Materiały źródłowe

• #1 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. […] The pathogenesis of this tumor is not still completely understood, but abnormal vasculogenesis and angiogenesis have been speculated to be involved. […] Some hemangiomas have the receptor for the estrogens and they grown during the puberty, pregnancy (following ovarian stimulation therapy with clomiphene citrate and human chorionic gonadotrophin), or oral contraceptive use, androgen or/and steroid administration. […] The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #2 Benign tumour of liver hemangioma | PPT

  https://www.slideshare.net/slideshow/benign-tumour-of-liver-hemangioma-136552731/136552731

  Hepatic hemangiomas are MC benign, vascular tumors of the liver, accounts for 73% of all benign liver tumors and is the second most common tumor seen in the liver after metastases. The prevalence of hemangiomas in autopsy series is 0.4%-20%. […] Pathogenesis HH are congenital vascular malformations. They enlarge by ectasia rather than hyperplasia or hypertrophy and are considered to be hamartomas. They compress, rather than infiltrate the surrounding liver parenchyma. A pathogenic role of sex hormones has been postulated, because of consistent female predominance in larger tumors and tumor enlargement/recurrence in hysterectomized women under estrogen replacement therapy and in pts with a long-term use of oral contraceptives. […] HH have been observed to in size during pregnancy and often display estrogen receptors, whereas no direct causal link between OC use and HH was observed in a case-control study. Moreover, tumor growth was also induced or influenced by drugs such as metaclopramide.

• #3 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hepatic hemangioma (HH) is a mesoderm-derived tumor consisting of a blood-filled space, fed by hepatic arterial circulation and lined by a single layer of flat endothelial cells. […] The pathophysiology of HH is not completely understood, and in some cases, a genetic predisposition has been described. HH arises from a vascular malformation with a growing pattern secondary to dilation rather than hypertrophy or hyperplasia. […] One hypothesis suggest HH results from abnormal angiogenesis and an increase in pro-angiogenic factors. […] Vascular endothelial growth factor (VEGF) is an important pro-angiogenic factor for endothelial cells. Mammalian target of rapamycin (mTOR) stimulates an autocrine loop of VEGF signaling and increase cell proliferation in vascular endotelial cells. […] Zhang et al found an increased expression of VEGF-A, pro-matrix metalloproteinase 2, and activated metalloproteinase 2 in HH cells compared to normal human liver endothelial cells.

• #4 What is a Liver Hemangioma and What Are the Symptoms and Causes? – Ezra

  https://ezra.com/blog/what-is-a-liver-hemangioma

  Liver hemangiomas are defined medically as benign tumors of the liver consisting of a clump of blood-filled cavities or tangled blood vessels fed by the hepatic artery (the major blood vessel of the liver). […] To this day, the exact cause of liver hemangiomas is unknown. However, the incidence of these tumors offers some clues into how they emerge. Genetic factors are thought to play a role in some individuals. […] There are several risk factors that increase the likelihood of developing liver hemangiomas, including age, which we mentioned previously. […] In many cases, individuals are born with liver hemangiomas. Sometimes, these tumors are fully grown, while others grow slowly throughout the individual’s lifetime. […] The altered blood flow within hemangiomas compared to malignant tumors and healthy tissue is important for their diagnosis and can be assessed with different imaging techniques. […] Liver hemangiomas appear darker on CT scans compared to adjacent liver tissue. They can be differentiated from malignant liver tumors due to distinct signaling patterns when a contrast agent is added to the bloodstream and by the lack of a dark rim surrounding the mass.

• #5 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. The team asked the question, Does the lesion need to be fully removed with benign pathology before any offer can be made? […] Hemangiomas are the most common benign tumor of the liver, seen in up to 20% of the general population. With the increase in abdominal imaging such as CT scans, MRIs, and ultrasounds, many more are being discovered incidentally when a person has no symptoms. Most are asymptomatic with excellent prognosis, although a few may have symptoms such as pain. Liver hemangiomas are often solitary, but sometimes multiple lesions are present. The majority are followed by serial imaging, with surgical resection being rare. […] Bleeding from a rupture of blood vessels is rare, but can occur. 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.

• #6 Liver hemangioma | PPT

  https://www.slideshare.net/slideshow/liver-hemangioma-109166980/109166980

  LIVER HEMANGIOMA NUCLEAR MEDICINE APPLICATION Ramin Sadeghi, MD INTRODUCTION The most common benign mesenchymal hepatic tumors Are often solitary, but multiple lesions may be present in both the right and left lobe of the liver in up to 40 percent of patients […] PREVALENCE AND PATHOGENESIS Estimates of the prevalence of hepatic hemangiomas have ranged from 0.4 to 20 percent 60 to 80 percent of cases are diagnosed in patients who are between the ages of 30 and 50 years. In adults, hemangiomas occur more frequently in women with a ratio of 3:1 Lesions responsible for symptoms are more likely in young women […] PATHOGENESIS The etiology of hepatic hemangiomas is incompletely understood. They are considered to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy. Hormonal influence over tumor growth is suggested by enlargement during pregnancy and estrogen and progesterone therapy and regression after withdrawal of therapy.

• #7 Liver Hemangioma : Pathogenesis

  https://webpathology.com/images/gastrointestinal/liver/liver-tumors-and-tumor-like-lesions—i/42956

  The exact pathogenesis of liver hemangiomas is not known. A subset of cases that occur in families may have an underlying genetic predisposition. Many consider them to be hamartomatous rather than true neoplasms. The tumors can have estrogen receptors and studies have shown an association between hormone exposure/increased hormone levels (e.g. steroid therapy, estrogen therapy, adolescence, pregnancy, or oral contraceptive use) and increased growth of the tumors. […] Liver hemangiomas in adults can be broadly classified into two types: cavernous hemangiomas (most common) and capillary hemangiomas. Capillary hemangiomas are small, asymptomatic, may be multiple, and located peripherally. Cavernous hemangiomas are larger, solitary masses that are more likely to produce symptoms. Tumors in the pediatric age group are classified into congenital hemangioma and infantile hemangioma subtypes (formerly called infantile hemangioendothelioma of liver).

• #8 Hepatic hemangioma – UpToDate

  https://www.uptodate.com/contents/hepatic-hemangioma

  Hepatic hemangiomas (also referred to as cavernous hemangiomas because of the cavernous vascular space seen histologically) are the most common benign liver lesion. […] The etiology of hepatic hemangiomas is incompletely understood. They are thought to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy.

