Materiały źródłowe

• #1

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4564031/

  HH belong to the class of hepatic incidentalomas, so-called because they are diagnosed incidentally, on imaging studies performed as routine examinations or for other reasons than the evaluation of a possible liver mass. Less than half of HH present with overt clinical symptoms, consisting, most often, of upper abdominal pain (this is usually the case for large lesions, which cause the distension of Glissons capsule). […] Literature places the HH incidence at 0.4% to 20% of the total population. At necropsy, the frequency is of 0.4 to 7.3%, all the authors agreeing with an incidence of over 7%. The HH prevalence in the general population varies greatly, most often being discovered incidentally during imaging investigations for various unrelated pathologies. […] Regarding sex distribution, it seems that women are more susceptible, as confirmed by all pertaining studies, with a reported 4.5:1 to 5:1 ratio of female to male cases. Most often, HH are mono-lesions but multiple-lesions are possible; they account for 2.3% and up to 20-30% of the cases, depending on the source. At the initial diagnosis, the majority of HH measure below 3 cm in size, the so-called capillary hemangiomas; of these, only 10% undergo a size increase with time, for reasons still unknown. […] The next size class covers lesions between 3 cm and 10 cm in size, referred to as medium hemangiomas. Lastly, giant or cavernous hemangiomas measure up to 10 cm, with occasional literature reports of giant HH reaching 20-40+ cm in size.

• #1 One stop shop approach for the diagnosis of liver hemangioma

  https://www.wjgnet.com/1948-5182/full/v13/i12/1892.htm

  Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The rate of detection of HHs has increased as imaging methods have become more effectiveness and accessible. The prevalence depends on the method used for detection: 2%-4% for ultrasonography, up to 5% for computed tomography and up to 7% of cases in autopsy cases. HH are more common in women than in men. The natural history of hemangiomas is variable: Most of them remain stable, some may grow or involute. In the vast majority of cases does not require treatment or monitoring. Ultrasound examination is the main method of detecting HH due to the fact that it is widely available, inexpensive, rapidly performed without exposing the patient to radiation. Contrast enhanced ultrasound (CEUS) can be performed immediately after standard ultrasound exam while focal liver lesion (FLL) is found, in the same session, using a dedicated contrast software. The advantages of CEUS are related to the immediate availability in the ultrasound room where the lesion was detected, the real-time visualization of the tumor perfusion, non-ionizing technique and low financial costs. CEUS can be performed immediately after standard ultrasound in the consulting room, without the need to assess renal function as needed in the administration of contrast agents for CT/MRI. Studies to date have shown that CEUS has similar performance to computed tomography or MRI in the diagnosis of HH.

• #1 Liver Masses: Work up and When to Worry – Practical Gastro

  https://practicalgastro.com/2024/02/09/liver-masses-work-up-and-when-to-worry/

  Liver lesions are common. The best data on population-based prevalence comes from incidental findings in scans ordered for reasons unrelated to the risk of liver lesions. For example, among 17,309 people receiving cross-sectional imaging ordered for lung cancer screening, 6.1% had liver lesions. Of these 1,064 lesions, one in three were potentially significant and 8 (0.8% of lesions) were found to be malignant. There is variation depending on the population and the imaging modality selected. In general, when examining ultrasounds of the abdomen, cysts are detected in 6-8%, hemangiomas in 3-5%, focal nodular hyperplasia in 0.2-0.8%, and adenoma in 0.04%. […] A hemangioma is mass consisting of septate clusters of vascular endothelium fed with hepatic arterial supply. The classic ultrasound appearance is homogenously hyperechoic and sharp margins. On MRI, hemangiomas display strong signal intensity on T2-weighted sequences and enhance strongly with contrast. They are more common among women, can be large (5cm), but do not grow or transform into malignancy. There is no need for further monitoring on oral contraceptives or during pregnancy. Rarely, the so-called cavernous hemangioma (5-10cm) can cause symptoms or rupture. […] Surgical resection or embolization is successful in highly selected cases. Among patients with hemangiomas 20cm, there have been case reports of Kasabach-Merrit Syndrome, a consumptive coagulopathy that improves with resection of the lesion.

