Difference between revisions of "Hemangioma of the liver"

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'''Hemangioma of the liver''' is a benign tumour of the liver, that may be mistaken for [[metastatic disease]].
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Cavernous liver hemangioma - intermed mag.jpg
| Width      =
| Caption    = Cavernous liver hemangioma. [[H&E stain]].
| Synonyms  =
| Micro      =
| Subtypes  =
| LMDDx      = [[epithelioid hemangioendothelioma]], [[angiosarcoma]], [[metastatic disease]]
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[liver]]
| Assdx      =
| Syndromes  =
| Clinicalhx = often an incidental finding
| Signs      =
| Symptoms  = +/-upper abdominal pain
| Prevalence =
| Bloodwork  =
| Rads      = well circumscribed mass
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = [[metastatic disease]]
| Tx        = usually follow-up, non-conservative if very large
}}
'''Hemangioma of the liver''', also '''liver hemangioma''' and '''hepatic hemangioma''', is a benign [[vascular tumour]] of the [[liver]], that may be mistaken for [[metastatic disease]].<ref name=pmid11039718>{{Cite journal  | last1 = Yamashita | first1 = Y. | last2 = Shimada | first2 = M. | last3 = Taguchi | first3 = K. | last4 = Gion | first4 = T. | last5 = Hasegawa | first5 = H. | last6 = Utsunomiya | first6 = T. | last7 = Hamatsu | first7 = T. | last8 = Matsumata | first8 = T. | last9 = Sugimachi | first9 = K. | title = Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case. | journal = Surg Today | volume = 30 | issue = 9 | pages = 849-52 | month =  | year = 2000 | doi =  | PMID = 11039718 }}</ref>
 
''Hemangiomas'', more generally, are dealt with in the ''[[hemangioma]]'' article.


==General==
==General==
*Benign.<ref name=pmid26361504>{{Cite journal  | last1 = Bajenaru | first1 = N. | last2 = Balaban | first2 = V. | last3 = Săvulescu | first3 = F. | last4 = Campeanu | first4 = I. | last5 = Patrascu | first5 = T. | title = Hepatic hemangioma -review. | journal = J Med Life | volume = 8 Spec Issue | issue =  | pages = 4-11 | month =  | year = 2015 | doi =  | PMID = 26361504 }}</ref>
*Benign.<ref name=pmid26361504>{{Cite journal  | last1 = Bajenaru | first1 = N. | last2 = Balaban | first2 = V. | last3 = Săvulescu | first3 = F. | last4 = Campeanu | first4 = I. | last5 = Patrascu | first5 = T. | title = Hepatic hemangioma -review. | journal = J Med Life | volume = 8 Spec Issue | issue =  | pages = 4-11 | month =  | year = 2015 | doi =  | PMID = 26361504 }}</ref>
*Usually an incidental finding (incidentaloma) and often asymptomatic.<ref name=pmid26361504/>
**Can be hard to differentiate from metastatic disease on imaging.<ref name=pmid11039718/>
*Large lesions may present with upper abdominal pain.
*May cause [[congestive heart failure]] in infants - if large.<ref name=pmid26322113>{{Cite journal  | last1 = Kayaalp | first1 = C. | last2 = Sabuncuoglu | first2 = MZ. | title = Embolization of Liver Hemangiomas. | journal = Hepat Mon | volume = 15 | issue = 8 | pages = e30334 | month = Aug | year = 2015 | doi = 10.5812/hepatmon.30334 | PMID = 26322113 }}</ref>
*May rupture and be life-threatening.<ref name=pmid19241936>{{Cite journal  | last1 = Vokaer | first1 = B. | last2 = Kothonidis | first2 = K. | last3 = Delatte | first3 = P. | last4 = De Cooman | first4 = S. | last5 = Pector | first5 = JC. | last6 = Liberale | first6 = G. | title = Should ruptured liver haemangioma be treated by surgery or by conservative means? A case report. | journal = Acta Chir Belg | volume = 108 | issue = 6 | pages = 761-4 | month =  | year =  | doi =  | PMID = 19241936 }}</ref>


Clinical:
Clinical:
*Do not grow in size - can be followed if small or medium size (<10 cm).<ref name=pmid26361504/>
*Do not grow in size - can be followed if small or medium size (<10 cm).<ref name=pmid26361504/>
*Usually an incidental finding (incidentaloma) and often asymptomatic.<ref name=pmid26361504/>
**Large lesions may present with upper abdominal pain.