• #9 Liver Hemangioma : Pathogenesis

  https://webpathology.com/images/gastrointestinal/liver/liver-tumors-and-tumor-like-lesions—i/42956

  The exact pathogenesis of liver hemangiomas is not known. A subset of cases that occur in families may have an underlying genetic predisposition. Many consider them to be hamartomatous rather than true neoplasms. The tumors can have estrogen receptors and studies have shown an association between hormone exposure/increased hormone levels (e.g. steroid therapy, estrogen therapy, adolescence, pregnancy, or oral contraceptive use) and increased growth of the tumors. […] Liver hemangiomas in adults can be broadly classified into two types: cavernous hemangiomas (most common) and capillary hemangiomas. Capillary hemangiomas are small, asymptomatic, may be multiple, and located peripherally. Cavernous hemangiomas are larger, solitary masses that are more likely to produce symptoms. Tumors in the pediatric age group are classified into congenital hemangioma and infantile hemangioma subtypes (formerly called infantile hemangioendothelioma of liver).

• #10 Hepatic hemangioma – UpToDate

  https://www.uptodate.com/contents/hepatic-hemangioma

  Hepatic hemangiomas (also referred to as cavernous hemangiomas because of the cavernous vascular space seen histologically) are the most common benign liver lesion. […] The etiology of hepatic hemangiomas is incompletely understood. They are thought to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy.

• #11 Liver hemangioma – Treatment abroad

  https://www.gsdinternational.com/conditions/liver-hemangioma

  Hemangioma is the most common benign tumor of the liver and has a prevalence in the population of 5% to 20%. […] Cavernous angiomas, along with focal nodular hyperplasia, are considered congenital vascular malformations; in fact, the possible increase in the size of the lesions is more associated with progressive ectasia (i.e., dilation) of the vessels, rather than with cell proliferation. […] Fibrous involution or angioma thrombosis can lead to formation of dense fibrous masses, which are often difficult to distinguish from other lesions. […] Although the natural history of angiomas (i.e., the evolution of neoplasms in the absence of treatment) is not well documented, most neoplasms remain stable over time with a very low risk of rupture or bleeding.

• #12 Cavernous Hepatic Hemangioma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470283/

  Hepatic hemangiomas are benign, hypervascular, venous malformations in the liver. They are the most common benign mesenchymal tumors of the liver. […] The etiology of hepatic hemangiomas is not completely understood. They sporadically occur without any known predisposing factors. When hemangiomas are greater than 10 cm, they are considered giant hemangiomas. Since they are considered vascular malformations, they enlarge by ectasia rather than hyperplasia or hypertrophy. […] Several associated abnormalities include focal nodular hyperplasia of the liver and Kasabach-Merritt syndrome, consisting of multiple hemangiomas throughout the body, elevated fibrin degradation products, and thrombocytopenia.

• #13

  https://journals.lww.com/md-journal/fulltext/2017/12080/long_term_result_of_transcatheter_arterial.81.aspx

  Transcatheter arterial embolization (TAE) is a method for the treatment of liver hemangioma, but fewer studies reported the long-term result. […] Their pathogenesis is ill known, but many authors consider that they are vascular malformations or hamartomas of congenital origin that enlarge by ectasia, but not by hyperplasia or hypertrophy. […] The long-term result of TAE for liver hemangioma was not satisfying, and the treatment had the risk of severe complication. For patients with asymptomatic liver hemangioma, TAE should not be conducted. […] The result of this study showed that the long-term outcome of TAE was not satisfying. For most patients, TAE was incapable to stop the growth of liver hemangioma, especially for the patients with giant lesions (10 cm). […] The possible reason was that giant lesion had multiple nourishing vessels which made the total embolization impossible. Moreover, vasculogenesis may occur after the TAE and the tumor will get larger.

• #14 Benign tumour of liver hemangioma | PPT

  https://www.slideshare.net/slideshow/benign-tumour-of-liver-hemangioma-136552731/136552731

  Hepatic hemangiomas are MC benign, vascular tumors of the liver, accounts for 73% of all benign liver tumors and is the second most common tumor seen in the liver after metastases. The prevalence of hemangiomas in autopsy series is 0.4%-20%. […] Pathogenesis HH are congenital vascular malformations. They enlarge by ectasia rather than hyperplasia or hypertrophy and are considered to be hamartomas. They compress, rather than infiltrate the surrounding liver parenchyma. A pathogenic role of sex hormones has been postulated, because of consistent female predominance in larger tumors and tumor enlargement/recurrence in hysterectomized women under estrogen replacement therapy and in pts with a long-term use of oral contraceptives. […] HH have been observed to in size during pregnancy and often display estrogen receptors, whereas no direct causal link between OC use and HH was observed in a case-control study. Moreover, tumor growth was also induced or influenced by drugs such as metaclopramide.

• #15 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. […] The pathogenesis of this tumor is not still completely understood, but abnormal vasculogenesis and angiogenesis have been speculated to be involved. […] Some hemangiomas have the receptor for the estrogens and they grown during the puberty, pregnancy (following ovarian stimulation therapy with clomiphene citrate and human chorionic gonadotrophin), or oral contraceptive use, androgen or/and steroid administration. […] The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #16 Hepatic hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hepatic_hemangioma_pathophysiology

  Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hepatic hemangiomas has not been elucidated, but there are two competing theories. […] The first theory supports the notion that hepatic hemangioma may be the result of overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The second theory suggests that the presence of liver hemangiomas involves a genetic background of mutations.

• #17 Hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hemangioma_pathophysiology

  Development of hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories; […] The second theory is that the presence of liver hemangiomas involves a genetic background of mutations. […] Genetic errors in growth factor receptors have also been shown to affect development of hemangiomas. […] Metalloproteinases can accumulate in the endoplasmic reticulum of the tumor cells causing: self-digestion, vacuole formation. […] Cavernous hemangioma cell can downregulate Derlin-1. Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size. […] The third theory suggests that hemangioma endothelial cells arise from disrupted placental tissue imbedded in fetal soft tissues during gestation or birth. […] Markers of hemangiomas have been shown to coincide with those found in placental tissue.

• #18 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hepatic hemangioma (HH) is a mesoderm-derived tumor consisting of a blood-filled space, fed by hepatic arterial circulation and lined by a single layer of flat endothelial cells. […] The pathophysiology of HH is not completely understood, and in some cases, a genetic predisposition has been described. HH arises from a vascular malformation with a growing pattern secondary to dilation rather than hypertrophy or hyperplasia. […] One hypothesis suggest HH results from abnormal angiogenesis and an increase in pro-angiogenic factors. […] Vascular endothelial growth factor (VEGF) is an important pro-angiogenic factor for endothelial cells. Mammalian target of rapamycin (mTOR) stimulates an autocrine loop of VEGF signaling and increase cell proliferation in vascular endotelial cells. […] Zhang et al found an increased expression of VEGF-A, pro-matrix metalloproteinase 2, and activated metalloproteinase 2 in HH cells compared to normal human liver endothelial cells.