• #1 Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies

  https://www.mdpi.com/1648-9144/60/3/449

  Hepatic hemangiomas, the most prevalent benign liver tumors, are characterized as slow-flow venous malformations with an incidence rate ranging between 0.4% and 20.0%. […] The detection of hepatic hemangiomas has significantly increased in recent years, largely due to advancements in imaging technologies. […] The vast majority of hepatic hemangiomas are asymptomatic, maintain a stable size, do not affect liver function, and are incidentally detected during routine abdominal imaging. […] Conservative management, encompassing periodic observation and surveillance via imaging at intervals of 6 or 12 months, is typically recommended as a suitable treatment strategy for these lesions. […] The management strategy for hepatic hemangiomas depends on various factors, including the size, location, symptoms, and potential complications of the lesion.

• #1

  https://journals.lww.com/hepcomm/fulltext/2024/11010/practical_approach_to_diagnose_and_manage_benign.24.aspx

  Hepatic hemangiomas are the most common solid benign lesions in the liver. They have a prevalence of 3% to 20%, with the highest incidence rate in adults between 30 and 50 years. Women are more commonly affected with a female-to-male ratio of 4.5:1 to 5:1. Most hemangiomas are 5 cm in diameter, and they usually remain stable, asymptomatic, and without complications. These hemangiomas are most commonly found in the right lobe of the liver. The etiology of the disease could potentially be genetic in a subset of patients. External factors such as hormonal exposure, specifically steroid therapy, estrogen therapy, and pregnancy, have also been associated with increased risk of hepatic hemangioma growth and can increase the risk of bleeding and rupture. At diagnosis, most hemangiomas are asymptomatic. However, giant hemangiomas can cause symptoms like abdominal discomfort, nausea, early satiety and rarely jaundice, or high output cardiac failure. The definition of a giant hemangioma varies, with some experts considering them giant if they exceed 5 cm, while others reserve this classification for those over 10 cm. Very rarely, giant hemangiomas can lead to a clinical presentation of Kasabach-Merritt syndrome, the constellation of which includes hemolytic anemia, thrombocytopenia, prolonged prothrombin time, and hypofibrinogenemia.

• #1 Real-world data on the clinicopathological traits and outcomes of hospitalized liver hemangioma patients: a multicenter study

  https://atm.amegroups.org/article/view/70525/html

  A total of 5,143 patients hospitalized for hepatic hemangioma were included in the study, of whom 34.42% were male and 65.58% were female. The age distribution was concentrated between 30 and 60 years old, accounting for 87.41% of the patients. […] Most patients in this study who were hospitalized for hepatic hemangioma did not meet the indications for requiring treatment. Surveillance is the recommended course of action for definitively diagnosed hepatic hemangioma, and a new classification system is needed to standardize the diagnosis of this condition.

• #1 :: PGHN :: Pediatric Gastroenterology, Hepatology & Nutrition

  https://pghn.org/DOIx.php?id=10.5223/pghn.2020.23.1.72

  Infantile hepatic hemangioma, the most common vascular tumor of the liver in infancy, can occur with acute postnatal liver and congestive heart failure. Nevertheless, its course is often benign, and many children can be diagnosed and treated without surgical intervention. […] IHH is a rare disease; with an incidence of 5 in 1,000,000 children per year, it is difficult to perform large cohort studies. […] Most of our patients (42%) presented with a palpable abdominal mass but no further symptoms correlating with other studies showing that 47% of patients presented with abdominal distension as the most frequent symptom. […] The incidence of life-threatening conditions in IHH is 10-20% with a high mortality rate. In these cases, prompt diagnosis and intervention are necessary to prevent progression or even death.

• #1 Hepatic haemangioma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hepatic-haemangioma-3?embed_domain=hackmd.io%2525252F%25252540yIPUAFeCSL2JsU8smR5nJQ%2525252Fbnjhjgjghjghjghfavicon.icofavicon.icoradiopaedia-icon-144.png&lang=gb

  Hepatic haemangiomas are much more common in females, with an F:M of up to 5:1. They are rarely seen in young children, but infantile hepatic haemangioma is the most common, benign hepatic vascular tumour in infants. […] Hepatic haemangiomas are thought to be congenital in origin, non-neoplastic, and are almost always of the cavernous subtype. […] Although more classically associated with hepatic adenomas, there is also believed to be a link between high oestrogen states (pregnancy, exogenous intake) and increased size/number of hepatic haemangiomas.

