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The majority of giant hepatic cavernous hemangiomas are asymptomatic and can safely be observed. However, when a lesion becomes symptomatic, affecting quality of life or cannot be distinguished from a malignancy, then operative therapy should be considered. We herein present a case of a symptomatic 12cm x 14cm x 17cm "mega" hemangioma (>10cm) of the left hepatic lobe. This lesion was initially refractory to transarterial embolization of the left hepatic artery, but was subsequently treated successfully with a left lateral extended hepatic segmentectomy (resection). We thus advocate a rational treatment algorithm for management of hepatic "mega" hemangiomas. [ABSTRACT FROM AUTHOR]

A 47-year-old male presented with a six-month history of fatigue and a four-month history of alanine and aspartate aminopherase elevation. Laboratory examination revealed that the serum α-fetoprotein (AFP) level was 371.51 µg/l (normal range, 0-20 µg/l), and a computed tomography scan revealed a hypodense lesion in the left hepatic lobe. During laparotomy, a dark red-colored soft tumor (1.5x1.7 cm in diameter) was found in segment eight of the liver. Intra-operative pathology and post-operative histopathology examinations revealed that the tumor was a hepatic cavernous hemangioma. The serum AFP level was decreased to 24.45 µg/l by the second post-operative week. The literature was searched and only three similar cases were found. A brief review of this rare disease entity was produced, which attempted to explain this appearance reasonably. [ABSTRACT FROM AUTHOR]

A 39-year old woman with antiphospholipid antibody positive systemic lupus erythematosus (SLE) was admitted to our department because of high fever, liver dysfunction and high level of C-reactive protein. At hospitalization, there was no anemia or jaundice. A tumor was palpable in the epigastric region, and there was tenderness in this region, but no muscular defense. There were no findings which indicated disease activity of SLE. The result of abdominal ultrasonography showed that there was a giant tumor, which occupied the majority of the left lobule of the liver, and a nonuniform ultrasound image was observed inside the tumor. The result of dynamic computed tomography (CT) showed peripheral globular enhancement, and enhancement then extended to the tumor center with time. Consequently, the patient was diagnosed with multiple hepatic hemangiomas. After admission, anemia rapidly deteriorated, and platelet count tended to decline. Therefore, intratumor hemorrhage was suspected, and emergent angiography was performed. For hemostatic purposes, transcatheter arterial embolization (TAE) and extended left hepatic lobectomy were performed. In patients with autoimmune diseases such as SLE and antiphospholipid syndromes, when thrombocytopenia is observed, care should be paid to identifying its cause, considering thrombocytopenia may be induced by hemangioma, although these cases are extremely rare. [ABSTRACT FROM AUTHOR]

Thermal ablation of large hepatic cavernous hemangiomas may lead to intravascular hemolysis, hemoglobinuria, and even acute renal failure. This study aimed to identify the risk factors associated with hemoglobinuria after ultrasonography-guided percutaneous microwave ablation for large hepatic cavernous hemangiomas. In our study, 11 related risk factors were analyzed using univariate and multivariate binary logistic regression model and Receiver operating characteristic curves to determine the contribution to hemoglobinuria after microwave ablation for 49 patients with 51 hepatic cavernous hemangiomas. By multivariate analysis, the ablation time ( p = 0.021; Odds Ratio, 1.005), and the number of antenna insertions ( p = 0.036; Odds Ratio, 3.568) were the independent risk factors associated with hemoglobinuria. The cutoff value for ablation time and the number of antenna insertions in predicting the presence of hemoglobinuria was 1185s (sensitivity, 75%; specificity, 69%) and 4.5 (sensitivity, 55%; specificity, 83%), respectively. Less than 5 of antenna insertions and less than 20 mins of ablation time may therefore be recommended in patients with microwave ablation of large hepatic cavernous hemangiomas, in order to reduce the occurrence of hemoglobinuria. This is the first report about the risk factors analysis associated with hemoglobinuria after thermal ablation for large hepatic cavernous hemangiomas., Competing Interests: CONFLICTS OF INTEREST The authors report no conflicts of interest.

We describe here a case of 36-year-old man with a hepatic cavernous hemangioma that was misdiagnosed as a gastric submucosal tumor (SMT) with endoscopic ultrasound (EUS) and CT scan. On gastroscopy, a submucosal tumor was found on the cardia of the stomach. Based on EUS and abdominal CT scan, the lesion was diagnosed as a gastric duplication cyst. The patient underwent gastroscopy after receiving laparotomy at the median point of the abdomen. A spherical mass arising from the left triangular ligament of the liver region was found. There was no abnormal finding at the cardia of the stomach.