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Jin X, Zhu Z, Zhao W, Sun L, Hu B, Huan H, Tu Y, Wang D, Jiang K. A novel and effective strategy for the treatment of large hepatic hemangioma: combining preoperative embolization with laparoscopic-assisted and ultrasound-guided ablation. World J Surg Oncol 2025; 23:203. [PMID: 40413559 PMCID: PMC12102798 DOI: 10.1186/s12957-025-03856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2025] [Accepted: 05/16/2025] [Indexed: 05/27/2025] Open
Abstract
BACKGROUND Hepatic hemangioma is the most common benign liver tumor. This study aims to evaluate the feasibility, safety and efficacy of Trans-arterial embolization (TAE) combined with thermal ablation in the treatment of large hepatic hemangioma (> 5 cm). METHODS From January 2018 to December 2021, 82 patients and 112 large HH with a maximum mean diameter of 8.24 ± 0.26 cm (range: 4.3-16.0 cm) and a cumulative diameter of 9.45 ± 0.45 cm (range:5.0-29.6 cm) were treated with laparoscopic-assisted and ultrasound (US)-guided percutaneous radiofrequency ablation (RFA) or microwave ablation (MWA) during a single general anesthesia episode following TAE. After surgery, therapeutic efficacy was assessed by contrast-enhanced imagings during follow-up. Median follow-up time was 14 months (range: 2-48 months). RESULTS All patients have a mean operating time of 79.10 ± 2.59 min. The plain CT revealed that 112 treated lesions were totally covered (100%). Hemoglobinuria was detected in 28 patients (34.1%), and there were no cases of acute renal failure. Abdominal pain occurred in 40 patients (48.8%), while peritoneal effusion in six (7.3%). Acute cholecystitis developed in 11 patients (13.4%), constipation in five (6.1%), and nausea and vomiting in 14 (17.1%). According to the Clavien-Dindo classification, 54 patients (65.9%) had minor complications, while none had severe complications. The follow-up, no Hepatic hemangioma growth was observed. CONCLUSION Preoperative TAE combined with thermal ablation is a novel therapeutic strategy for large HH. This strategy is simple, less risky, and feasible.
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Affiliation(s)
- Xin Jin
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Ziman Zhu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Wei Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Liyuan Sun
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Bin Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Hongbo Huan
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Yuliang Tu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Dadong Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China
| | - Kai Jiang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Beijing, 100853, China.
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Zhang L, Wang D, Zhang LZ, Yang WH, Yu C, Qin J, Feng LZ, Liu Z, Teng GJ. Pickering emulsion with tumor vascular destruction and microenvironment modulation for transarterial embolization therapy. Biomaterials 2025; 316:123018. [PMID: 39709852 DOI: 10.1016/j.biomaterials.2024.123018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 12/02/2024] [Accepted: 12/13/2024] [Indexed: 12/24/2024]
Abstract
In the clinic, Lipiodol chemotherapeutic emulsions remain a main choice for patients diagnosed with hepatocellular carcinoma (HCC) via the mini-invasive transarterial chemoembolization (TACE) therapy. However, the poor stability of conventional Lipiodol chemotherapeutic emulsions would result in the fast drug diffusion and incomplete embolization, inducing systemic toxicity and impairing the efficacy of TACE therapy. Therefore, it is of great importance to construct alternative formulations based on commercial Lipiodol to achieve the improved efficacy and safety of HCC treatment. Herein, calcium phosphate (CaP) nanoparticles-stabilized Lipiodol Pickering emulsion (CaP-LPE) with improved stability and pH-responsiveness is prepared and utilized for the encapsulation of combretastatin A4-phosphate (CA4P), a clinically approved vascular disrupting agent. The obtained CA4P-loaded CaP-LPE (CCaP-LPE) was shown to be enhanced stability compared to conventional Lipiodol emulsion and pH-responsive release of the encapsulated drugs. On one hand, the released CA4P could disrupt tumor vascular and cut off the blood supplying of tumor cells, thus starving cancer cells. Moreover, it was revealed that CCaP-LPE could reverse immunosuppressive tumor microenvironment (TME) by neutralizing tumor acidity, leading to the increased infiltration of CD8+ T cells and the decreased percentages of immunosuppressive cells. As the result, such CCaP-LPE could effectively shrink orthotopic N1S1 HCC tumors in rats by eliciting a potent antitumor immune response. Therefore, this study highlights a simple strategy to construct a novel LPE with the potencies of tumor vascular disruption and TME modulation, holding a great promise for TAE therapy of HCC.
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Affiliation(s)
- Lei Zhang
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China; National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Nanjing, 210009, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, China; State Key Laboratory of Digital Medical Engineering, Southeast University, Nanjing, 210009, China
| | - Duo Wang
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China; National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Nanjing, 210009, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, China; State Key Laboratory of Digital Medical Engineering, Southeast University, Nanjing, 210009, China
| | - Lin-Zhu Zhang
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China; National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Nanjing, 210009, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, China; State Key Laboratory of Digital Medical Engineering, Southeast University, Nanjing, 210009, China
| | - Wei-Hao Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Chao Yu
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China; National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Nanjing, 210009, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, China; State Key Laboratory of Digital Medical Engineering, Southeast University, Nanjing, 210009, China
| | - Juan Qin
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China; National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Nanjing, 210009, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, China; State Key Laboratory of Digital Medical Engineering, Southeast University, Nanjing, 210009, China
| | - Liang-Zhu Feng
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, Suzhou 215123, China
| | - Zhuang Liu
- Institute of Functional Nano & Soft Materials (FUNSOM), Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices, Soochow University, Suzhou 215123, China.
| | - Gao-Jun Teng
- Center of Interventional Radiology and Vascular Surgery, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Department of Radiology, Zhongda Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, China; National Innovation Platform for Integration of Medical Engineering Education (NMEE) (Southeast University), Nanjing, 210009, China; Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, Nanjing, 210009, China; State Key Laboratory of Digital Medical Engineering, Southeast University, Nanjing, 210009, China.