• #1 Giant hepatic hemangioma versus conventional hepatic hemangioma: Clinical findings, risk factors, and management | Revista de Gastroenterología de México

  http://www.revistagastroenterologiamexico.org/en-hemangioma-heptico-gigante-versus-hemangioma-articulo-resumen-S2255534X14001029

  Giant hepatic hemangiomas (GHHs) are those that are larger than 4cm in size. The aim of this study was to describe GHH clinical findings, their risk factors, diagnostic approach and management, and to compare these data with those of conventional hemangiomas. Of the 57 patients with liver hemangioma, 41 (72%) were women and 32 (56%) had GHH. Liver hemangioma median size was 4.49cm. In regard to the patients with GHH, 31.2% were asymptomatic and when symptoms presented, pain was the most common. Both symptoms and oral contraceptive exposure were more common in the GHH patients. Nine patients with GHH underwent surgery: 2 open biopsies due to diagnostic uncertainty, one enucleation, and 6 resections. GHHs are more prevalent in women and when symptomatic, pain is the most frequent complaint. Diagnosis is usually made through imaging studies, but when there is diagnostic doubt, surgical exploration is sometimes needed. Oral contraceptive use is most likely more of a risk factor for GHH than for conventional hemangioma, but this association needs to be studied further. Hepatic hemangiomas (HHs) are the most common benign hepatic tumors, with an estimated prevalence of 7% in autopsies and 1-20% in the general population. They are more common in women, probably as a result of an influence of female sex hormones on their growth. Giant hepatic hemangiomas (GHHs), defined as those HHs greater than 4cm in size, represent 10% of all HHs. HHs are usually asymptomatic and found incidentally. Symptoms have been reported in up to 40% of patients with a GHH in some case series, mainly abdominal pain, but also symptoms related to a mass effect such as early satiety, nausea, vomiting, cholestasis, or even cough. Diagnosis of GHH was initially made with ultrasound in 29 patients and with TCT in the other 3. Diagnosis was confirmed with TCT or MRI in all cases except for one patient in whom hepatic resection was performed after the diagnostic ultrasound was made. Surveillance was indicated in 23 (72%) of the patients with GHH. Three of them had pain, but did not undergo surgery; the pain was consistent with a functional disorder and disappeared with antispasmodics in 2 of those patients, and one did not accept the surgical procedure. Surgery was performed in the other 9 patients (28%). Two of them were asymptomatic and the indication was to perform an open biopsy because of diagnostic uncertainty after a thorough radiological evaluation; in both cases the radiologists could not exclude a metastasis of an unknown primary. Most authors consider GHHs as those larger than 4cm, while others define them as larger than 5cm. Compared to conventional HH, GHHs were more common in female patients who had been previously exposed to oral contraceptives and in patients who said they had no prior or present alcohol consumption. Patients in the surveillance group developed no symptoms during follow-up, supporting the benign course of this entity, regardless of hemangioma size. In conclusion, GHHs are more frequent in women, many of them are asymptomatic, and when they are symptomatic, pain is the most frequent complaint. As imaging techniques have evolved, diagnosis is usually made in terms of radiological studies. However, in a minority of cases, diagnostic uncertainty remains and surgical exploration may be needed. Oral contraceptive use is probably more a risk factor for the development of GHH than for conventional HH, while alcohol consumption seems to be less frequent in GHH patients. Nevertheless, these associations need to be studied further.

• #1 Liver hemangioma // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/liver-hemangioma

  A liver hemangioma is a noncancerous (benign) mass in the liver made up of a tangle of blood vessels. […] These liver masses are common and are estimated to occur in up to 20% of the population. […] Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. […] A liver hemangioma can be diagnosed at any age, but it’s most commonly diagnosed in people ages 30 to 50. […] Women are more likely to be diagnosed with a liver hemangioma than are men. […] Women who have been pregnant are more likely to be diagnosed with a liver hemangioma than women who have never been pregnant. […] It’s believed the hormone estrogen, which rises during pregnancy, may play a role in liver hemangioma growth. […] In most people, a liver hemangioma will never grow and never cause any signs and symptoms.

