P<0.05)。2组T_(1)、T_(2)时HR、MAP均较T_(0)时提高,但B组T_(1)、T_(2)时HR、MAP均低于A组,差异均有统计学意义(P<0.05)。术前及术后d3、d7,2组血清ALT、AST、TBIL水平呈先升高后降低趋势,且B组上述指标水平均低于A组,差异有统计学意义(P<0.05)。2组术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论与Pringle阻断法比较,巨大肝血管瘤切除术中行Glisson鞘外阻断可有效减少患者术中出血量,缩短住院时间,对患者血流动力学及肝功能的影响较小。

CT联合常规超声引导微波消融术治疗肝血管瘤患者的效果

目的:观察CT联合常规超声引导微波消融术治疗肝血管瘤患者的效果。方法:选取2021年7月至2023年7月该院收治的80例肝血管瘤患者进行前瞻性研究,按照随机数字表法将其分为观察组和对照组各40例。对照组采用常规超声引导微波消融术治疗,观察组在对照组基础上联合CT检查,比较两组消融指标水平、治疗前后肝功能指标[丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆红素(TBIL)]水平、术后1个月并发症发生率和术后随访6个月的复发率。结果:观察组消融能量低于对照组,消融时间短于对照组,消融点数少于对照组,完全消融率高于对照组,差异均有统计学意义(P<0.05);术后7 d,两组ALT、AST和TBIL水平均低于术前,但组间比较,差异无统计学意义(P>0.05);两组并发症发生率比较,差异无统计学意义(P>0.05);术后随访6个月,两组均无复发。结论:CT联合常规超声引导微波消融术治疗肝血管瘤患者可改善消融指标水平,效果优于单纯常规超声引导微波消融术治疗。