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Kutlu R, Dag N, Saparbekov E, Yagin FH. Nontarget Hemangioma Size Reduction after Bleomycin-Ethiodized Oil Embolization of Primary Hepatic Hemangioma. J Vasc Interv Radiol 2025; 36:787-794. [PMID: 39884351 DOI: 10.1016/j.jvir.2025.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 01/16/2025] [Accepted: 01/21/2025] [Indexed: 02/01/2025] Open
Abstract
PURPOSE To evaluate changes in nontarget hepatic hemangiomas, which are neither subjected to embolization nor targeted for treatment, following selective bleomycin-ethiodized oil transarterial chemoembolization (TACE) of a giant hepatic hemangioma. MATERIALS AND METHODS This single-center, retrospective study included 24 patients with nontarget hepatic hemangiomas distinct from primary giant hemangiomas treated with selective bleomycin-ethiodized oil TACE between 2009 and 2022. The size and volume of the lesions were assessed using computed tomography (CT) scans obtained before treatment and at 6, 12, and 24 months. RESULTS A significant reduction in the size of nontarget lesions (n = 34) was observed during follow-up (P < .05). Eighteen of 34 lesions (53%) showed a reduction in volume of 50% or greater. Overall clinical success rate for the primary lesion, defined as a significant size reduction and symptom improvement, was 96%. Logistic regression analysis showed no statistically significant association between demographic or primary lesion variables and changes in nontarget lesions (P = .901). Spearman correlation analysis revealed no significant relationship between changes in primary and nontarget lesions (P > .05). CONCLUSIONS Bleomycin-ethiodized oil TACE of a giant hepatic hemangioma significantly reduced the size of untreated, nontarget hemangiomas. This may be related to systemic absorption of the chemotherapeutic agent, lymphatic dissemination, or an abscopal effect, although the exact mechanism remains unclear.
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Affiliation(s)
- Ramazan Kutlu
- Department of Radiology & Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey.
| | - Nurullah Dag
- Department of Radiology & Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Eldiiar Saparbekov
- Department of Radiology & Liver Transplantation Institute, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Fatma Hilal Yagin
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Zdanowicz-Ratajczak A, Patrzałek D, Janczak D, Guziński M. Evaluation of Predictive Factors for Transarterial Bleomycin-Lipiodol Embolization Success in Treating Giant Hepatic Hemangiomas. Cancers (Basel) 2024; 17:42. [PMID: 39796672 PMCID: PMC11718885 DOI: 10.3390/cancers17010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Revised: 12/21/2024] [Accepted: 12/26/2024] [Indexed: 01/13/2025] Open
Abstract
Introduction: Giant hepatic hemangiomas are challenging to manage, requiring effective therapeutic approaches. Transarterial bleomycin-lipiodol embolization (TACE) has shown promise as a treatment option, yet predictive factors for its success are not well defined. This study aimed to assess the efficacy of TACE for giant hepatic hemangiomas and identify factors influencing treatment outcomes. Methods: A retrospective analysis of 31 adult patients who underwent TACE with bleomycin and lipiodol between December 2014 and October 2022 was conducted. Clinical parameters including age, sex, hemangioma location, lesion size, bleomycin dose, number of TACE sessions, and follow-up duration were evaluated. The primary outcome was hemangioma volume reduction, with statistical analyses identifying factors associated with significant lesion regression. Results: Higher bleomycin doses and longer intervals from procedure to follow-up were positively correlated with hemangioma volume reduction, while variables such as patient sex and lesion location showed no statistically significant impact on clinical success. The findings suggest that increased bleomycin dosage and extended follow-up periods may enhance treatment efficacy. Conclusions: The study identifies bleomycin dose and follow-up duration as predictive factors for TACE success in treating giant hepatic hemangiomas, underscoring their role in optimizing therapeutic strategies. These insights contribute to improved treatment personalization for patients with giant hepatic hemangiomas and highlight the need for further prospective studies to validate and expand upon these findings.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Mateusz Dorochowicz
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Agata Zdanowicz-Ratajczak
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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Akhlaghpour S. Commentary on Long-Term Outcomes of Transarterial Chemoembolization of Giant Liver Hemangiomas with Lipiodol-Bleomycin Emulsion. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03922-7. [PMID: 39638970 DOI: 10.1007/s00270-024-03922-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 11/16/2024] [Indexed: 12/07/2024]
Affiliation(s)
- Shahram Akhlaghpour
- Pardis Noor Medical Imaging and Cancer Center, No.5, 25th St, Saadat Abad Ave, Tehran, Iran.
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Young S, Golzarian J. The Perfect Fit: Unraveling the Treatment Algorithms for Symptomatic Hepatic Hemangiomas. Cardiovasc Intervent Radiol 2024; 47:943-944. [PMID: 38890184 DOI: 10.1007/s00270-024-03749-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 04/27/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Shamar Young
- University of Arizona, 4615 N, Lason Lane, Tucson, 85749, USA
| | - Jafar Golzarian
- University of Minnesota and North Star Vascular and Interventional Institute, 8401 Golden Valley Road, Suite 340, Golden Valley, Minnesota, 55427, USA.