• #1 Hepatic hemangioma: What internists need to know

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6952297/

  Hepatic hemangioma (HH) is the most common benign liver tumor and it is usually found incidentally during radiological studies. […] This tumor arises from a vascular malformation; however, the pathophysiology has not been clearly elucidated. […] The diagnosis can be established by the identification of HH hallmarks in several imaging studies. […] In asymptomatic patients treatment is not required and follow up is usually reserved for HH of more than 5 cm. […] The natural progression of HH varies, previously these lesions were considered to remain stable. However, multiple studies have shown progression and increase in size when followed throughout the years. […] Most HH are diagnosed incidentally on imaging tests since most patients remain asymptomatic throughout their life. […] Since the natural history of HH is benign and an increase in size progression occurs in less than 40%, most patients can be reassured and only observed. […] When a patient is symptomatic, the first step is to exclude other causes of their symptoms. […] If treatment is needed, a minimal invasive approach should be pursued.

• #1

  https://journals.lww.com/hepcomm/fulltext/2024/11010/practical_approach_to_diagnose_and_manage_benign.24.aspx

  As benign liver lesions continue to be identified with increasing frequency, the importance of distinguishing between those requiring intervention and those that can be safely monitored cannot be overstated. Hepatic hemangiomas require more meticulous evaluation in 2 clinical contexts: when they occur against a background of fatty liver disease or cirrhosis. Hemangiomas should be diagnosed with extreme caution in patients with cirrhosis and only after other malignant processes with targetoid enhancement patterns are considered to be excluded. […] Most hepatic hemangiomas are small (5 cm), asymptomatic, and stable in size, with patients generally having normal liver function. In such patients, if imaging shows characteristic features of hemangiomas, no further treatment or imaging surveillance is needed, and patients should be reassured of the lack of risk for malignant transformation. If the hemangioma is large (≥ 7 cm) at diagnosis, it is reasonable to perform imaging surveillance for 6 to 12 months to ensure stability in size. For large lesions that continue to grow or directly cause symptoms, therapeutic interventions may be necessary. Surgical options like resection or enucleation are the cornerstone for the management of symptomatic hemangiomas or progressively enlarging giant hemangiomas. However, advancements in minimally invasive techniques have shifted preferences toward options such as transarterial embolization or ablative therapies. […] In summary, hepatic hemangiomas are common benign liver lesions that typically require careful evaluation and management, particularly in specific clinical contexts such as cirrhosis or when symptomatic.

• #1 Liver hemangiomas

  https://www.munichre.com/ca-life/en/perspectives/2023/case-clinic/case-clinic-liver-hemangiomas.html

  Hemangiomas are the most common benign tumor of the liver, seen in up to 20% of the general population. […] Most are asymptomatic with excellent prognosis, although a few may have symptoms such as pain. […] The majority are followed by serial imaging, with surgical resection being rare. […] Once hepatic cellular carcinoma is ruled out, the overall prognosis for most patients is excellent, as the majority remain asymptomatic with stable lesions. […] Size is an important prognostic factor along with stability on surveillance imaging. […] Munich Re determined that a careful review of the serial imaging studies is required for any applicant with a history of liver hemangioma(s). […] For lesions 5 cm, repeat imaging, preferably with a contrast-enhanced MRI, should be done in six to twelve months. […] If the lesion remains stable (i.e. growth rate 3 mm/year), then no further imaging is needed and the risk may be accepted at standard.

• #1 Liver hemangiomas

  https://www.munichre.com/us-life/en/insights/clinical-knowledge/case-clinic-liver-hemangiomas.html

  The Munich Re medical team investigated the insurability of a person with liver hemangiomas. […] Hemangiomas are the most common benign tumor of the liver, seen in up to 20% of the general population. […] The majority are followed by serial imaging, with surgical resection being rare. […] Size is an important prognostic factor along with stability on surveillance imaging. […] Munich Re determined that a careful review of the serial imaging studies is required for any applicant with a history of liver hemangioma(s). […] For lesions 5 cm, repeat imaging, preferably with a contrast-enhanced MRI, should be done in six to twelve months. […] If the lesion remains stable (i.e. growth rate 3 mm/year), then no further imaging is needed and the risk may be accepted at standard.