• #19 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hepatic hemangioma (HH) is a mesoderm-derived tumor consisting of a blood-filled space, fed by hepatic arterial circulation and lined by a single layer of flat endothelial cells. […] The pathophysiology of HH is not completely understood, and in some cases, a genetic predisposition has been described. HH arises from a vascular malformation with a growing pattern secondary to dilation rather than hypertrophy or hyperplasia. […] One hypothesis suggest HH results from abnormal angiogenesis and an increase in pro-angiogenic factors. […] Vascular endothelial growth factor (VEGF) is an important pro-angiogenic factor for endothelial cells. Mammalian target of rapamycin (mTOR) stimulates an autocrine loop of VEGF signaling and increase cell proliferation in vascular endotelial cells. […] Zhang et al found an increased expression of VEGF-A, pro-matrix metalloproteinase 2, and activated metalloproteinase 2 in HH cells compared to normal human liver endothelial cells.

• #20 Hepatic sclerosing hemangioma mimics hepatic malignancies: a case report and multidisciplinary approach | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-019-0007-6

  Hepatic sclerosing hemangioma (HSH) is a rare benign vascular tumor showing degenerative changes, fibrosis, and sclerosis as a result of thrombosis of the blood vessels. […] In 1994, the objective basis for the development of HSH was postulated, and the lesion was recognized as a mimicker of hepatic malignancy. […] The neoplastic cells were positive for CD34 and negative for CK7 confirm the vascular nature of neoplasm. […] Several theories have been proposed. Takahashi et al. reported the role of VEGF in promoting angiogenesis and endothelial proliferation in the proliferating phase. On the contrary, SMA was expressed in the pericytes and functioned through inhibition of endothelial cell proliferation in the involuting and involuted phases. […] Therefore, we performed a panel of IHC to estimate the possible phase of hemangioma. The endothelial cells were negative for VEGF indicating the arrested phase of proliferation.

• #21 Hepatic hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hepatic_hemangioma_pathophysiology

  Development of hepatic hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hepatic hemangiomas has not been elucidated, but there are two competing theories. […] The first theory supports the notion that hepatic hemangioma may be the result of overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The second theory suggests that the presence of liver hemangiomas involves a genetic background of mutations.

• #22 Hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hemangioma_pathophysiology

  Development of hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories; […] The second theory is that the presence of liver hemangiomas involves a genetic background of mutations. […] Genetic errors in growth factor receptors have also been shown to affect development of hemangiomas. […] Metalloproteinases can accumulate in the endoplasmic reticulum of the tumor cells causing: self-digestion, vacuole formation. […] Cavernous hemangioma cell can downregulate Derlin-1. Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size. […] The third theory suggests that hemangioma endothelial cells arise from disrupted placental tissue imbedded in fetal soft tissues during gestation or birth. […] Markers of hemangiomas have been shown to coincide with those found in placental tissue.

• #23 Hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hemangioma_pathophysiology

  Development of hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories; […] The second theory is that the presence of liver hemangiomas involves a genetic background of mutations. […] Genetic errors in growth factor receptors have also been shown to affect development of hemangiomas. […] Metalloproteinases can accumulate in the endoplasmic reticulum of the tumor cells causing: self-digestion, vacuole formation. […] Cavernous hemangioma cell can downregulate Derlin-1. Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size. […] The third theory suggests that hemangioma endothelial cells arise from disrupted placental tissue imbedded in fetal soft tissues during gestation or birth. […] Markers of hemangiomas have been shown to coincide with those found in placental tissue.

• #24 Cavernous hemangioma – Wikipedia

  https://en.wikipedia.org/wiki/Cavernous_hemangioma

  Cavernous hemangioma, also called cavernous angioma, venous malformation, or cavernoma, is a type of venous malformation due to endothelial dysmorphogenesis from a lesion which is present at birth. […] The pathogenesis of hemangioma is still not understood. It has been suggested that growth factors and hormonal influences contribute to the abnormal cell proliferation. Cavernous liver hemangiomas are more commonly diagnosed in women who have been pregnant. […] Genetic studies show that specific gene mutations or deletions are causes for the disease. The genes identified for cerebral cavernous hemangiomas (or malformations), are CCM1 (also KRIT1), CCM2 (also MGC4607, malcavernin) and CCM3 (also PDCD10). The loss of function of these genes is believed to be responsible for cerebral cavernous malformations.

• #25 Liver Hemangioma : Pathogenesis

  https://www.webpathology.com/images/gastrointestinal/liver/liver-tumors-and-tumor-like-lesions—i/42956

  The exact pathogenesis of liver hemangiomas is not known. A subset of cases that occur in families may have an underlying genetic predisposition. Many consider them to be hamartomatous rather than true neoplasms. […] The tumors can have estrogen receptors and studies have shown an association between hormone exposure/increased hormone levels (e.g. steroid therapy, estrogen therapy, adolescence, pregnancy, or oral contraceptive use) and increased growth of the tumors.

• #26

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

  The cause of HH is not known, it may be congenitally determined, there are researchers who reported cases of HH running in families, suggesting a possible genetic connection, others with mesenchymal origin, still, others considered congenital hematoma in some articles. […] Predisposing factors of complications of HH: adulthood, chronic medication use (such as steroid use, can accelerate the development of an existing HH), female sex: estrogen therapy, use of oral contraceptives (increase the risk or increase the size, discontinuing contraceptive regimen can lead to lesion regression, but not necessarily); pregnancy and multiparity (by disrupting estrogen and progesterone hormone levels, leading to an increase in size of a preexisting HH); replacement therapy for menopausal symptoms; ovarian stimulation treatment with clomiphene citrate and human chorionic gonadotropin. Genetic gene penetrance or sex hormone proliferative factors could also be an explanation.

• #27

  https://healthmatch.io/liver-disease/hemangioma-liver

  The underlying cause of a liver hemangioma isnt fully understood. There may be certain genetic factors that increase susceptibility. […] There are several theories about the mechanism of a liver hemangioma. One view is that people with a liver hemangioma have issues with the process of blood vessel development. People with the condition may have too much of certain substances that cause blood vessel growth. […] There may be a hormonal component to this condition, as it disproportionately affects women, and hemangioma size increases more in those who are on hormonal oral contraceptive pills and those who have had hormone replacement therapy. Therefore, it is thought that estrogen might play a role in developing liver hemangiomas. […] The cause of liver hemangiomas isnt well understood, but there is thought to be a genetic component. Additionally, hormonal factors (estrogen) may play a role.