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Zhao D, Xie L, Makamure J, Liu Z, Zhang L, Li Q, Zhang X, Zhao Y, Zheng C, Shi L, Liang B. Transcatheter Arterial Embolization with Bleomycin-Lipiodol of Hepatic Hemangiomas: Safety, Efficacy and Predictors of Response. Cardiovasc Intervent Radiol 2024; 47:931-942. [PMID: 38509337 DOI: 10.1007/s00270-024-03690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To evaluate the safety, efficacy and predictors of response of transcatheter arterial embolization (TAE) to treat hepatic hemangiomas (HHs). MATERIALS AND METHODS A retrospective analysis was conducted of consecutive HH patients who received TAE with bleomycin-Lipiodol emulsion and gelatin sponge particles at three institutions from January 2014 to January 2021. TAE effectiveness was defined as more than 50% reduction of tumor volume. The effectiveness, safety, and CT changes of hemangiomas after TAE were assessed. Factors affecting TAE efficacy on tumor size were analyzed with logistic regression analysis. RESULTS A total of 102 patients with 109 HHs were included. After treatment, both the tumor diameter and volume were significantly reduced from 8.5 ± 3.9 to 5.9 ± 3.8 cm (P < 0.001) and 412.6 ± 742.3 cm3 to 102.0 ± 232.7 cm3 (P < 0.001), respectively. TAE effectiveness was achieved in 80.7% (88/109) of hemangiomas, which was characterized by progressive reduction in tumor volume over time with Lipiodol retention. Atypical enhancement pattern (tiny enhancing dots in the hepatic arterial and portal venous phase) (p = 0.001) and central arterioportal shunt (APS) (p = 0.002) associated with the tumor were independent predictors of TAE ineffectiveness. Postembolization syndrome and transient increase in liver enzymes were common without severe complications and death. CONCLUSION TAE was safe and effective in reducing HH size. Lesion enhancement pattern and APS type were associated with TAE efficacy on tumor shrinkage. LEVEL OF EVIDENCE Level 3, non-controlled retrospective cohort study.
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Affiliation(s)
- Dan Zhao
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lingli Xie
- Department of Gastroenterology, General Hospital of the Yangtze River Shipping, No. 1 Huiji Road, Wuhan, 430010, China
| | - Joyman Makamure
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Ziyi Liu
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Lijie Zhang
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Qing Li
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Xin Zhang
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Yazhuo Zhao
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China
| | - Chuansheng Zheng
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China
| | - Liangrong Shi
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Road, Changsha, 410008, China.
| | - Bin Liang
- Department of Radiology, Hubei Province Key Laboratory of Molecular Imaging, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China.
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Li J, Zhang S, Ning C, Li G, Guo S. Efficacy of radiofrequency ablation vs. transcatheter arterial embolization for hepatic hemangiomas. Eur J Gastroenterol Hepatol 2024; 36:750-757. [PMID: 38555605 PMCID: PMC11045395 DOI: 10.1097/meg.0000000000002724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/10/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the safety and effectiveness of radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) in the treatment of large hepatic hemangiomas (LHH) (5-9.9 cm in diameter). METHODS AND MATERIALS This study retrospectively collected data from 82 patients with LHH treated at Chaoyang Central Hospital. The study analyzed the differences in postoperative efficacy, operative time, blood routine, liver and kidney function on the first day after surgery, postoperative hospitalization time and postoperative complications. RESULTS There were statistically significant differences in indicators such as white blood cell count, alanine aminotransferase, aspartate aminotransferase and total bilirubin on the first day after surgery between the RFA group (39 cases) and the TACE group (43 cases) ( P < 0.001). Compared to RFA, LHH patients treated with TACE had a general complication rate of 39.5% (vs. 43.6%; P = 0.7), a procedure-related complication rate of 30.2% (vs. 59.0%; P = 0.009), an effective rate at 6-12 months postoperatively of 55.8% (vs. 82.1%; P = 0.01), an operating-time of 41.2 ± 14.9 min (vs. 100.8 ± 35.5 min; P < 0.001) and hospitalization costs of 17052.7 ± 1364.8 yuan (vs. 30952.1 ± 4327.6 yuan; P < 0.001). CONCLUSION This study indicates that the efficacy of RFA in treating LHH is significantly superior to TACE. Microwave ablation and RFA appear to be safe treatments for LHH. The TACE group exhibited shorter operating-time, lower hospitalization costs and lower demands on cardiopulmonary function.
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Affiliation(s)
- Jushang Li
- Chaoyang Central Hospital, China Medical University
| | - Shuaiguo Zhang
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Chunmin Ning
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Guoming Li
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
| | - Shigang Guo
- Department of General Surgery, Chaoyang Central Hospital, Chaoyang, Liaoning, China
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Kacała A, Dorochowicz M, Matus I, Puła M, Korbecki A, Sobański M, Jacków-Nowicka J, Patrzałek D, Janczak D, Guziński M. Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:449. [PMID: 38541175 PMCID: PMC10972168 DOI: 10.3390/medicina60030449] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 10/30/2024]
Abstract
Hepatic hemangiomas are the most common benign liver tumors. Typically, small- to medium-sized hemangiomas are asymptomatic and discovered incidentally through the widespread use of imaging techniques. Giant hemangiomas (>5 cm) have a higher risk of complications. A variety of imaging methods are used for diagnosis. Cavernous hemangioma is the most frequent type, but radiologists must be aware of other varieties. Conservative management is often adequate, but some cases necessitate targeted interventions. Although surgery was traditionally the main treatment, the evolution of minimally invasive procedures now often recommends transarterial chemoembolization as the treatment of choice.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
| | - Mateusz Dorochowicz
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.D.); (I.M.)
| | - Iwona Matus
- Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (M.D.); (I.M.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (M.P.); (A.K.); (M.S.)
| | - Jagoda Jacków-Nowicka
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.J.-N.); (M.G.)
