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Background: Hepatic hemangioma is the most common type of benign mesenchymal liver tumor and often has a good prognosis. However, giant hepatic hemangioma larger than 10 cm is an unusual event, and accompanying symptoms of internal hemorrhagic necrosis are extremely rare. There are only a few cases reported. Case summary: Herein, we report the case of a 52-year-old man with hemorrhagic necrosis of a giant hepatic hemangioma. The patient presented to the Department of Hepatobiliary Surgery with a complaint of distending pain on the right abdomen. The patient underwent hepatic artery embolization for giant hepatic hemangioma 2 weeks before presentation. During hospitalization, abdominal computed tomography revealed a mass (15.8 × 14.2 × 14.7 cm) with high density below the right lobe of the liver. The patient subsequently underwent irregular right hepatectomy with the guidance of three-dimensional visualization technology. The surgical anatomy confirmed the diagnosis of internal hemorrhagic necrosis. There was no recurrence or complications in a 4-month follow-up. Previous cases were reviewed to characterize the clinical features of giant hepatic hemangioma with internal hemorrhage necrosis. Conclusion: Cases of giant hepatic hemangioma with internal hemorrhagic necrosis are rare and usually only exhibit fever or epigastric pain. All patients in reviewed cases finally underwent surgical resection. Under these circumstances, the healing effect of transhepatic arterial treatment is not very satisfactory. Patients are deemed poor laparoscopic surgical candidates due to limited abdominal cavity. In order to standardize the diagnosis of these rare cares, the aggregation of existing and future case data is certainly warranted. If diagnosed, consideration should be given to implementing surgical resection according to patients' condition by three-dimensional visualized technology.

Simple Summary: The article explores an innovative treatment for large liver tumors known as giant hepatic hemangiomas. These tumors, although typically benign, can cause significant health issues and symptoms, necessitating effective treatment methods. This study focuses on the use of a specific technique called superselective transcatheter arterial chemoembolization (TACE), utilizing a bleomycin–lipiodol emulsion. The researchers aimed to assess the efficacy of this method in reducing the size of these tumors and alleviating the associated symptoms. The findings of this research are important because they provide insights into a less-invasive alternative to surgical treatment for giant hepatic hemangiomas. This study demonstrates that this technique has a high rate of technical success, with a significant reduction in tumor size observed in the majority of cases. Importantly, this approach also appears to have a manageable safety profile. The results of this study could have a significant impact on the medical community's approach to treating giant hepatic hemangiomas, offering a potentially safer and more effective treatment option than traditional surgical methods. This study evaluates the effectiveness of superselective transcatheter arterial chemoembolization (TACE) using a bleomycin–lipiodol emulsion in treating giant hepatic hemangiomas. A retrospective review included 31 patients with a mean age of 53 ± 10.42 years who underwent TACE from December 2014 to October 2022, with follow-up imaging examinations to assess outcomes. Technical success was defined as successful embolization of all feeding arteries, and clinical success was defined as a reduction in hemangioma volume by 50% or more on follow-up imaging. This study observed a 100% technical success rate. Post-embolization syndrome was common, and two cases of asymptomatic hepatic artery dissection were noted. Clinical success was achieved in 80.6% of patients, with significant volume reduction observed in the majority. Conclusively, superselective transcatheter arterial chemoembolization with bleomycin–lipiodol emulsions is presented as a viable and effective treatment option for giant hepatic hemangiomas. With no procedure-related mortality and significant volume reduction in most cases, this method offers a promising alternative to surgical intervention. This study's findings suggest a need for further exploration and validation in larger-scale prospective studies. [ABSTRACT FROM AUTHOR]

