Hepatic hemangioma overview: Difference between revisions
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A hepatic hemangioma is a noncancerous [[liver tumor]] made of dilated (widened) [[blood vessels]] and is the most common primary [[liver tumor]]. | A hepatic hemangioma is a noncancerous [[liver tumor]] made of dilated (widened) [[blood vessels]] and is the most common primary [[liver tumor]]. | ||
===Historical perspective=== | ===Historical perspective=== | ||
The case of spontaneous rupture of a hepatic hemangioma was first described by Van Haefen in 1898.<ref name="Jr2010">{{cite journal|last1=Jr|first1=Marcelo AF Ribeiro|title=Spontaneous rupture of hepatic hemangiomas: A review of the literature|journal=World Journal of Hepatology|volume=2|issue=12|year=2010|pages=428|issn=1948-5182|doi=10.4254/wjh.v2.i12.428}}</ref> | The case of spontaneous rupture of a [[hepatic hemangioma]] was first described by Van Haefen in 1898.<ref name="Jr2010">{{cite journal|last1=Jr|first1=Marcelo AF Ribeiro|title=Spontaneous rupture of hepatic hemangiomas: A review of the literature|journal=World Journal of Hepatology|volume=2|issue=12|year=2010|pages=428|issn=1948-5182|doi=10.4254/wjh.v2.i12.428}}</ref> | ||
===Classification=== | ===Classification=== | ||
Hepatic hemangioma may be classified into capillary hemangioma and cavernous hemangioma.<ref name="Jr2010">{{cite journal|last1=Jr|first1=Marcelo AF Ribeiro|title=Spontaneous rupture of hepatic hemangiomas: A review of the literature|journal=World Journal of Hepatology|volume=2|issue=12|year=2010|pages=428|issn=1948-5182|doi=10.4254/wjh.v2.i12.428}}</ref> | Hepatic hemangioma may be classified into [[capillary hemangioma]] and [[cavernous hemangioma]].<ref name="Jr2010">{{cite journal|last1=Jr|first1=Marcelo AF Ribeiro|title=Spontaneous rupture of hepatic hemangiomas: A review of the literature|journal=World Journal of Hepatology|volume=2|issue=12|year=2010|pages=428|issn=1948-5182|doi=10.4254/wjh.v2.i12.428}}</ref> | ||
===Pathophysiology=== | ===Pathophysiology=== | ||
They arise from the endothelial cells that line the blood vessels and consists of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls. | They arise from the endothelial cells that line the blood vessels and consists of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls. | ||
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According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatic hemangioma.<ref name=ij>Hepatic hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatic+hemangioma</ref> | According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatic hemangioma.<ref name=ij>Hepatic hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatic+hemangioma</ref> | ||
===Differentiating Hepatic hemangioma from other Diseases=== | ===Differentiating Hepatic hemangioma from other Diseases=== | ||
Hepatic hemangioma must be differentiated from other diseases such as hepatic metastases, hepatocellular carcinoma, hepatic cyst.<ref name=a> Radiopaedia 2015 Hepatic hemangioma {{cite web | title = Radiopedia 2015 Hepatic hemangioma [Dr Yuranga Weerakkody]| url = http://radiopaedia.org/articles/hepatic-haemangioma-3 }}</ref> | Hepatic hemangioma must be differentiated from other diseases such as hepatic metastases, [[hepatocellular carcinoma]], [[hepatic cyst]].<ref name=a> Radiopaedia 2015 Hepatic hemangioma {{cite web | title = Radiopedia 2015 Hepatic hemangioma [Dr Yuranga Weerakkody]| url = http://radiopaedia.org/articles/hepatic-haemangioma-3 }}</ref> | ||
===Natural History, Complications and Prognosis=== | ===Natural History, Complications and Prognosis=== | ||
If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. [[Pregnancy]] and [[estrogen]]-based medications can cause [[cavernous hemangioma]]s to grow. | If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. [[Pregnancy]] and [[estrogen]]-based medications can cause [[cavernous hemangioma]]s to grow. | ||
===Diagnosis=== | ===Diagnosis=== | ||
====History and symptoms==== | ====History and symptoms==== | ||
Symptoms of hepatic hemangioma include intermittent right upper quadrant pain, biliary colic, obstructive jaundice.<ref name="pmid21191518">{{cite journal| author=Jr MA, Papaiordanou F, Gonçalves JM, Chaib E| title=Spontaneous rupture of hepatic hemangiomas: A review of the literature. | journal=World J Hepatol | year= 2010 | volume= 2 | issue= 12 | pages= 428-33 | pmid=21191518 | doi=10.4254/wjh.v2.i12.428 | pmc=PMC3010512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21191518 }} </ref> | Symptoms of hepatic hemangioma include intermittent [[right upper quadrant pain]], [[biliary colic]], [[obstructive jaundice]].<ref name="pmid21191518">{{cite journal| author=Jr MA, Papaiordanou F, Gonçalves JM, Chaib E| title=Spontaneous rupture of hepatic hemangiomas: A review of the literature. | journal=World J Hepatol | year= 2010 | volume= 2 | issue= 12 | pages= 428-33 | pmid=21191518 | doi=10.4254/wjh.v2.i12.428 | pmc=PMC3010512 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21191518 }} </ref> | ||
====Physical Examination==== | ====Physical Examination==== | ||
They are frequently asymptomatic and incidentally discovered at imaging, surgery, or autopsy. Hepatic hemangioma is usually not discovered until medical pictures are taken of the liver for some other reason. If a [[cavernous hemangioma]] ruptures, the only sign may be an [[enlarged liver]]. | They are frequently asymptomatic and incidentally discovered at imaging, surgery, or autopsy. Hepatic hemangioma is usually not discovered until medical pictures are taken of the liver for some other reason. If a [[cavernous hemangioma]] ruptures, the only sign may be an [[enlarged liver]]. |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Nawal Muazam M.D.[2]
Overview
A hepatic hemangioma is a noncancerous liver tumor made of dilated (widened) blood vessels and is the most common primary liver tumor.