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Kacała A, Dorochowicz M, Korbecki A, Sobański M, Puła M, Patrzałek D, Janczak D, Guziński M. Transarterial Bleomycin-Lipiodol Chemoembolization for the Treatment of Giant Hepatic Hemangiomas: An Assessment of Effectiveness. Cancers (Basel) 2024; 16:380. [PMID: 38254869 PMCID: PMC10814004 DOI: 10.3390/cancers16020380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
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.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
| | | | - Adrian Korbecki
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Sobański
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Michał Puła
- Department of General, Interventional and Neuroradiology, Wroclaw University Hospital, 50-556 Wrocław, Poland; (A.K.); (M.P.)
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, 50-367 Wrocław, Poland; (D.P.); (D.J.)
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, 50-367 Wrocław, Poland
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11
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Xie LL, Huang YB, Dong KR, Yang SB, Shen C, Ma YY. Postnatal treatment and evolution patterns of giant fetal hepatic hemangioma: a case series of 29 patients. BMC Pediatr 2024; 24:8. [PMID: 38172842 PMCID: PMC10765870 DOI: 10.1186/s12887-023-04476-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVES To explore the clinical characteristics, postnatal treatment and prognosis of giant fetal hepatic hemangioma (GFHH). METHOD Retrospective analysis was performed on children with giant fetal hepatic hemangioma (maximum tumor diameter > 40 mm) diagnosed by prenatal ultrasound and MRI from December 2016 to December 2020. These patients were observed and treated at the Children's Hospital of Fudan University after birth. The clinical data were collected to analyze the clinical characteristics, treatment, and prognosis of GFHH using independent sample t tests or Fisher's exact tests. RESULTS Twenty-nine patients who were detected by routine ultrasound in the second and third trimester of pregnancy with giant fetal hepatic hemangiomas were included. The first prenatal ultrasound diagnosis of gestational age was 34.0 ± 4.3 weeks, ranging from 22 to 39 weeks. Of the patients, 28 had focal GFHHs and 1 had multifocal GFHHs. Surgery was performed, and the diagnosis was confirmed histopathologically in two patients. There were 8 cases with echocardiography-based evidence of pulmonary hypertension, 11 cases had a cardiothoracic ratio > 0.6, and 4 cases had hepatic arteriovenous fistula (AVF). The median follow-up time was 37 months (range: 14-70 months). During the follow-up, 12 patients received medical treatment with propranolol as the first-line therapy. The treatment group had a higher ratio of cardiothoracic ratio > 0.6 (P = 0.022) and lower albumin levels (P = 0.018). Four (14.8%) lesions showed postnatal growth before involuting. Complete response was observed in 13 (13/29) patients, and partial response was observed in 16 (16/29) patients. CONCLUSIONS Fetal giant hepatic hemangioma is mainly localized, and its clinical outcome conforms to RICH (rapidly involuting) and PICH (partially involuting), but some fetal giant hepatic hemangiomas will continue to grow after birth and then gradually decrease. For uncomplicated giant fetal hepatic hemangioma, postnatal follow-up is the main concern, while those with complications require aggressive medical treatment. Propranolol may have no effect on the volume change of GFHH.
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Affiliation(s)
- Lu-Lu Xie
- Shanghai Institute of Infectious Disease and Biosecurity, Shanghai, 200032, China
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Yan-Bing Huang
- College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Children's Hospital, Fujian Medical University, Fuzhou, 350001, China
| | - Kui-Ran Dong
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China
| | - Shao-Bo Yang
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
| | - Chun Shen
- Department of Pediatric Surgery, Shanghai Key Laboratory of Birth Defect, Key Laboratory of Neonatal Disease, Ministry of Health, Children's Hospital of Fudan University, 399 Wan Yuan Road, Shanghai, 201102, China.
| | - Yang-Yang Ma
- Department of Pathology, Children's Hospital of Fudan University, Shanghai, China
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12
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Gupta VF, Ronald J, Befera NT, Cline BC, Suhocki PV, Kim CY. Yttrium-90 Radioembolization of a Large Hepatic Hemangioma. Cardiovasc Intervent Radiol 2024; 47:142-145. [PMID: 38010506 DOI: 10.1007/s00270-023-03615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023]
Affiliation(s)
| | - James Ronald
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Duke University, Durham, NC, 27710, USA
| | - Nicholas T Befera
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Duke University, Durham, NC, 27710, USA
| | - Brendan C Cline
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Duke University, Durham, NC, 27710, USA
| | - Paul V Suhocki
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Duke University, Durham, NC, 27710, USA
| | - Charles Y Kim
- Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Duke University, Durham, NC, 27710, USA.
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13
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Shin YC, Cho EJ, Na HY, Cho JY, Han HS, Lee YJ, Kim H, Jang S, Choi GH, Jang ES, Kim JW, Jeong SH. Hepatic hemangioma: proportion and predictor of surgical treatment with emphasis on its growth rate. Korean J Intern Med 2023; 38:818-830. [PMID: 37939665 PMCID: PMC10636540 DOI: 10.3904/kjim.2023.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/16/2023] [Accepted: 06/09/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND/AIMS There are limited studies on the management of hepatic hemangiomas (HHs). We investigated the proportion and predictors of surgical resection and analyzed HH growth rates in addition to associated factors. METHODS A retrospective case-control study of patients treated in 2 centers was conducted. Thirty-six patients who underwent surgical resection were assigned to the case group. Patients who did not undergo surgical treatment were randomly sigselected at a 1:10 ratio and assigned to the control group (n = 360). Baseline characteristics, clinical course and surgical outcomes were analyzed. RESULTS The proportion of surgically treated HH patients was 0.3% (36 per 11,049). The longest diameter at diagnosis (mean ± standard deviation) was 7.7 ± 5.2 cm in the case group and 2.4 ± 1.8 cm in the control group (p < 0.001). In the multivariate analysis, the presence of more than 2 HHs (odds ratio [OR] 7.64, 95% confidence interval [CI] 1.40-41.72) and a growth rate of more than 4.8%/year (OR 30.73, 95% CI 4.86-194.51) were independently associated with surgical treatment. Symptom development during follow-up was related to HH size > 10 cm (OR 10.50, 95% CI 1.06-103.77, p = 0.04). The subgroup analysis showed substantial growth in 41.3% with an overall mean annual growth rate of 0.14 cm. CONCLUSION Approximately one in 300 patients with an HH underwent surgical treatment. Multiple HHs and a growth rate of more than 4.8%/year were indications for surgical treatment. Nearly half of the HHs showed growing pattern in our study.