Objective：To compare the clinical outcome and literature review of laparoscopic microwave ablation and laparoscopic hepatectomy for the treatment of giant hepatic hemangioma,and explore the treatment strategiesgiant hepatic hemangioma. Method： From January 2020 to December 2022,a total of 18 patientsdiagnosed with giant hepatic hemangiomaunderwent laparoscopic vascular tumor microwave ablation at the First Affiliated Hospital of Nanjing Medical University. Based on the size,location,and body mass index of the hemangioma,18 patients who underwent laparoscopic hemangioma resection duringthe same period were selected for a 1∶ 1 matched case⁃control study. The surgical duration,intraoperative blood loss,postoperative complications,postoperative hospital stay, andpostoperative liver function［alanine transaminase(ALT),aspartate transaminase(AST),and total bilirubin(TBIL) ］on the first day were compared between two groups of patients,as well as the short ⁃term and long ⁃term complicationsand prognosis. Results：The surgical duration in the laparoscopic microwave ablation group was shorter than that in the laparoscopic surgery group(P < 0.001),the intraoperative blood loss was lower than that in the laparoscopic surgery group(P < 0.001),and the postoperative hospital stay was shorter than that in the laparoscopic surgery group(P < 0.001) . There were no significant difference in the incidence of postoperative adverse reaction(P > 0.05),postoperative liver function on the first day after surgery(ALT,AST,TBIL,P > 0.05) between the two groups. No midium ⁃ term or long ⁃ term complications were observedduring the follow ⁃ up period after surgery in both groups. Conclusion：Laparoscopic microwave ablation is an effective and safe treatment for giant liverhemangioma,and it can significantly reduce intraoperative blood loss,surgical duration,and postoperative hospital stay. [ABSTRACT FROM AUTHOR]

Liver hemangiomas are the most common benign tumors of the liver with a prevalence of 1%-20% according to autopsy series. They can in some cases reach measurable sized. These giant hemangiomas can have fatal complications such as hemorrhaging, intraperitoneal rupture, mass of effect and Kasabach-Merritt syndrome. We report an adult case in which recent right quadrant pain revealed a liver hemangioma associated with Kasabach-Merritt syndrome.

Background: Hepatic hemangioma (HH) is described as the most prevalent benign hepatic tumor, and it is usually discovered incidentally as a symptomless mass of less than 3 cm. Kasabach-Merritt syndrome is described as a rare but severe complication of some vascular tumors. This syndrome presents as severe thrombocytopenia accompanied by a consumptive coagulopathy. Case Presentation: A 35-year-old female, with a history of a hepatic tumor that was incidentally diagnosed with an ultrasound, later develops abdominal distention, petechiae, and prominent hematomas that appear with minimal trauma. At the initial approach, hematological data of microangiopathic anemia, thrombocytopenia, and consumptive coagulopathy were accompanied by the histopathological and imaging diagnosis of a Giant HH. Conclusion: Although, it is a very rare complication, the severity of this syndrome requires a prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Background: To report the safety and effectiveness of laparoscopic intratumoral resection facilitated by coagulation (LIRC) compared with laparoscopic hepatectomy (LH) in treating giant hepatic hemangioma.Methods: From 2017 to 2020, 19 consecutive patients with giant hepatic hemangioma (≥ 10 cm) received LIRC in one center. We selected a subgroup of 103 patients treated by LH in other four centers who well matched the 19 consecutive patients treated with LIRC, in a 1:1 fashion based on the tumor location, tumor size, and body mass index. Furthermore, the differences in technical success, operative time, operative blood loss, change of laboratory indexes, hospital stays, complication and clinical responds are compared between the two groups.Results: Technical success was achieved in all 38 patients. Patients in the LIRC group had a relative shorter operative time (P < 0.001) and less operative blood loss (P = 0.003). The serum levels of C-reactive protein (CRP), total bilirubin (TBil), alanine aminotransferase (ALT), and aspartate transaminase (AST) were elevated significantly (P < 0.05) 1 day after the resection and returned to normal within 7 days in both groups; however, relatively lower serum levels of those indexes were observed in the LIRC group (P < 0.05). The total complication rate was relatively lower in the LIRC group compared with the LH group (P = 0.029). Patients in the LIRC group had shorter hospital stays than those in the LH group (P = 0.010). The clinical response was similar in the two groups.Conclusions: LIRC is safe and effective for treating giant hepatic hemangioma. [ABSTRACT FROM AUTHOR]

Hepatic hemangioma (HH) is a congenital vascular anomaly comprising networks of abnormal blood and/or lymphatic vessels with endothelial cell proliferation. Their pathophysiology is not fully understood, and no specific drug is available to treat them. Conservative management, which limits observation, is preferred for most patients. A HH larger than 4 cm is considered a giant HH that may be treated using surgery ranging from embolization to hepatic resection or liver transplantation. Here, we describe a case with multiple and giant HHs that regressed significantly after treatment with azithromycin (AZM). A systematic literature review of HH and the effects of AZM on angiogenesis was then conducted.