• #28 Hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hemangioma_pathophysiology

  Development of hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories; […] The second theory is that the presence of liver hemangiomas involves a genetic background of mutations. […] Genetic errors in growth factor receptors have also been shown to affect development of hemangiomas. […] Metalloproteinases can accumulate in the endoplasmic reticulum of the tumor cells causing: self-digestion, vacuole formation. […] Cavernous hemangioma cell can downregulate Derlin-1. Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size. […] The third theory suggests that hemangioma endothelial cells arise from disrupted placental tissue imbedded in fetal soft tissues during gestation or birth. […] Markers of hemangiomas have been shown to coincide with those found in placental tissue.

• #29 Hemangioma pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hemangioma_pathophysiology

  Development of hemangioma is the result of genetic mutations, overexpression of angiogenic factors and downregulation of inhibitors of angiogenesis. […] The pathogenesis of hemangiomas has not been elucidated, but there are two competing theories; […] The second theory is that the presence of liver hemangiomas involves a genetic background of mutations. […] Genetic errors in growth factor receptors have also been shown to affect development of hemangiomas. […] Metalloproteinases can accumulate in the endoplasmic reticulum of the tumor cells causing: self-digestion, vacuole formation. […] Cavernous hemangioma cell can downregulate Derlin-1. Derlin-1 is a protein that when overexpressed induces the dilated endoplasmic reticulum to return to its normal size. […] The third theory suggests that hemangioma endothelial cells arise from disrupted placental tissue imbedded in fetal soft tissues during gestation or birth. […] Markers of hemangiomas have been shown to coincide with those found in placental tissue.

• #30 Liver hemangioma | PPT

  https://www.slideshare.net/slideshow/liver-hemangioma-109166980/109166980

  LIVER HEMANGIOMA NUCLEAR MEDICINE APPLICATION Ramin Sadeghi, MD INTRODUCTION The most common benign mesenchymal hepatic tumors Are often solitary, but multiple lesions may be present in both the right and left lobe of the liver in up to 40 percent of patients […] PREVALENCE AND PATHOGENESIS Estimates of the prevalence of hepatic hemangiomas have ranged from 0.4 to 20 percent 60 to 80 percent of cases are diagnosed in patients who are between the ages of 30 and 50 years. In adults, hemangiomas occur more frequently in women with a ratio of 3:1 Lesions responsible for symptoms are more likely in young women […] PATHOGENESIS The etiology of hepatic hemangiomas is incompletely understood. They are considered to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy. Hormonal influence over tumor growth is suggested by enlargement during pregnancy and estrogen and progesterone therapy and regression after withdrawal of therapy.

• #31 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  Hepatic cavernous hemangioma accounts for 73% of all benign liver tumors with a frequency of 0.4-7.3% at autopsy and is the second most common tumor seen in the liver after metastases. […] The pathogenesis of this tumor is not still completely understood, but abnormal vasculogenesis and angiogenesis have been speculated to be involved. […] Some hemangiomas have the receptor for the estrogens and they grown during the puberty, pregnancy (following ovarian stimulation therapy with clomiphene citrate and human chorionic gonadotrophin), or oral contraceptive use, androgen or/and steroid administration. […] The right indications for surgery remain rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #32 Liver Hemangioma : Pathogenesis

  https://www.webpathology.com/images/gastrointestinal/liver/liver-tumors-and-tumor-like-lesions—i/42956

  The exact pathogenesis of liver hemangiomas is not known. A subset of cases that occur in families may have an underlying genetic predisposition. Many consider them to be hamartomatous rather than true neoplasms. […] The tumors can have estrogen receptors and studies have shown an association between hormone exposure/increased hormone levels (e.g. steroid therapy, estrogen therapy, adolescence, pregnancy, or oral contraceptive use) and increased growth of the tumors.

• #33 Benign tumour of liver hemangioma | PPT

  https://www.slideshare.net/slideshow/benign-tumour-of-liver-hemangioma-136552731/136552731

  Hepatic hemangiomas are MC benign, vascular tumors of the liver, accounts for 73% of all benign liver tumors and is the second most common tumor seen in the liver after metastases. The prevalence of hemangiomas in autopsy series is 0.4%-20%. […] Pathogenesis HH are congenital vascular malformations. They enlarge by ectasia rather than hyperplasia or hypertrophy and are considered to be hamartomas. They compress, rather than infiltrate the surrounding liver parenchyma. A pathogenic role of sex hormones has been postulated, because of consistent female predominance in larger tumors and tumor enlargement/recurrence in hysterectomized women under estrogen replacement therapy and in pts with a long-term use of oral contraceptives. […] HH have been observed to in size during pregnancy and often display estrogen receptors, whereas no direct causal link between OC use and HH was observed in a case-control study. Moreover, tumor growth was also induced or influenced by drugs such as metaclopramide.

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

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

  It’s not clear what causes a liver hemangioma to form. Doctors believe liver hemangiomas are present at birth (congenital). […] 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. […] 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. […] Medications that affect hormone levels in your body, such as birth control pills, could cause an increase in size and complications if you’ve been diagnosed with a liver hemangioma. But this is controversial. If you’re considering this type of medication, discuss the benefits and risks with your doctor.

• #35 Liver hemangioma // Middlesex Health

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

  It’s not clear what causes a liver hemangioma to form. Doctors believe liver hemangiomas are present at birth (congenital). […] 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. […] 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. […] Medications that affect hormone levels in your body, such as birth control pills, could cause an increase in size and complications if you’ve been diagnosed with a liver hemangioma. But this is controversial.

• #36 Enlargement of hepatic hemangioma in successive pregnancies

  https://www.degruyter.com/document/doi/10.1515/crpm-2014-0053/html?lang=en

  Hemangiomas are the most common benign tumor of the liver and are commonly seen as incidental findings on abdominal imaging. Little is known regarding the natural course and pathogenesis of hepatic hemangiomas during pregnancy. It is believed estrogen may play a role in their growth; however, the precise mechanism remains undefined. […] The mechanism of enlargement is unclear. Hepatic hemangioma enlargement appears to be affected by both endogenous and exogenous female sex hormones. […] Enlargement of these tumors has also been reported during pregnancy further suggesting a possible relationship between hemangiomas and estrogen. […] The precise mechanism linking estrogen to hemangioma enlargement is incompletely understood. […] However, despite the progression of hepatic hemangiomas in the presence of estrogen, there has been no report of estrogen receptors specifically in hepatic hemangiomas.

• #37 Enlargement of hepatic hemangioma in successive pregnancies

  https://www.degruyter.com/document/doi/10.1515/crpm-2014-0053/html?lang=en

  Hemangiomas are the most common benign tumor of the liver and are commonly seen as incidental findings on abdominal imaging. Little is known regarding the natural course and pathogenesis of hepatic hemangiomas during pregnancy. It is believed estrogen may play a role in their growth; however, the precise mechanism remains undefined. […] The mechanism of enlargement is unclear. Hepatic hemangioma enlargement appears to be affected by both endogenous and exogenous female sex hormones. […] Enlargement of these tumors has also been reported during pregnancy further suggesting a possible relationship between hemangiomas and estrogen. […] The precise mechanism linking estrogen to hemangioma enlargement is incompletely understood. […] However, despite the progression of hepatic hemangiomas in the presence of estrogen, there has been no report of estrogen receptors specifically in hepatic hemangiomas.