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Affiliation(s)
- Young Cheol Shin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hee Young Na
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sangmi Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Gwang Hyeon Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Jin-Wook Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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14
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Aziz H, Nordan T, Feng LR, Kwon YK, Khreiss M, Karagozian R, Schnelldorfer T. Association Between Preoperative Angioembolization and Bleeding Complications in Patients With Benign Liver Tumors: Analysis of a National Database. J Surg Res 2023; 291:536-545. [PMID: 37540971 DOI: 10.1016/j.jss.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 08/06/2023]
Abstract
INTRODUCTION The role of angioembolization (AE) in patients with benign liver diseases is an area of active research. This study aims to assess any difference in liver resection outcomes in patients with benign tumors dependent on utilization of preoperative AE. METHODS A retrospective cohort study of patients undergoing elective liver resections for benign liver tumors was performed using the National Surgical Quality Improvement Program database (2014-2019). Only tumors of 5 cm in size or more were included in the analysis. We categorized the patients based on preoperative AE (AE + versus AE -). The primary outcome measured included bleeding complications within 72 h. The secondary outcomes were to determine predictors of bleeding. RESULTS After propensity score matching, there were 103 patients in both groups. There was no difference in intraoperative or postoperative blood transfusions within 72 h of surgery (14.6% versus 12.6%; P = 0.68), reoperation (1.9% versus 1.9%; P = 1), or mortality (1.0% versus 0.0%; P = 1) between the two groups. Multivariate regression analysis revealed an open surgical approach (odds ratio [OR]: 4.59 confidence interval [CI]: 2.94-7.16), use of Pringle maneuver (OR: 1.7, CI: 1.26-2.310), preoperative anemia (OR: 2.79, CI: 2.05-3.80), and preoperative hypoalbuminemia (OR: 1.53 [1.14-2.05]) were associated with the need for intraoperative or postoperative blood transfusions within 72 h of surgery. CONCLUSIONS Preoperative AE was not associated with reducing intraoperative or postoperative bleeding complications or blood transfusions within 72 h after surgery.
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Affiliation(s)
- Hassan Aziz
- Division of Transplant and Hepatobiliary Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa.
| | - Taylor Nordan
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lawrence R Feng
- Division of Transplant and Hepatobiliary Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa
| | - Yong K Kwon
- Division of Transplant and Hepatobiliary Surgery, University of Washington, Seattle, Washington
| | - Mohammad Khreiss
- Division of Surgical Oncology, Banner University Medical Center, Tucson, Arizona
| | - Raffi Karagozian
- Department of Surgery, Tufts Medical Center, Boston, Massachusetts
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15
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Ghaemi O, Mehrabi Nejad MM, Rouhezamin MR, Ayoobi Yazdi N, Pourghorban R, Rokni Yazdi H. A technical review of percutaneous sclerotherapy with bleomycin for giant hepatic venous malformation. CVIR Endovasc 2023; 6:46. [PMID: 37755623 PMCID: PMC10533756 DOI: 10.1186/s42155-023-00394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Hepatic venous malformation (HVM), traditionally called liver haemangioma, is considered the most common benign hepatic lesion. Treatment might be indicated in large and symptomatic HVMs. We aim to describe stepwise technical aspects of trans-hepatic percutaneous sclerotherapy of hepatic venous malformation (HVM). MAIN TEXT Patients with symptomatic HVM larger than 5 cm are selected after discussion in hepatobiliary multidisciplinary team. After prophylactic antibiotic and corticosteroid administration, local anaesthesia and conscious sedation are applied. A 22-gauge spinal or Chiba needle is used to obtain percutaneous access to the HVM through normal liver parenchyma under ultrasound guidance. To ensure proper needle placement and to prevent accidental delivery of sclerosant into unintended areas, about 5-10 mL iodine contrast is injected under fluoroscopy. Then, 45-60 IU bleomycin is mixed with 10 mL distilled water and 10 mL lipiodol and is slowly injected under fluoroscopy over a period of 20-30 s. After the needle is removed, manual pressure is applied over the puncture site for a period of 5 min followed by placement of a sandbag. Patients are monitored for 6-8 h post-procedure. CONCLUSION In this technical review, we described our institutional technique of percutaneous sclerotherapy, which could be regarded as an alternative to TAE in the management of HVM.
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Affiliation(s)
- Omid Ghaemi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran
| | | | - Niloofar Ayoobi Yazdi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran
| | - Ramin Pourghorban
- Department of Radiology, Sina Hospital, Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Department of Medical Imaging, Nepean Hospital, Kingswood, NSW, Australia
| | - Hadi Rokni Yazdi
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Sciences (TUMS), Qarib St, Keshavarz Blvd, Tehran, 1419733141, Iran.