Hepatic hemangioma is the most frequent liver's tumor. The majority are small, asymptomatic and have an excellent prognosis. Those larger than 5 cm can be associated to a consumptive coagulopathy called Kasabach-Merrit syndrome. We present a patient with a giant hepatic hemangioma with multiple hemangimatosis associated to Kasabach-Merrit syndrome. [ABSTRACT FROM AUTHOR]

Background: Surgical treatment of giant hepatic hemangioma larger than 10 cm in diameter often requires major laparoscopic liver resection (LLR), which is very difficult and has a high risk of bleeding. There is no consensus as to whether giant hepatic hemangioma is an indication or a contraindication for laparoscopic surgery.Methods: From 2011/09 to 2018/05, 58 patients with giant hepatic hemangioma larger than 10 cm underwent laparoscopic surgery. They were divided into high-difficulty (HD) group and low-difficulty (LD) group according to the operation difficulty score. The perioperative data of the two groups were analyzed and compared.Results: There were 30 patients in the LD group and 28 in the HD group. No differences were showed in sex, age, ASA grade, tumor size, operation time, conversion rate, intraoperative and post-operative blood transfusion rate, and post-operative complications between the two groups. The amount of bleeding in the HD group was significantly higher than that in the LD group (285.7 ± 224.0 vs 189.6 ± 157.6 ml, p = 0.007). The time of hepatic hilar occlusion in the HD group was longer than that in the LD group (25.4 ± 8.8 vs 20.6 ± 7.3 min, p = 0.001), and the rate of hepatic hilar occlusion in the HD group was also higher than that in the LD group (71.4% vs 33.3%, p = 0.004). The incidence of hospitalization days and discharge time in the LD group were shorter than those in the HD group (6.3 ± 1.6 vs 8.2 ± 1.4 days, p = 0.000; 16.4 ± 5.5 vs 21.9 ± 4.6 h, p = 0.019). There was no significant difference in enzymatic parameters between the two groups after operation.Conclusions: Although there are great difficulties and risks objectively, laparoscopic treatment of giant hepatic hemangioma is safe and feasible. [ABSTRACT FROM AUTHOR]

Background: Hepatic hemangioma is a common benign liver tumor. The majority of cases are asymptomatic and require no specific treatment. The aim of this study was to evaluate the feasibility, safety and efficacy of microwave ablation (MWA) for symptomatic or enlarging giant hepatic hemangioma (≥10 cm). Methods: From December 2013 to June 2016, 12 patients with giant hepatic hemangioma (≥10 cm) underwent ultrasound-guided percutaneous MWA, and ablation-related complications were observed. All patients were followed up with magnetic resonance or enhanced CT imaging at one month postoperatively to evaluate efficacy. Results: This study included a total of 13 giant hepatic hemangiomas (mean: 11.7 ± 1.6 cm) in 12 patients who initially underwent 16 sessions of MWA; three lesions were treated with two sessions of planned ablation. The average ablation time for a single hepatic hemangioma was 39.0 ± 14.4 minutes. Two patients had acute postoperative non-oliguric renal insufficiency without intra-abdominal hemorrhage, liver failure or other complications. Initially, complete ablation was achieved in ten lesions in nine patients (76.9%, 10/13). One patient underwent a second session of MWA at 5 months postoperatively due to fast growing residual tissue; complete necrosis was achieved after treatment. The remaining two cases did not receive any invasive treatment due to small residual volumes. The total complete ablation rate was 84.6% (11/13). Conclusion: Image-guided MWA is a safe, feasible, effective treatment for giant hepatic hemangioma; these findings may open a new avenue for treatment. [ABSTRACT FROM AUTHOR]