• #38 Enlargement of hepatic hemangioma in successive pregnancies

  https://www.degruyter.com/document/doi/10.1515/crpm-2014-0053/html?lang=en

  An alternative premise to explain this hemangioma enlargement in the presence of hormones has been proposed suggesting that as hemangiomas are considered to be vascular malformations that enlarge by dilation of tissue, estrogen plays an indirect role through vascular dilatation. […] However, the exact role and interaction between estrogen and hepatic hemangioma enlargement remains unclear.

• #39

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

  The cause of HH is not known, it may be congenitally determined, there are researchers who reported cases of HH running in families, suggesting a possible genetic connection, others with mesenchymal origin, still, others considered congenital hematoma in some articles. […] Predisposing factors of complications of HH: adulthood, chronic medication use (such as steroid use, can accelerate the development of an existing HH), female sex: estrogen therapy, use of oral contraceptives (increase the risk or increase the size, discontinuing contraceptive regimen can lead to lesion regression, but not necessarily); pregnancy and multiparity (by disrupting estrogen and progesterone hormone levels, leading to an increase in size of a preexisting HH); replacement therapy for menopausal symptoms; ovarian stimulation treatment with clomiphene citrate and human chorionic gonadotropin. Genetic gene penetrance or sex hormone proliferative factors could also be an explanation.

• #40 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hormones such as estrogens play a role in HH growth, as they are seen more frequently among women and their size increase after hormone replacement therapy (HRT), oral contraceptive pills (OCPs), and pregnancy. […] The direct mechanisms of hormone effects are unknown, as HH are negative for estrogen and progesterone receptors and current evidence does not support a contraindication of OCPs/HRT/anabolic steroids in patients with HH.

• #41 Hepatic Hemangiomas: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/177106-overview

  Hepatic hemangiomas may result from abnormal angiogenesis. […] Some authors have reported that steroid therapy, female sex hormones, and pregnancy could increase the size of an already existing hemangioma. […] The focal liver lesion practice guideline of the American College of Gastroenterology (ACG) states: „There has been no clear causative link between hemangiomas and female sex hormones, and thus, it is not recommended to avoid OCP [oral contraceptive pills] or pregnancy in patients with hemangiomas.” […] It is postulated that some cavernous hemangiomas will degenerate and undergo fibrous replacement, leading to the development of the relatively uncommon sclerosed hemangioma.

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

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

  The pathogenesis of hemangioma is not entirely understood, the theory of congenital disorder with possible hormonal dependence has been taken into account. […] HH arises from a vascular malformation and increases in size mainly by dilating the vessels inside the tumour. […] Currently, according to newer classification system of the International Society for the Study of Vascular Anomalies ISSVA, last updated in 2018, HH is a vascular tumor, considered as a slow flow venous malformation.

• #43 Hepatic hemangioma – UpToDate

  https://www.uptodate.com/contents/hepatic-hemangioma

  Hepatic hemangiomas (also referred to as cavernous hemangiomas because of the cavernous vascular space seen histologically) are the most common benign liver lesion. […] The etiology of hepatic hemangiomas is incompletely understood. They are thought to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy.

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

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

  The pathogenesis of hemangioma is not entirely understood, the theory of congenital disorder with possible hormonal dependence has been taken into account. […] HH arises from a vascular malformation and increases in size mainly by dilating the vessels inside the tumour. […] Currently, according to newer classification system of the International Society for the Study of Vascular Anomalies ISSVA, last updated in 2018, HH is a vascular tumor, considered as a slow flow venous malformation.

• #45 Hepatic Hemangiomas: Background, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/177106-overview

  Hepatic hemangiomas may result from abnormal angiogenesis. […] Some authors have reported that steroid therapy, female sex hormones, and pregnancy could increase the size of an already existing hemangioma. […] The focal liver lesion practice guideline of the American College of Gastroenterology (ACG) states: „There has been no clear causative link between hemangiomas and female sex hormones, and thus, it is not recommended to avoid OCP [oral contraceptive pills] or pregnancy in patients with hemangiomas.” […] It is postulated that some cavernous hemangiomas will degenerate and undergo fibrous replacement, leading to the development of the relatively uncommon sclerosed hemangioma.

• #46 Hepatic sclerosing hemangioma mimics hepatic malignancies: a case report and multidisciplinary approach | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-019-0007-6

  Hepatic sclerosing hemangioma (HSH) is a rare benign vascular tumor showing degenerative changes, fibrosis, and sclerosis as a result of thrombosis of the blood vessels. […] In 1994, the objective basis for the development of HSH was postulated, and the lesion was recognized as a mimicker of hepatic malignancy. […] The neoplastic cells were positive for CD34 and negative for CK7 confirm the vascular nature of neoplasm. […] Several theories have been proposed. Takahashi et al. reported the role of VEGF in promoting angiogenesis and endothelial proliferation in the proliferating phase. On the contrary, SMA was expressed in the pericytes and functioned through inhibition of endothelial cell proliferation in the involuting and involuted phases. […] Therefore, we performed a panel of IHC to estimate the possible phase of hemangioma. The endothelial cells were negative for VEGF indicating the arrested phase of proliferation.

• #47 Hepatic sclerosing hemangioma mimics hepatic malignancies: a case report and multidisciplinary approach | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-019-0007-6

  Hepatic sclerosing hemangioma (HSH) is a rare benign vascular tumor showing degenerative changes, fibrosis, and sclerosis as a result of thrombosis of the blood vessels. […] In 1994, the objective basis for the development of HSH was postulated, and the lesion was recognized as a mimicker of hepatic malignancy. […] The neoplastic cells were positive for CD34 and negative for CK7 confirm the vascular nature of neoplasm. […] Several theories have been proposed. Takahashi et al. reported the role of VEGF in promoting angiogenesis and endothelial proliferation in the proliferating phase. On the contrary, SMA was expressed in the pericytes and functioned through inhibition of endothelial cell proliferation in the involuting and involuted phases. […] Therefore, we performed a panel of IHC to estimate the possible phase of hemangioma. The endothelial cells were negative for VEGF indicating the arrested phase of proliferation.