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16
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Kacała A, Dorochowicz M, Patrzałek D, Janczak D, Guziński M. Safety and Feasibility of Transarterial Bleomycin-Lipiodol Embolization in Patients with Giant Hepatic Hemangiomas. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1358. [PMID: 37629648 PMCID: PMC10456525 DOI: 10.3390/medicina59081358] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/12/2023] [Accepted: 07/19/2023] [Indexed: 08/27/2023]
Abstract
Giant hepatic hemangiomas present a significant clinical challenge, and effective treatment options are warranted. This study aimed to assess the safety and feasibility of transarterial bleomycin-lipiodol embolization in patients with giant hepatic hemangiomas. A retrospective analysis was conducted on patients with giant hepatic hemangiomas (>5 cm). Transarterial chemoembolization (TACE) was performed using 7-20 cc of lipiodol mixed with 1500 IU of bleomycin. Safety outcomes, including post-embolization syndrome (PES), hepatic artery dissection, systemic complications, and access site complications, were evaluated. Radiation doses were also measured. Feasibility was assessed based on the achieved hemangioma coverage. Seventy-three patients (49 female, 24 male) with a mean age of 55.52 years were treated between December 2014 and April 2023. The average hospitalization duration was 3.82 days, and 97.3% of lesions were limited to one liver lobe. The average bleomycin dose per procedure was 1301.5625 IU, while the average lipiodol dose was 11.04 cc. The average radiation dose was 0.56 Gy. PES occurred after 45.7% of TACE procedures, with varying severity. Complications such as hepatic artery dissection (three cases), access site complications (two cases), and other complications (one case) were observed. No treatment-related mortality occurred. Hemangioma coverage exceeding 75% was achieved in 77.5% of cases. The study results suggest that transarterial bleomycin-lipiodol embolization is a safe and feasible treatment option for a heterogeneous group of patients with giant hepatic hemangiomas. This approach may hold promise in improving outcomes for patients with this challenging condition.
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Affiliation(s)
- Arkadiusz Kacała
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Mateusz Dorochowicz
- Faculty of Medicine, Wroclaw Medical University, Wybrzeże L. Pasteura 1, 50-367 Wroclaw, Poland
| | - Dariusz Patrzałek
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Maciej Guziński
- Department of General, Interventional and Neuroradiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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17
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Wang MQ, Duan F, Zhang H, Zhang JL, Fu J, Ye HY, Zhang GD, Zhang XJ. Comparison of Polyvinyl Alcohol Versus Combination of Lipiodol-Bleomycin Emulsion and NBCA-Lipiodol Emulsion for Renal Angiomyolipoma Embolization: A Prospective Randomized Study. AJR Am J Roentgenol 2023; 220:873-883. [PMID: 36475816 DOI: 10.2214/ajr.22.28587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND. Consensus is lacking regarding optimal embolic agents for transcatheter arterial embolization (TAE) of renal angiomyolipomas (AMLs). OBJECTIVE. The purpose of our study was to compare the safety and efficacy of TAE with polyvinyl alcohol (PVA) and TAE with a combination of ethiodized oil (Lipiodol)-bleomycin emulsion and N-butyl cyanoacrylate (NBCA)-Lipiodol emulsion for the treatment of patients with large or symptomatic AMLs. METHODS. This prospective study enrolled patients referred for TAE of a large (> 4 cm) or symptomatic renal AML from July 2007 to December 2018. Patients were randomized to undergo TAE using PVA particles or a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Patients underwent serial clinical follow-up visits and follow-up CT or MRI examinations after TAE. Outcomes were compared between groups. RESULTS. Seventy-eight patients were enrolled. After exclusions, the analysis included 72 patients (15 men, 57 women; mean age, 35.0 years; 51 patients with hematuria, 66 patients with flank pain): 35 patients were randomized to treatment by PVA and 37 were randomized to treatment by a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion. Complete occlusion of all angiographically visible arterial supply was achieved in all patients. No major adverse event occurred in any patient. The mean follow-up after TAE was 77 ± 45 (SD) months (range, 37-180 months). The frequency of resolution of hematuria after initial TAE without recurrence was greater after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 80.0%, respectively; p = .03). At 12-month follow-up, the frequency of complete resolution of flank pain was higher after treatment by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (100.0% vs 75.0%, p = .03). Mean reduction in AML volume at 36 months or longer after TAE versus at baseline was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than in those treated by PVA (98.0% vs 85.7%, respectively; p = .04). The frequency of complete response by modified RECIST (mRECIST) criteria at 36 months or longer after TAE was greater in patients treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than by PVA (94.6% vs 74.3%, p = .04). The rate of repeat TAE was higher among patients treated by PVA than among those treated by Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion (25.7% vs 8.1%, p = .04). CONCLUSION. Superior outcomes after TAE of AML were achieved using Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion than using PVA. CLINICAL IMPACT. TAE using a combination of Lipiodol-bleomycin emulsion and NBCA-Lipiodol emulsion is a safe and effective treatment option for large or symptomatic AMLs. TRIAL REGISTRATION. Chinese Clinical Trial Registry ChiCTR2100053296.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, PRC
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, PRC
| | - Heng Zhang
- Department of Radiology, the Second Medical Center, Chinese PLA General Hospital, Beijing, PRC
| | - Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, PRC
| | - Jinxin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, 28 Fuxing Rd, Beijing 100853, PRC
| | - Hui Yi Ye
- Department of Diagnostic Radiology, Chinese PLA General Hospital, Beijing, PRC
| | - Guo Dong Zhang
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Jinan, PRC
| | - Xiu Jun Zhang
- Department of Interventional Radiology, Tianjin Nankai Hospital, Tianjin, PRC
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Liu T, Pan W, Lai S, Luo J. Can angiogenesis inhibitor therapy cause changes in imaging features of hepatic hemangioma- Initial study. Front Oncol 2023; 13:1134179. [PMID: 36969035 PMCID: PMC10036792 DOI: 10.3389/fonc.2023.1134179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/27/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundTo observe whether anti-angiogenesis therapy can induce changes in size and enhancement characteristics of hepatic hemangioma.Method133 patients with hepatic hemangioma lesions were analyzed and classified into a Bevacizumab group (n=65) and the control group (n=68). The parameters (Volume, CT enhancement ratio, enhancement patterns) of pre-and post-treatment in the bevacizumab and control groups independently calculated and compared by two radiologists. Correlation among the systolic blood pressure, diastolic blood pressure, heart rate with the hemangioma volume was evaluated using Pearson’s correlation analysis.ResultsThe hepatic hemangioma volume was significantly decreased after treatment in the Bevacizumab group (8.6 ± 18.7mL vs.7.3 ± 16.3mL, P<0.05), and there was no significant change in the control group (15.1 ± 19.8mL vs.15.4 ± 20.7mL, P = 0.504). A significant difference in enhancement patterns of hepatic hemangiomas was observed after treatment with Bevacizumab (P<0.01). There was no significant difference in arterial phase (AP)enhancement rate and arterial phase-portal venous phase (AP-PVP) enhancement ratios after treatment in the Bevacizumab and control groups (Ps>0.05).The Pearson correlation results showed that blood pressure, heart rate, and hemangioma volume were unrelated or weakly related before and after bevacizumab treatment under the control of factors including weight, contrast injection scheme and CT scanning scheme.ConclusionsAnti-angiogenesis therapy can cause changes in enhancement pattern and volume of hepatic hemangioma. Radiologists should pay more attention to the reexamination of tumor patients treated with anti-angiogenesis therapy.