• #1 Hemangioma – Hepatic Tumors – Liver Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.7.30.4.2.

  Liver hemangioma is the most common benign neoplasm of the liver (it occurs in 2%-5% of the population and is several times more frequent in women). […] The vast majority of hepatic hemangiomas do not require treatment. Perform ultrasonography periodically, every 12 months (more often in the case of enlarging lesions). […] Regardless of their size, hemangiomas do not require surveillance during pregnancy. Testing is necessary when new symptoms develop.

• #1 Liver hemangioma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/symptoms-causes/syc-20354234

  A liver hemangioma (he-man-jee-O-muh) is a noncancerous (benign) mass in the liver made up of a tangle of blood vessels. Also known as hepatic hemangiomas or cavernous hemangiomas, these liver masses are common and are estimated to occur in up to 20% of the population. […] Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. People who have a liver hemangioma rarely experience signs and symptoms and typically don’t need treatment. […] In most people, a liver hemangioma will never grow and never cause any signs and symptoms. But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. It’s not clear why this happens. […] Factors that can increase the risk that a liver hemangioma will be diagnosed include: Your age. A liver hemangioma can be diagnosed at any age, but it’s most commonly diagnosed in people ages 30 to 50. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. The female hormone estrogen, which increases during pregnancy, is believed to cause some liver hemangiomas to grow larger.

• #1 Liver hemangioma // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/liver-hemangioma

  But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. […] The female hormone estrogen, which increases during pregnancy, is believed to cause some liver hemangiomas to grow larger. […] Very rarely, a growing hemangioma can cause signs and symptoms that may require treatment. […] If your liver hemangioma is small and doesn’t cause any signs or symptoms, you won’t need treatment. […] In most cases a liver hemangioma will never grow and will never cause problems. […] Your doctor may schedule follow-up exams to check your liver hemangioma periodically for growth if the hemangioma is large.

• #1 Liver haemangioma – British Liver Trust

  https://britishlivertrust.org.uk/information-and-support/liver-conditions/liver-haemangioma/

  Liver haemangiomas are the most common type of liver tumour. They are not a type of cancer, and it is very rare for them to cause any problems. […] It is thought that around 1 in 20 of us has a haemangioma in our liver. But they are almost always harmless, and most people never have any symptoms. […] Liver haemangiomas are very common. […] They usually cause no problems. […] You only need treatment if the haemangioma causes symptoms. […] Haemangiomas are often found by accident when you have a scan for something else. […] Most haemangiomas will never cause any problems. If you have no symptoms, the safest thing is to leave the haemangioma alone. […] Liver haemangiomas are almost always harmless.

• #1 Liver Hemangioma Treatment Without Surgery – Prof. Dr. Özgür Kılıçkesmez

  https://ozgurkilickesmez.com/en/liver-hemangioma-treatment-without-surgery/

  Liver hemangiomas are the most common benign tumors of the liver. Discovered incidentally, they are usually asymptomatic and do not require intervention. Studies have shown a wide prevalence of these tumors: […] Prevalence ranges from 0.4% to 7.3%. […] Morbid rate is approximately 2.5%. […] Typically detected during routine exams or when causing nonspecific symptoms like abdominal pain, hemangiomas rarely require treatment. They can occur at any age but are most common between 30 and 50 years old, with women at higher risk (female-to-male ratio up to 6:1). […] Although the exact cause is unknown, embryonic malformation of vascular channels is implicated. […] Liver hemangiomas usually do not require treatment. Indications for intervention include: […] Symptomatic lesions causing pain or mass effect,

• #1 Liver Hemangioma Treatment Without Surgery – Prof. Dr. Özgür Kılıçkesmez

  https://ozgurkilickesmez.com/en/liver-hemangioma-treatment-without-surgery/

  Risk of rupture or hemorrhage, […] Kasabach-Merritt syndrome, […] Progressive growth (2 cm annual increase), […] Diagnostic uncertainty, […] Severe anxiety affecting quality of life (rarely as surgical option). […] Prophylactic treatment of asymptomatic hemangiomas is generally not recommended except in exceptional cases, such as during pregnancy with large lesions or in physically active patients with exophytic hemangiomas. Treatment decisions should balance risks and benefits on an individual basis.