• #48 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1057

  Sclerosing hemangiomas and sclerosed hemangiomas are rare conditions that were first reported by Shepherd and Lee in 1983. […] A subsequent report of two more solitary „necrotic nodules” of the liver identified a vascular component, suggesting a probable pathogenesis of sclerosis of a preexisting hemangioma. […] An additional theory proposed by Makhlouf et al suggests that mast cells play a pivotal role in the development of a sclerosing hemangioma. […] According to previous reports, sclerosing hemangiomas arise in cavernous hemangiomas with thin-walled cavernous vascular spaces of variable size that lack an elastic tissue. […] The sclerotic area in a sclerosing cavernous hemangioma is best explained by localized regressive changes secondary to thrombosis, infarction, or hemorrhage. […] The pathogenesis of sclerosing hemangiomas remains unknown and has no definite familial or genetic factor of inheritance, although several theories have been proposed.

• #49 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1057

  Sclerosing hemangiomas and sclerosed hemangiomas are rare conditions that were first reported by Shepherd and Lee in 1983. […] A subsequent report of two more solitary „necrotic nodules” of the liver identified a vascular component, suggesting a probable pathogenesis of sclerosis of a preexisting hemangioma. […] An additional theory proposed by Makhlouf et al suggests that mast cells play a pivotal role in the development of a sclerosing hemangioma. […] According to previous reports, sclerosing hemangiomas arise in cavernous hemangiomas with thin-walled cavernous vascular spaces of variable size that lack an elastic tissue. […] The sclerotic area in a sclerosing cavernous hemangioma is best explained by localized regressive changes secondary to thrombosis, infarction, or hemorrhage. […] The pathogenesis of sclerosing hemangiomas remains unknown and has no definite familial or genetic factor of inheritance, although several theories have been proposed.

• #50 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1057

  Sclerosing hemangiomas and sclerosed hemangiomas are rare conditions that were first reported by Shepherd and Lee in 1983. […] A subsequent report of two more solitary „necrotic nodules” of the liver identified a vascular component, suggesting a probable pathogenesis of sclerosis of a preexisting hemangioma. […] An additional theory proposed by Makhlouf et al suggests that mast cells play a pivotal role in the development of a sclerosing hemangioma. […] According to previous reports, sclerosing hemangiomas arise in cavernous hemangiomas with thin-walled cavernous vascular spaces of variable size that lack an elastic tissue. […] The sclerotic area in a sclerosing cavernous hemangioma is best explained by localized regressive changes secondary to thrombosis, infarction, or hemorrhage. […] The pathogenesis of sclerosing hemangiomas remains unknown and has no definite familial or genetic factor of inheritance, although several theories have been proposed.

• #51 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1057

  Sclerosing hemangiomas and sclerosed hemangiomas are rare conditions that were first reported by Shepherd and Lee in 1983. […] A subsequent report of two more solitary „necrotic nodules” of the liver identified a vascular component, suggesting a probable pathogenesis of sclerosis of a preexisting hemangioma. […] An additional theory proposed by Makhlouf et al suggests that mast cells play a pivotal role in the development of a sclerosing hemangioma. […] According to previous reports, sclerosing hemangiomas arise in cavernous hemangiomas with thin-walled cavernous vascular spaces of variable size that lack an elastic tissue. […] The sclerotic area in a sclerosing cavernous hemangioma is best explained by localized regressive changes secondary to thrombosis, infarction, or hemorrhage. […] The pathogenesis of sclerosing hemangiomas remains unknown and has no definite familial or genetic factor of inheritance, although several theories have been proposed.

• #52 Clinical and Molecular Hepatology

  https://www.e-cmh.org/m/journal/view.php?number=1057

  Sclerosing hemangiomas and sclerosed hemangiomas are rare conditions that were first reported by Shepherd and Lee in 1983. […] A subsequent report of two more solitary „necrotic nodules” of the liver identified a vascular component, suggesting a probable pathogenesis of sclerosis of a preexisting hemangioma. […] An additional theory proposed by Makhlouf et al suggests that mast cells play a pivotal role in the development of a sclerosing hemangioma. […] According to previous reports, sclerosing hemangiomas arise in cavernous hemangiomas with thin-walled cavernous vascular spaces of variable size that lack an elastic tissue. […] The sclerotic area in a sclerosing cavernous hemangioma is best explained by localized regressive changes secondary to thrombosis, infarction, or hemorrhage. […] The pathogenesis of sclerosing hemangiomas remains unknown and has no definite familial or genetic factor of inheritance, although several theories have been proposed.

• #53 Giant hepatic hemangioma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/giant-hepatic-haemangioma-1?lang=us

  Giant hepatic hemangiomas, also known as giant hepatic venous malformations, are relatively uncommon non-neoplastic vascular lesions of the liver, which can be strikingly large and mimic tumors. […] Giant hepatic venous malformations may contain areas of central necrosis/liquefaction, hemorrhage, peripheral calcification, fibrosis, and thrombosis, resulting in heterogeneous appearance and incomplete enhancement, even on very delayed imaging.

• #54 Giant hepatic hemangioma | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/giant-hepatic-haemangioma-1?lang=us

  Giant hepatic hemangiomas, also known as giant hepatic venous malformations, are relatively uncommon non-neoplastic vascular lesions of the liver, which can be strikingly large and mimic tumors. […] Giant hepatic venous malformations may contain areas of central necrosis/liquefaction, hemorrhage, peripheral calcification, fibrosis, and thrombosis, resulting in heterogeneous appearance and incomplete enhancement, even on very delayed imaging.

• #55 Cavernous Hepatic Hemangioma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470283/

  Hepatic hemangiomas are benign, hypervascular, venous malformations in the liver. They are the most common benign mesenchymal tumors of the liver. […] The etiology of hepatic hemangiomas is not completely understood. They sporadically occur without any known predisposing factors. When hemangiomas are greater than 10 cm, they are considered giant hemangiomas. Since they are considered vascular malformations, they enlarge by ectasia rather than hyperplasia or hypertrophy. […] Several associated abnormalities include focal nodular hyperplasia of the liver and Kasabach-Merritt syndrome, consisting of multiple hemangiomas throughout the body, elevated fibrin degradation products, and thrombocytopenia.

• #56 Cavernous Hepatic Hemangioma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470283/

  Hepatic hemangiomas are benign, hypervascular, venous malformations in the liver. They are the most common benign mesenchymal tumors of the liver. […] The etiology of hepatic hemangiomas is not completely understood. They sporadically occur without any known predisposing factors. When hemangiomas are greater than 10 cm, they are considered giant hemangiomas. Since they are considered vascular malformations, they enlarge by ectasia rather than hyperplasia or hypertrophy. […] Several associated abnormalities include focal nodular hyperplasia of the liver and Kasabach-Merritt syndrome, consisting of multiple hemangiomas throughout the body, elevated fibrin degradation products, and thrombocytopenia.