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19
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Xie W, Li H, Yu H, Zhou H, Guo A, Yao Q, Zhang L, Zhao Y, Tian H, Li L. A thermosensitive Pickering gel emulsion with a high oil-water ratio for long-term X-ray imaging and permanent embolization of arteries. NANOSCALE 2023; 15:1835-1848. [PMID: 36602166 DOI: 10.1039/d2nr05963k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Iodized oil has an excellent X-ray imaging effect, but it shows poor embolization performance. When used as an embolic agent, it is easily washed off by the blood flow and eliminated from the body. Therefore, it is essential to use iodized oil in combination with solid embolic agents such as gelatin sponge or to perform multiple embolization procedures to achieve the therapeutic effect. In the present study, a poly(N-isopropyl acrylamide)-co-acrylic acid (PNCAA) temperature-sensitive nanogel was synthesized by emulsion polymerization; the nanogel was then emulsified with iodized oil to prepare a thermosensitive iodized oil Pickering gel emulsion (TIPE). The oil-water (O/W) ratio of an O/W emulsion system can reach 4 : 6. When injected into the body, TIPE transforms into a nonflowing coagulated state at physiological temperature; the iodized oil is locked in the emulsion structure, thereby achieving local embolization and continuous imaging effects, which not only retain the X-ray imaging effect of the iodized oil but also improve its embolization effect. Subsequently, we further evaluated renal artery embolization in a normal rabbit renal artery model, and the results showed that TIPE shows a long-term conformal embolization performance and excellent long-term X-ray imaging ability.
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Affiliation(s)
- Wenjing Xie
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, P. R. China.
| | - Han Li
- Intervention and Cell Therapy Center, Peking University Shenzhen Hospital, Shenzhen 518035, Guangdong, China
| | - Houqiang Yu
- Department of Mathematics and Statistics, Hubei University of Science and Technology, Xianning 437100, P. R. China
| | - Hongfu Zhou
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, P. R. China.
| | - Anran Guo
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, P. R. China.
| | - Qing Yao
- Hubei Key Laboratory of Diabetes and Angiopathy, Medicine Research Institute, Xianning Medical College, Hubei University of Science and Technology, Xianning, Hubei, China
| | - Ling Zhang
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, P. R. China.
| | - Yongsheng Zhao
- Department of Nuclear Medicine, Peking University Shenzhen Hospital, Shenzhen 518035, Guangdong, China.
| | - Hongan Tian
- Department of Radiology, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, P. R. China.
| | - Ling Li
- School of Biomedical Engineering and Imaging, Xianning Medical College, Hubei University of Science and Technology, Xianning 437100, P. R. China.
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20
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Yan JY, Duan F, Fu JX, Wang Y, Zhang JL, Guan Y, Yuan B, Yuan K, Zhang H, Meng LM, Wang MQ. Outcomes of transarterial embolization for large symptomatic focal nodular hyperplasia in 17 pediatric patients. Dig Liver Dis 2023:S1590-8658(22)00872-6. [PMID: 36669995 DOI: 10.1016/j.dld.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND To evaluate the safety and the long-term outcomes of transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus N-Butyl cyanoacrylate (NBCA) in the treatment of children with large symptomatic focal nodular hyperplasia (FNH). METHODS This is a retrospective case serial study. Children (aged <18 years) with FNH were treated. Indications for TAE were patients who were presenting with FNH related abdominal pain and the maximum diameter of FNH is more than 7 cm, and who were not candidates for surgical treatment. Technical success, adverse events, symptoms relief rate, and changes in the lesion size after TAE were evaluated. RESULTS Between January 2003 and February 2018, 17 pediatric patients were included. Technical success was achieved in all patients. Mean follow-up was 67.5 months. All patients had complete resolution of abdominal symptom. The mean largest diameter of the lesions decreased from 10.5 cm to 1.9 cm (P < 0.01). The mean volume reduction rate was 96.9%. The complete resolution of the FNH was observed in 16 patients. No further therapy was needed for all patients. CONCLUSIONS TAE with LBE plus NBCA appears to be a safe and effective treatment in pediatric patients with large symptomatic FNH. It could be considered as the first-line treatment for symptomatic large FNH.