Historical perspective
The case of spontaneous rupture of a hepatic hemangioma was first described by Van Haefen in 1898.[1]
Classification
Hepatic hemangioma may be classified into capillary hemangioma and cavernous hemangioma.[1]
Pathophysiology
They arise from the endothelial cells that line the blood vessels and consists of multiple, large vascular channels lined by a single layer of endothelial cells and supported by collagenous walls.
Causes
There are no established causes for hepatic hemangioma.[1]
Epidemiology and Demographics
Prevalence
The prevalence of hepatic hemangioma is up to 7% in normal adult population.[2]
Risk factors
There are no known risk factors for hepatic hemangioma.[3]
Screening
According to the United States Preventive Services Task Force, there is insufficient evidence to recommend routine screening for hepatic hemangioma.[4]
Differentiating Hepatic hemangioma from other Diseases
Hepatic hemangioma must be differentiated from other diseases such as hepatic metastases, hepatocellular carcinoma, hepatic cyst.[5]
Natural History, Complications and Prognosis
If left untreated, patients with giant hepatic hemangiomas may progress to develop complications. Pregnancy and estrogen-based medications can cause cavernous hemangiomas to grow.
Diagnosis
History and symptoms
Symptoms of hepatic hemangioma include intermittent right upper quadrant pain, biliary colic, obstructive jaundice.[6]
Physical Examination
They are frequently asymptomatic and incidentally discovered at imaging, surgery, or autopsy. Hepatic hemangioma is usually not discovered until medical pictures are taken of the liver for some other reason. If a cavernous hemangioma ruptures, the only sign may be an enlarged liver.
Laboratory Findings
Some patients with hepatic hemangioma may have elevated concentration of transaminases, bilirubin and alkaline phosphatase even in asymptomatic cases.[6]
Treatment
Patients with small hemangiomas (less than 4 cm) are managed by observation, whereas asymptomatic patients are followed up with periodic radiological examination.[7]Elective surgical resection is recommended for all patients who develop progressive abdominal pain and a size of more than 5cm.[8]
References
- ↑ 1.0 1.1 1.2 Jr, Marcelo AF Ribeiro (2010). "Spontaneous rupture of hepatic hemangiomas: A review of the literature". World Journal of Hepatology. 2 (12): 428. doi:10.4254/wjh.v2.i12.428. ISSN 1948-5182.
- ↑ Heiken, Jay P. (2007). "Distinguishing benign from malignant liver tumours". Cancer Imaging. 7 (Special Issue A): S1–S14. doi:10.1102/1470-7330.2007.9084. ISSN 1470-7330.
- ↑ Marrero, Jorge A; Ahn, Joseph; Rajender Reddy, K (2014). "ACG Clinical Guideline: The Diagnosis and Management of Focal Liver Lesions". The American Journal of Gastroenterology. 109 (9): 1328–1347. doi:10.1038/ajg.2014.213. ISSN 0002-9270.
- ↑ Hepatic hemangioma. USPSTF. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=hepatic+hemangioma
- ↑ Radiopaedia 2015 Hepatic hemangioma "Radiopedia 2015 Hepatic hemangioma [Dr Yuranga Weerakkody]".
- ↑ 6.0 6.1 Jr MA, Papaiordanou F, Gonçalves JM, Chaib E (2010). "Spontaneous rupture of hepatic hemangiomas: A review of the literature". World J Hepatol. 2 (12): 428–33. doi:10.4254/wjh.v2.i12.428. PMC 3010512. PMID 21191518.
- ↑ Jones BE, Moore RY (1977). "Ascending projections of the locus coeruleus in the rat. II. Autoradiographic study". Brain Res. 127 (1): 25–53. PMID http://www.ncbi.nlm.nih.gov/pmc/articles/PMC301051 Check
|pmid=
value (help). - ↑ Erdogan D, Busch OR, van Delden OM, Bennink RJ, ten Kate FJ, Gouma DJ; et al. (2007). "Management of liver hemangiomas according to size and symptoms". J Gastroenterol Hepatol. 22 (11): 1953–8. doi:10.1111/j.1440-1746.2006.04794.x. PMID 17914976.