Hepatic hemangioma is one of the most common benign liver tumors. Hemangiomas can occur in people of all ages but are more commonly found in young women. Most patients have only one hemangioma, but multiple lesions are possible. The natural history of hemangiomas is usually benign, and bleeding or rupture is very rare. The treatment for bleeding or ruptured hemangioma includes embolization or surgery. The authors reported a case of a young female with giant bilateral hepatic hemangioma with bleeding. The size of the hemangioma precluded resection or enucleation. Transarterial embolization of her hepatic arteries was done but failed. She received orthotopic liver transplantation and had an uneventful post-operative course. Currently, she is doing well. This report is the first case in Thailand of liver transplantation as the rescue therapy for a patient with bleeding giant hepatic hemangioma.

Hemangiomas are the most common benign hepatic tumors and are usually asymptomatic. Lesions measuring more than 4 cm in diameter are known as “giant hemangiomas” and may cause various symptoms or complications depending on the size, the location, and the degree of compression of adjacent structures. Pulmonary embolism is a very rare complication of giant hepatic hemangiomas. In this case report, we describe a patient with acute pulmonary emboli, which presumably originated from laminar thrombi in the inferior vena cava caused by compression by giant hepatic hemangiomas.

We report a rare case of diffuse hepatic hemangiomatosis (DHH) of the left hepatic lobe coexistent with giant hepatic hemangioma and without extra-hepatic involvement in an asymptomatic adult patient. Liver hemangiomas are the most common benign liver tumors. However, DHH without extra-hepatic involvement has rarely been reported in adults. Furthermore, giant hepatic hemangioma coexistent with DHH is even uncommon, although an association between hemangiomatosis and giant hepatic hemangiomas may be supposed. In this peculiar case, we observed an exclusive and widespread involvement of the left hepatic lobe with a sharp boundary between normal and altered liver parenchyma running along Cantlie's line. [ABSTRACT FROM AUTHOR]

Hemangioma is the most common benign tumor of liver and is often asymptomatic. Spontaneous rupture is rare but has a catastrophic outcome if not promptly managed. Emergent hepatic resection has been the treatment of choice but has high operative mortality. Preoperative transcatheter arterial embolization (TAE) can significantly improve outcome in such patients. We report a case of spontaneous rupture of giant hepatic hemangioma that presented with abdominal pain and shock due to hemoperitoneum. Patient was successfully managed by TAE, followed by tumor resection. TAE is an effective procedure in symptomatic hemangiomas, and should be considered in such high risk patients prior to surgery.

INTRODUÇÃO: Ruptura por hemangioma hepático é rara e há somente 32 casos descritos na literatura. RELATO DO CASO: Homem com 39 anos foi admitido com dor abdominal em hipocôndrio direito de início súbito associado à lipotímia. A investigação inicial demonstrou hemangioma hepático gigante (7x13 cm) em lobo direito associado a sinais de sangramento recente. Com o intuito de minimizar possibilidade de sangramento no intra-operatório, foi realizado embolização da artéria hepática direita. A operação transcorreu sem intercorrências, sem necessidade de hemotransfusão no intra-operatório. A transecção foi realizada com grampeador linear cortante de 75 mm. O tempo de internação foi de 13 dias. CONCLUSÃO: Procedimento cirúrgico é mandatório para hemangioma hepático roto, e a embolização é eficiente para controlar o sangramento e preparar melhor o paciente para a operação.BACKGROUND: Hepatic hemangioma rupture is rare and there are only 32 cases in the literature. CASE REPORT: A 39-years-old man was admitted for sudden severe upper abdominal pain. Examination revealed a giant liver hemangioma (7x13 cm) in right lobe of the liver with signals of recent bleeding. Large feeding artery was embolised to reduce bleeding risk. The surgery occurred without transfusion. The liver trans-section was done with 75 mm linear stapler. The patient was discharged in the 13th post-operative day. CONCLUSION: Surgery is mandatory in hepatic hemangioma rupture and embolization is efficient in controlling pre-operative bleeding giving better opportunity to successful surgical procedure.