• #1

  https://journals.lww.com/hepcomm/fulltext/2024/11010/practical_approach_to_diagnose_and_manage_benign.24.aspx

  Hepatic hemangiomas are highly prevalent, which makes it extremely important to distinguish them from other hypervascular liver lesions which may be malignant, such as HCC and metastatic cancer. The characteristic imaging features of hemangiomas across various modalities, primarily ultrasound, CT, and MRI, allow for a noninvasive and accurate diagnosis in most cases. The diagnostic approach for suspected hemangiomas typically starts with ultrasound, followed by CT or MRI for definitive characterization. While generally benign, these liver lesions can occasionally lead to clinical symptoms. Complications such as abdominal discomfort, pain, or, more rarely, internal bleeding may occur, particularly with larger lesions or those located in areas that can lead to compression of surrounding tissues. Furthermore, certain hepatic adenoma subtypes harbor a small risk of malignant transformation, which necessitates careful monitoring and, sometimes, surgical intervention. The management of patients with benign liver lesions benefits immensely from a multidisciplinary approach involving hepatologists, surgeons, and radiologists.

• #1 I thought it was a hemangioma! A pictorial essay about common and uncommon liver hemangiomas’ mimickers | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01745-1

  Liver hemangiomas represent the most common primary benign liver tumor, with a prevalence of 220% in autoptic studies and a female-to-male ratio of 2:15:1. […] According to published series, hemangiomas may be detected in 5% of CT examinations and in 24% of US examinations. […] In non-oncologic patients with a healthy liver, US is enough for the diagnosis of characteristic lesions smaller than 3cm. […] Imaging follow-up is not indicated once the diagnosis is established. […] Liver hemangiomas have many benign and malignant mimickers showing one or more imaging features resembling hemangiomas, but all of them also show imaging features that enable to avoid misinterpretation.

• #2 One stop shop approach for the diagnosis of liver hemangioma

  https://www.wjgnet.com/1948-5182/full/v13/i12/1892.htm

  Hepatic hemangioma is usually detected on a routine ultrasound examination because of silent clinical behaviour. The rate of detection of HHs has increased as imaging methods have become more effectiveness and accessible. The prevalence depends on the method used for detection: 2%-4% for ultrasonography, up to 5% for computed tomography and up to 7% of cases in autopsy cases. HH are more common in women than in men. The natural history of hemangiomas is variable: Most of them remain stable, some may grow or involute. In the vast majority of cases does not require treatment or monitoring. Ultrasound examination is the main method of detecting HH due to the fact that it is widely available, inexpensive, rapidly performed without exposing the patient to radiation. Contrast enhanced ultrasound (CEUS) can be performed immediately after standard ultrasound exam while focal liver lesion (FLL) is found, in the same session, using a dedicated contrast software. The advantages of CEUS are related to the immediate availability in the ultrasound room where the lesion was detected, the real-time visualization of the tumor perfusion, non-ionizing technique and low financial costs. CEUS can be performed immediately after standard ultrasound in the consulting room, without the need to assess renal function as needed in the administration of contrast agents for CT/MRI. Studies to date have shown that CEUS has similar performance to computed tomography or MRI in the diagnosis of HH.