==Gross==
==Gross==
*Variable size.
*Variable size.
*Well circumscribed.
*Well circumscribed.
*Classically subcapsular.{{fact}}


==Microscopic==
==Microscopic==
Features:
Features:
*Channels lined by benign endothelium containing [[RBC]]s.
*Channels lined by benign endothelium containing [[RBC]]s.
*Surrounding (non-endothelial) cells without significant atypia.


DDx:
DDx:
*[[Epithelioid hemangioendothelioma]].
*[[Epithelioid hemangioendothelioma]] - atypical perivascular cells, classically with cytoplasmic vacuolization ("blister cells").
*[[Angiosarcoma]].
*[[Angiosarcoma]].
*[[Metastatic disease]].
*[[Metastatic disease]].
Line 34: Line 72:
- NEGATIVE for malignancy.
- NEGATIVE for malignancy.
</pre>
</pre>
===Micro===
The sections show dilated vascular spaces containing red blood cells that are lined by endothelial cells without significant atypia.  The vascular spaces are separated by bland fibrous tissue.
Abnormal perivascular cells are not identified. The background liver is without atypia and does not have appreciable fat.


==See also==
==See also==
*[[Hemangioma]].
*[[Hemangioma]].
*[[Vascular tumours]].


==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
[[Category:Diagnosis]]
[[Category:Diagnosis]]

Latest revision as of 16:55, 19 October 2015

Hemangioma of the liver
Diagnosis in short

Cavernous liver hemangioma. H&E stain.
LM DDx epithelioid hemangioendothelioma, angiosarcoma, metastatic disease
Site liver
Clinical history often an incidental finding
Symptoms +/-upper abdominal pain
Radiology well circumscribed mass
Prognosis benign
Clin. DDx metastatic disease
Treatment usually follow-up, non-conservative if very large

Hemangioma of the liver, also liver hemangioma and hepatic hemangioma, is a benign vascular tumour of the liver, that may be mistaken for metastatic disease.[1]

Hemangiomas, more generally, are dealt with in the hemangioma article.

General

Clinical:

  • Do not grow in size - can be followed if small or medium size (<10 cm).[2]
  • Usually an incidental finding (incidentaloma) and often asymptomatic.[2]
    • Large lesions may present with upper abdominal pain.

Gross

  • Variable size.
  • Well circumscribed.
  • Classically subcapsular.[citation needed]

Microscopic

Features:

  • Channels lined by benign endothelium containing RBCs.
  • Surrounding (non-endothelial) cells without significant atypia.

DDx:

Images

  • Cavernous liver hemangioma - intermed. mag. (WC/Nephron)

  • Cavernous liver hemangioma - high mag. (WC/Nephron)

Sign out

Liver Lesion, Core Biopsy:
- Cavernous hemangioma.
- NEGATIVE for malignancy.

Micro

The sections show dilated vascular spaces containing red blood cells that are lined by endothelial cells without significant atypia. The vascular spaces are separated by bland fibrous tissue.

Abnormal perivascular cells are not identified. The background liver is without atypia and does not have appreciable fat.

See also

References

  1. ↑ 1.0 1.1 Yamashita, Y.; Shimada, M.; Taguchi, K.; Gion, T.; Hasegawa, H.; Utsunomiya, T.; Hamatsu, T.; Matsumata, T. et al. (2000). "Hepatic sclerosing hemangioma mimicking a metastatic liver tumor: report of a case.". Surg Today 30 (9): 849-52. PMID 11039718.
  2. ↑ 2.0 2.1 2.2 Bajenaru, N.; Balaban, V.; Săvulescu, F.; Campeanu, I.; Patrascu, T. (2015). "Hepatic hemangioma -review.". J Med Life 8 Spec Issue: 4-11. PMID 26361504.
  3. ↑ Kayaalp, C.; Sabuncuoglu, MZ. (Aug 2015). "Embolization of Liver Hemangiomas.". Hepat Mon 15 (8): e30334. doi:10.5812/hepatmon.30334. PMID 26322113.
  4. ↑ Vokaer, B.; Kothonidis, K.; Delatte, P.; De Cooman, S.; Pector, JC.; Liberale, G.. "Should ruptured liver haemangioma be treated by surgery or by conservative means? A case report.". Acta Chir Belg 108 (6): 761-4. PMID 19241936.
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