El hemangioma hepático es el tumor benigno más frecuente del hígado. La gran mayoría de ellos son de pequeño tamaño, asintomáticos y con un pronóstico excelente. En raras ocasiones son de mayor tamaño y pueden estar asociados a una coagulopatía de consumo denominada síndrome de Kasabach-Merrit. Presentamos el caso de un paciente varón joven con un hemangioma hepático gigante y hemangiomatosis múltiple asociado al síndrome de Kasabach-Merrit.Hepatic hemangioma is the most frequent liver's tumor. The majority are small, asymptomatic and have an excellent prognosis. Those larger than 5 cm can be associated to a consumptive coagulopathy called Kasabach-Merrit syndrome. We present a patient with a giant hepatic hemangioma with multiple hemangimatosis associated to Kasabach-Merrit syndrome.

Hepatic hemangioma patients with Kasabach-Merritt syndrome have reportedly been cured by liver transplantation. However, liver transplantation as a potential cure for a stable patient without Kasabach-Merritt syndrome remains debatable. We report the case of a 27-year-old female patient with a giant hepatic hemangioma. The hemangioma measured 50 x 40 x 25 cm in size and weighed 15 kg, which is the largest and heaviest hemangioma reported in the literature. The patient showed jaundice, ascites, anemia, and appetite loss; but no disseminated intravascular coagulation was observed through laboratory findings. We successfully operated using a right lobe graft without the middle hepatic vein from a 55-yearold donor. At the long-term follow-up, the patient experienced two acute rejections, which were confirmed by biopsy. However, the patient still survives with good graft function after 50 months. [ABSTRACT FROM AUTHOR]

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The aim of the present study is to analyze the feasibility and the impact of a two-step approach in the treatment of giant hemangiomas (GH) i.e., exceeding 10 cm in maximum diameter, consisting of transarterial embolization (TAE) followed by laparoscopic liver resection (LLR). Ten patients with 11 GH were treated with TAE and subsequent LLR between 2017 and 2020 (Group A). A matched cohort of 10 patients with GH treated with upfront LLR between 2014 and 2017 was identified for comparison (Group B). Data were analyzed regarding intraoperative and postoperative outcomes, including successful completion of LLR, morbidity, and mortality. Successful microparticle embolization of the GH-feeding arteries was performed in all patients in group A. In three cases a liquid embolic agent (Squid-18) was also injected to obtain complete embolization. No complications were observed after TAE. Successful surgery was performed after a mean time interval of 2.2 days from TAE without any case of conversion to laparotomy. Statistically significant differences between group A and group B were found in intraoperative blood loss (250 ± 200 vs. 400 ± 300 mL, p = 0.039), operative time (245 ± 60 vs. 420 ± 60 min, p = 0.027), and length of stay (5 ± 1 vs. 8 ± 2 days, p = 0.046). Our data suggest that two-step TAE + LLR might be a safe and effective option for surgical treatment of GH >10 cm. [ABSTRACT FROM AUTHOR]

Abstract: Hemangiomas are the most common benign tumors of the liver. Most of them remain stable. However, when a hemangioma continues to grow, it may become symptomatic. We describe a 40-year-old woman who initially presented with a hemangioma approximately 3 cm in diameter in the right lobe of the liver. Eight years after the initial presentation, the hemangioma had grown to 11 × 8 cm with the symptom of abdominal pain. She was managed with conservative treatment at another hospital. However, the symptoms and tumor bothered her physically and psychologically for 1 year. Surgical resection was performed to relieve her symptoms. The huge tumor was compressing the inferior vena cava and was very close to the middle hepatic vein, which made the operation difficult. The postoperative course was uneventful. We suggest early surgical resection for symptomatic giant hepatic hemangiomas. We also review reports in the literature about the treatment of symptomatic hepatic hemangiomas, including surgery, transcatheter arterial embolization and radiofrequency ablation. [Tzu Chi Med J 2008;20(1):70–72] [Copyright &y& Elsevier]