• #57 A rare cause of systemic inflammatory response syndrome | Gastroenterología y Hepatología (English Edition)

  https://www.elsevier.es/en-revista-gastroenterologia-hepatologia-english-edition–382-articulo-a-rare-cause-systemic-inflammatory-S2444382419301294

  Liver haemangiomas are the most common primary tumours of the liver with a prevalence of 520%. Believed to be of congenital aetiology and benign, they consist of intrahepatic vascular malformations characterised by cavernous spaces lined with flat endothelial cells. […] In summary, although most giant liver haemangiomas are asymptomatic and do not require any form of treatment, in exceptional cases they can cause significant complications like systemic inflammatory response syndrome. In such cases, surgical resection is considered the treatment of choice as it achieves complete abatement of symptoms and resolution of lab test abnormalities.

• #58 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  The malignant transformation is practically inexistent. […] The causes of pain should be critically analyzed in case of hepatic hemangioma because more than 50% of the patients with abdominal pain and liver hemangioma have been found to have various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease. […] The Kasabach Merritt syndrome (also known as hemangioma thrombocytopenia syndrome) is a rare but life-threatening disease and represents a valid indication for immediate surgery in patients with hepatic hemangioma. […] The size of the tumor do not represent a valid indication for treatment. […] The right indications for surgery remain strictly related to the tumor complications. In fact rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #59 Cavernous Hepatic Hemangioma – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470283/

  Hepatic hemangiomas are benign, hypervascular, venous malformations in the liver. They are the most common benign mesenchymal tumors of the liver. […] The etiology of hepatic hemangiomas is not completely understood. They sporadically occur without any known predisposing factors. When hemangiomas are greater than 10 cm, they are considered giant hemangiomas. Since they are considered vascular malformations, they enlarge by ectasia rather than hyperplasia or hypertrophy. […] Several associated abnormalities include focal nodular hyperplasia of the liver and Kasabach-Merritt syndrome, consisting of multiple hemangiomas throughout the body, elevated fibrin degradation products, and thrombocytopenia.

• #60 Infantile hepatic hemangiomas associated with high-output cardiac failure and pulmonary hypertension | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1200-6

  Infantile hepatic hemangioma (IHH) is a rare proliferative endothelial cell tumor. It appears to be a benign tumor, however, it may lead to poor outcomes because of severe complications such as congestive heart failure (CHF), which occurs in 15% of infants with this disease. […] The pathological mechanism of CHF in IHH is associated with arteriovenous shunts in hemangiomas. The arteriovenous shunts result in a decrease of systemic blood volume as well as increase of pulmonary blood volume, thus leading to the cardiac output increase. Furthermore, aggravated by the pulmonary hypertention it finally leads to high-output CHF. […] Nevertheless, the existence of IHH can increase the load of right heart system and affect circulation transition from fetus to neonate, which further increase pulmonary vascular resistance and cause pulmonary hypertention.

• #61 Infantile hepatic hemangiomas associated with high-output cardiac failure and pulmonary hypertension | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1200-6

  Infantile hepatic hemangioma (IHH) is a rare proliferative endothelial cell tumor. It appears to be a benign tumor, however, it may lead to poor outcomes because of severe complications such as congestive heart failure (CHF), which occurs in 15% of infants with this disease. […] The pathological mechanism of CHF in IHH is associated with arteriovenous shunts in hemangiomas. The arteriovenous shunts result in a decrease of systemic blood volume as well as increase of pulmonary blood volume, thus leading to the cardiac output increase. Furthermore, aggravated by the pulmonary hypertention it finally leads to high-output CHF. […] Nevertheless, the existence of IHH can increase the load of right heart system and affect circulation transition from fetus to neonate, which further increase pulmonary vascular resistance and cause pulmonary hypertention.

• #62 Infantile hepatic hemangiomas associated with high-output cardiac failure and pulmonary hypertension | BMC Cardiovascular Disorders | Full Text

  https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-019-1200-6

  Infantile hepatic hemangioma (IHH) is a rare proliferative endothelial cell tumor. It appears to be a benign tumor, however, it may lead to poor outcomes because of severe complications such as congestive heart failure (CHF), which occurs in 15% of infants with this disease. […] The pathological mechanism of CHF in IHH is associated with arteriovenous shunts in hemangiomas. The arteriovenous shunts result in a decrease of systemic blood volume as well as increase of pulmonary blood volume, thus leading to the cardiac output increase. Furthermore, aggravated by the pulmonary hypertention it finally leads to high-output CHF. […] Nevertheless, the existence of IHH can increase the load of right heart system and affect circulation transition from fetus to neonate, which further increase pulmonary vascular resistance and cause pulmonary hypertention.

• #63 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. The team asked the question, Does the lesion need to be fully removed with benign pathology before any offer can be made? […] Hemangiomas are the most common benign tumor of the liver, seen in up to 20% of the general population. With the increase in abdominal imaging such as CT scans, MRIs, and ultrasounds, many more are being discovered incidentally when a person has no symptoms. Most are asymptomatic with excellent prognosis, although a few may have symptoms such as pain. Liver hemangiomas are often solitary, but sometimes multiple lesions are present. The majority are followed by serial imaging, with surgical resection being rare. […] Bleeding from a rupture of blood vessels is rare, but can occur. 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.

• #64 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  The malignant transformation is practically inexistent. […] The causes of pain should be critically analyzed in case of hepatic hemangioma because more than 50% of the patients with abdominal pain and liver hemangioma have been found to have various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease. […] The Kasabach Merritt syndrome (also known as hemangioma thrombocytopenia syndrome) is a rare but life-threatening disease and represents a valid indication for immediate surgery in patients with hepatic hemangioma. […] The size of the tumor do not represent a valid indication for treatment. […] The right indications for surgery remain strictly related to the tumor complications. In fact rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #65 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  The malignant transformation is practically inexistent. […] The causes of pain should be critically analyzed in case of hepatic hemangioma because more than 50% of the patients with abdominal pain and liver hemangioma have been found to have various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease. […] The Kasabach Merritt syndrome (also known as hemangioma thrombocytopenia syndrome) is a rare but life-threatening disease and represents a valid indication for immediate surgery in patients with hepatic hemangioma. […] The size of the tumor do not represent a valid indication for treatment. […] The right indications for surgery remain strictly related to the tumor complications. In fact rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #66 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  The malignant transformation is practically inexistent. […] The causes of pain should be critically analyzed in case of hepatic hemangioma because more than 50% of the patients with abdominal pain and liver hemangioma have been found to have various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease. […] The Kasabach Merritt syndrome (also known as hemangioma thrombocytopenia syndrome) is a rare but life-threatening disease and represents a valid indication for immediate surgery in patients with hepatic hemangioma. […] The size of the tumor do not represent a valid indication for treatment. […] The right indications for surgery remain strictly related to the tumor complications. In fact rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

