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As yet there is no general consensus on a common rational therapeutic approach to hepatocellular carcinoma (HCC). Therefore, treatment strategies for HCC vary throughout the world due to geographical differences in the incidence and presentation of the disease and the treatment options available. Several treatment guidelines have been published by the European Association for the Study of the Liver (EASL) (Bruix et al. 2001), with the Barcelona Clinic Liver Cancer (BCLC) staging recommendation being the most accepted (Fig. 3.2.1) (Mor et al. 1998; Sala et al. 2004). It links tumoral stage with treatment strategy, and is aimed at incorporating an estimation of the prognosis and potential treatment advancements in a single unified proposal (Sala et al. 2004). According to these guidelines percutaneous alcohol instillation (PAI) has a place in the treatment strategy of HCC, generally as a second choice when surgical techniques are precluded, such as in patients with early-stage tumors; nevertheless, in some centers in Italy and Japan PAI is used as a first-line treatment option (Llovet et al. 2003). [ABSTRACT FROM AUTHOR]

Percutaneous alcohol instillation (PAI) continues to be performed in many centers despite gradual displacement by newer technologies such as thermoablation. It can be readily and easily performed under imaging guidance with the use of existing equipment and considerably low costs. In addition it may offer distinct advantages over other regional therapies in some situations (Livraghi et al. 1995; Lin et al. 2005). [ABSTRACT FROM AUTHOR]

Little has been published on the interventional treatment of benign liver tumors such as hemangiomas and adenomas. Hemangiomas have been reported to be present in as many as 7% of necropsies with women being affected predominantly (4:1 to 6:1) (Reddy et al. 2001). Incidental presentation is usually in the third or fourth decades. The majority of liver hemangiomas tend to be small with diameters less than 4 cm with no clinical symptoms. They are frequently discovered incidentally on routine ultrasound or computed tomography (CT). About 20% of hemangiomas are larger than 4 cm and 10%-29% are multiple. The latter are more likely to cause clinical symptoms with upper abdominal pain being the most common (Tait et al. 1992). Hemangiomas occasionally rupture spontaneously, resulting in hemoperitoneum or hemobilia. In children, Kasabach-Merritt syndrome with a large hemangioma combined with thrombocytopenia is a rare entity (Scribano et al. 1996). The therapeutic management of hemangiomas is still controversial. [ABSTRACT FROM AUTHOR]