• #2 Liver Hemangioma Treatment Without Surgery – Prof. Dr. Özgür Kılıçkesmez

  https://ozgurkilickesmez.com/en/liver-hemangioma-treatment-without-surgery/

  Liver hemangiomas are the most common benign tumors of the liver. Discovered incidentally, they are usually asymptomatic and do not require intervention. Studies have shown a wide prevalence of these tumors: […] Prevalence ranges from 0.4% to 7.3%. […] Morbid rate is approximately 2.5%. […] Typically detected during routine exams or when causing nonspecific symptoms like abdominal pain, hemangiomas rarely require treatment. They can occur at any age but are most common between 30 and 50 years old, with women at higher risk (female-to-male ratio up to 6:1). […] Although the exact cause is unknown, embryonic malformation of vascular channels is implicated. […] Liver hemangiomas usually do not require treatment. Indications for intervention include: […] Symptomatic lesions causing pain or mass effect,

• #2 Hepatic hemangioma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/hepatic-haemangioma-3?lang=us

  Hepatic hemangiomas are much more common in females, with an F:M of up to 5:1. They are rarely seen in young children, but infantile hepatic hemangioma is the most common, benign hepatic vascular tumor in infants. […] Hepatic hemangiomas or hepatic venous malformations are the most common benign vascular liver lesions. They are frequently diagnosed as an incidental finding on imaging, and most patients are asymptomatic. From a radiologic perspective, it is important to differentiate hemangiomas from hepatic malignancy.

• #2 I thought it was a hemangioma! A pictorial essay about common and uncommon liver hemangiomas’ mimickers | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01745-1

  Liver hemangiomas represent the most common primary benign liver tumor, with a prevalence of 220% in autoptic studies and a female-to-male ratio of 2:15:1. […] According to published series, hemangiomas may be detected in 5% of CT examinations and in 24% of US examinations. […] In non-oncologic patients with a healthy liver, US is enough for the diagnosis of characteristic lesions smaller than 3cm. […] Imaging follow-up is not indicated once the diagnosis is established. […] Liver hemangiomas have many benign and malignant mimickers showing one or more imaging features resembling hemangiomas, but all of them also show imaging features that enable to avoid misinterpretation.

• #2 Liver hemangiomas

  https://www.munichre.com/us-life/en/insights/clinical-knowledge/case-clinic-liver-hemangiomas.html

  The Munich Re medical team investigated the insurability of a person with liver hemangiomas. […] Hemangiomas are the most common benign tumor of the liver, seen in up to 20% of the general population. […] The majority are followed by serial imaging, with surgical resection being rare. […] Size is an important prognostic factor along with stability on surveillance imaging. […] Munich Re determined that a careful review of the serial imaging studies is required for any applicant with a history of liver hemangioma(s). […] For lesions 5 cm, repeat imaging, preferably with a contrast-enhanced MRI, should be done in six to twelve months. […] If the lesion remains stable (i.e. growth rate 3 mm/year), then no further imaging is needed and the risk may be accepted at standard.

• #2 Liver hemangioma // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/liver-hemangioma

  But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. […] The female hormone estrogen, which increases during pregnancy, is believed to cause some liver hemangiomas to grow larger. […] Very rarely, a growing hemangioma can cause signs and symptoms that may require treatment. […] If your liver hemangioma is small and doesn’t cause any signs or symptoms, you won’t need treatment. […] In most cases a liver hemangioma will never grow and will never cause problems. […] Your doctor may schedule follow-up exams to check your liver hemangioma periodically for growth if the hemangioma is large.

• #2 Liver Hemangioma Treatment Without Surgery – Prof. Dr. Özgür Kılıçkesmez

  https://ozgurkilickesmez.com/en/liver-hemangioma-treatment-without-surgery/

  Risk of rupture or hemorrhage, […] Kasabach-Merritt syndrome, […] Progressive growth (2 cm annual increase), […] Diagnostic uncertainty, […] Severe anxiety affecting quality of life (rarely as surgical option). […] Prophylactic treatment of asymptomatic hemangiomas is generally not recommended except in exceptional cases, such as during pregnancy with large lesions or in physically active patients with exophytic hemangiomas. Treatment decisions should balance risks and benefits on an individual basis.