• #67 What is changing in indications and treatment of hepatic hemangiomas. A review | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-what-is-changing-in-indications-S1665268119308397

  The malignant transformation is practically inexistent. […] The causes of pain should be critically analyzed in case of hepatic hemangioma because more than 50% of the patients with abdominal pain and liver hemangioma have been found to have various gastrointestinal pathologies including cholelithiasis and peptic ulcer disease. […] The Kasabach Merritt syndrome (also known as hemangioma thrombocytopenia syndrome) is a rare but life-threatening disease and represents a valid indication for immediate surgery in patients with hepatic hemangioma. […] The size of the tumor do not represent a valid indication for treatment. […] The right indications for surgery remain strictly related to the tumor complications. In fact rupture, intratumoral bleeding, Kasabach-Merritt syndrome and organ or vessels compression (gastric outlet obstruction, Budd-Chiari syndrome, etc.) represents the valid indication for surgery and at the same time they are all complications of the tumor itself.

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

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

  The pathogenesis of hemangioma is not entirely understood, the theory of congenital disorder with possible hormonal dependence has been taken into account. […] HH arises from a vascular malformation and increases in size mainly by dilating the vessels inside the tumour. […] Currently, according to newer classification system of the International Society for the Study of Vascular Anomalies ISSVA, last updated in 2018, HH is a vascular tumor, considered as a slow flow venous malformation.

• #69

  https://healthmatch.io/liver-disease/hemangioma-liver

  The underlying cause of a liver hemangioma isnt fully understood. There may be certain genetic factors that increase susceptibility. […] There are several theories about the mechanism of a liver hemangioma. One view is that people with a liver hemangioma have issues with the process of blood vessel development. People with the condition may have too much of certain substances that cause blood vessel growth. […] There may be a hormonal component to this condition, as it disproportionately affects women, and hemangioma size increases more in those who are on hormonal oral contraceptive pills and those who have had hormone replacement therapy. Therefore, it is thought that estrogen might play a role in developing liver hemangiomas. […] The cause of liver hemangiomas isnt well understood, but there is thought to be a genetic component. Additionally, hormonal factors (estrogen) may play a role.

• #70 Hepatic hemangioma – UpToDate

  https://www.uptodate.com/contents/hepatic-hemangioma

  Hepatic hemangiomas (also referred to as cavernous hemangiomas because of the cavernous vascular space seen histologically) are the most common benign liver lesion. […] The etiology of hepatic hemangiomas is incompletely understood. They are thought to be vascular malformations or hamartomas of congenital origin that enlarge by ectasia rather than by hyperplasia or hypertrophy.

• #71 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hormones such as estrogens play a role in HH growth, as they are seen more frequently among women and their size increase after hormone replacement therapy (HRT), oral contraceptive pills (OCPs), and pregnancy. […] The direct mechanisms of hormone effects are unknown, as HH are negative for estrogen and progesterone receptors and current evidence does not support a contraindication of OCPs/HRT/anabolic steroids in patients with HH.

• #72 Orthotopic liver transplantation for Management of a Giant Liver Hemangioma: a case report and review of literature | BMC Surgery | Full Text

  https://bmcsurg.biomedcentral.com/articles/10.1186/s12893-020-00801-z

  Hepatic hemangioma (HH) is the most common benign tumor of the liver. […] Estrogen therapy and pregnancy are the major causes promoting tumor growth in HHs, highlighting the role of female sex hormones in the pathogenesis of the tumor. […] Treatment is only indicated for rapidly growing tumors, persistent pain, hemorrhage and when pressure effect on adjacent organs and vessels exists, which may results in symptoms such as Budd-Chiari syndrome, jaundice and lower extremity edema. […] In rare cases, patients with huge HH undergo liver transplantation. Indications for liver transplantation include huge masses compromising liver function, KMS and inoperable life threatening huge masses. […] Currently the most common treatment approach, especially with huge HHs is surgical intervention.

• #73 Hepatic hemangioma: What internists need to know

  https://www.wjgnet.com/1007-9327/full/v26/i1/11.htm

  Hepatic hemangioma (HH) is a mesoderm-derived tumor consisting of a blood-filled space, fed by hepatic arterial circulation and lined by a single layer of flat endothelial cells. […] The pathophysiology of HH is not completely understood, and in some cases, a genetic predisposition has been described. HH arises from a vascular malformation with a growing pattern secondary to dilation rather than hypertrophy or hyperplasia. […] One hypothesis suggest HH results from abnormal angiogenesis and an increase in pro-angiogenic factors. […] Vascular endothelial growth factor (VEGF) is an important pro-angiogenic factor for endothelial cells. Mammalian target of rapamycin (mTOR) stimulates an autocrine loop of VEGF signaling and increase cell proliferation in vascular endotelial cells. […] Zhang et al found an increased expression of VEGF-A, pro-matrix metalloproteinase 2, and activated metalloproteinase 2 in HH cells compared to normal human liver endothelial cells.

• #74 Infantile Hemangiomas: An Update on Pathogenesis and Treatment

  https://www.mdpi.com/2077-0383/10/20/4631

  Over the years, scientists have postulated what seemed to be different theories of the pathogenesis of IH. It now appears that most of them are somehow connected. In recent studies, authors have suggested that IHs are a result of dysregulated vasculogenesis (i.e., the formation of new blood vessels from stem cells) and angiogenesis (i.e., the formation of new blood vessels from existing vessels). Hypoxia, which seems to be the trigger for this dysregulation, causes the overexpression of angiogenic factors such as vascular endothelial growth factor (VEGF) by inducing the transcription of the VEGF gene. […] Understanding the pathogenesis of IH is crucial for identifying patients at the highest risk of complications caused by the size or location of IH, and for developing a therapy with the most beneficial ratio of efficacy to adverse effects.

• #75 Infantile Hemangiomas: An Update on Pathogenesis and Treatment

  https://www.mdpi.com/2077-0383/10/20/4631

  Over the years, scientists have postulated what seemed to be different theories of the pathogenesis of IH. It now appears that most of them are somehow connected. In recent studies, authors have suggested that IHs are a result of dysregulated vasculogenesis (i.e., the formation of new blood vessels from stem cells) and angiogenesis (i.e., the formation of new blood vessels from existing vessels). Hypoxia, which seems to be the trigger for this dysregulation, causes the overexpression of angiogenic factors such as vascular endothelial growth factor (VEGF) by inducing the transcription of the VEGF gene. […] Understanding the pathogenesis of IH is crucial for identifying patients at the highest risk of complications caused by the size or location of IH, and for developing a therapy with the most beneficial ratio of efficacy to adverse effects.

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