• #2

  https://journals.lww.com/hepcomm/fulltext/2024/11010/practical_approach_to_diagnose_and_manage_benign.24.aspx

  Hepatic hemangiomas are the most common solid benign lesions in the liver. They have a prevalence of 3% to 20%, with the highest incidence rate in adults between 30 and 50 years. Women are more commonly affected with a female-to-male ratio of 4.5:1 to 5:1. Most hemangiomas are 5 cm in diameter, and they usually remain stable, asymptomatic, and without complications. These hemangiomas are most commonly found in the right lobe of the liver. The etiology of the disease could potentially be genetic in a subset of patients. External factors such as hormonal exposure, specifically steroid therapy, estrogen therapy, and pregnancy, have also been associated with increased risk of hepatic hemangioma growth and can increase the risk of bleeding and rupture. At diagnosis, most hemangiomas are asymptomatic. However, giant hemangiomas can cause symptoms like abdominal discomfort, nausea, early satiety and rarely jaundice, or high output cardiac failure. The definition of a giant hemangioma varies, with some experts considering them giant if they exceed 5 cm, while others reserve this classification for those over 10 cm. Very rarely, giant hemangiomas can lead to a clinical presentation of Kasabach-Merritt syndrome, the constellation of which includes hemolytic anemia, thrombocytopenia, prolonged prothrombin time, and hypofibrinogenemia.

• #3 Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies

  https://www.mdpi.com/1648-9144/60/3/449

  Hepatic hemangiomas, the most prevalent benign liver tumors, are characterized as slow-flow venous malformations with an incidence rate ranging between 0.4% and 20.0%. […] The detection of hepatic hemangiomas has significantly increased in recent years, largely due to advancements in imaging technologies. […] The vast majority of hepatic hemangiomas are asymptomatic, maintain a stable size, do not affect liver function, and are incidentally detected during routine abdominal imaging. […] Conservative management, encompassing periodic observation and surveillance via imaging at intervals of 6 or 12 months, is typically recommended as a suitable treatment strategy for these lesions. […] The management strategy for hepatic hemangiomas depends on various factors, including the size, location, symptoms, and potential complications of the lesion.

• #3 Liver hemangioma – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/liver-hemangioma/symptoms-causes/syc-20354234

  A liver hemangioma (he-man-jee-O-muh) is a noncancerous (benign) mass in the liver made up of a tangle of blood vessels. Also known as hepatic hemangiomas or cavernous hemangiomas, these liver masses are common and are estimated to occur in up to 20% of the population. […] Most cases of liver hemangiomas are discovered during an imaging study done for some other condition. People who have a liver hemangioma rarely experience signs and symptoms and typically don’t need treatment. […] In most people, a liver hemangioma will never grow and never cause any signs and symptoms. But in a small number of people, a liver hemangioma will grow to cause symptoms and require treatment. It’s not clear why this happens. […] Factors that can increase the risk that a liver hemangioma will be diagnosed include: Your age. A liver hemangioma can be diagnosed at any age, but it’s most commonly diagnosed in people ages 30 to 50. […] Women who have been diagnosed with liver hemangiomas face a risk of complications if they become pregnant. The female hormone estrogen, which increases during pregnancy, is believed to cause some liver hemangiomas to grow larger.

• #3

  https://journals.lww.com/hepcomm/fulltext/2024/11010/practical_approach_to_diagnose_and_manage_benign.24.aspx

  Hepatic hemangiomas are the most common solid benign lesions in the liver. They have a prevalence of 3% to 20%, with the highest incidence rate in adults between 30 and 50 years. Women are more commonly affected with a female-to-male ratio of 4.5:1 to 5:1. Most hemangiomas are 5 cm in diameter, and they usually remain stable, asymptomatic, and without complications. These hemangiomas are most commonly found in the right lobe of the liver. The etiology of the disease could potentially be genetic in a subset of patients. External factors such as hormonal exposure, specifically steroid therapy, estrogen therapy, and pregnancy, have also been associated with increased risk of hepatic hemangioma growth and can increase the risk of bleeding and rupture. At diagnosis, most hemangiomas are asymptomatic. However, giant hemangiomas can cause symptoms like abdominal discomfort, nausea, early satiety and rarely jaundice, or high output cardiac failure. The definition of a giant hemangioma varies, with some experts considering them giant if they exceed 5 cm, while others reserve this classification for those over 10 cm. Very rarely, giant hemangiomas can lead to a clinical presentation of Kasabach-Merritt syndrome, the constellation of which includes hemolytic anemia, thrombocytopenia, prolonged prothrombin time, and hypofibrinogenemia.

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