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Affiliation(s)
- Jie Yu Yan
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Feng Duan
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jin Xin Fu
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Yan Wang
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yang Guan
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Bing Yuan
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Kai Yuan
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China
| | - Heng Zhang
- Department of Radiology, The Second Medical Center of PLA General Hospital, Beijing 100853, China
| | - Li Min Meng
- Department of Medical Imaging, Air Force Medical Center of PLA, Beijing 100142, China
| | - Mao Qiang Wang
- Department of Interventional Radiology, The First Medical Center of PLA General Hospital, Beijing 100853, China.
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21
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Ghanaati H, Abrishami A, Hashem Zadeh A, Ghiasi M, Nasiri Toosi M, Jafarian A. Computed Tomography Fluoroscopy-Guided Percutaneous Transhepatic Bleomycin/Ethiodized Oil Sclerotherapy for Symptomatic Giant Hepatic Hemangioma. J Vasc Interv Radiol 2022; 33:1342-1348.e1. [PMID: 35863634 DOI: 10.1016/j.jvir.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 05/24/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To determine the safety and efficacy of computed tomography (CT) fluoroscopy-guided percutaneous transhepatic sclerotherapy with a bleomycin/ethiodized oil emulsion for symptomatic giant hepatic hemangiomas. MATERIALS AND METHODS The procedure was performed on 22 patients with symptomatic giant hepatic hemangiomas in an outpatient setting between 2018 and 2020. All patients were followed clinically and underwent contrast-enhanced magnetic resonance imaging after 1 month and again at a mean time of 15 months ± 2. Adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE, v5.0), in which a severe adverse event was defined as an adverse event with a grade of ≥3. The desired radiologic response (volume and index size) and improvement of pain intensity (visual analog scale [VAS]) and other symptoms were recorded as outcomes. RESULTS Overall, patients showed a 36.4% ± 8.6 reduction in volume and a 14% ± 1.6 reduction in index size after 1 month, with P values of .002 and .001, respectively. The final follow-up volume and index size were 194.7 cm3 ± 25.8 and 77 mm ± 36, respectively. Moreover, a 53.0% ± 7 reduction in volume and 22% ± 3.7 reduction in index size during the final imaging were reported, with the P values of .001 and .001, respectively. Significant reductions in the mean pain intensity (90% of patients with lower VAS scores after intervention) and symptoms were reported. Four patients were classified as clinically unsuccessful, and were recommended further procedures for residual pain. CONCLUSIONS CT fluoroscopy-guided transhepatic sclerotherapy is an effective, safe, and minimally invasive method to manage giant hepatic hemangiomas in an outpatient setting.
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Affiliation(s)
- Hossein Ghanaati
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Abrishami
- Department of Radiology, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Arezou Hashem Zadeh
- Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Ghiasi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohssen Nasiri Toosi
- Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Jafarian
- Division of Hepatopancreatobiliary Surgery and Liver Transplantation, Imam Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
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22
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Nault JC, Paradis V, Ronot M, Zucman-Rossi J. Benign liver tumours: understanding molecular physiology to adapt clinical management. Nat Rev Gastroenterol Hepatol 2022; 19:703-716. [PMID: 35835851 DOI: 10.1038/s41575-022-00643-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 12/08/2022]
Abstract
Improvements in understanding the pathophysiology of the different benign liver nodules have refined their nosological classification. New criteria have been identified using imaging, histology and molecular analyses for a precise diagnosis of these tumours. Improvement in the classification of liver tumours provides a more accurate prediction of disease progression and has modified patient management. Haemangioma and focal nodular hyperplasia, the most common benign liver tumours that develop in the absence of chronic liver disease, are usually easy to diagnose on imaging and do not require specific treatment. However, hepatocellular adenomas and cirrhotic macronodules can be difficult to discriminate from hepatocellular carcinoma. The molecular subtyping of hepatocellular adenomas in five major subgroups defined by HNF1A inactivation, β-catenin mutation in exon 3 or exon 7/8, and activation of inflammatory or Hedgehog pathways helps to identify the tumours at risk of malignant transformation or bleeding. New clinical, biological and molecular tools have gradually been included in diagnostic and treatment algorithms to classify benign liver tumours and improve patient management. This Review aims to explain the main pathogenic mechanisms of benign liver tumours and how this knowledge could influence clinical practice.
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Affiliation(s)
- Jean-Charles Nault
- Service d'hépatologie, Hôpital Avicenne, Hôpitaux Universitaires Paris-Seine-Saint-Denis, Assistance-Publique Hôpitaux de Paris, Bobigny, France. .,Unité de Formation et de Recherche Santé Médecine et Biologie Humaine, Université Paris Nord, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France. .,Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team «Functional Genomics of Solid Tumors», Paris, France. .,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France.
| | - Valérie Paradis
- Service de Pathologie, Hôpital Beaujon, AP-HP Nord, Clichy, France.,Université de Paris, INSERM U1149 "Centre de Recherche sur l'inflammation", CRI, Paris, France
| | - Maxime Ronot
- Université de Paris, INSERM U1149 "Centre de Recherche sur l'inflammation", CRI, Paris, France.,Department of Radiology, Assistance-Publique Hôpitaux de Paris, Hôpital Beaujon, AP-HP Nord, Clichy, France
| | - Jessica Zucman-Rossi
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris Cité, team «Functional Genomics of Solid Tumors», Paris, France. .,Equipe labellisée Ligue Nationale Contre le Cancer, Labex OncoImmunology, Paris, France. .,Hôpital Européen Georges Pompidou, APHP, Paris, France.
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23
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Bolger K, Choudhary MM, Kouri B. Transarterial chemoembolization as the primary treatment for a super-giant hepatic hemangioma. Radiol Case Rep 2022; 18:94-96. [PMID: 36324832 PMCID: PMC9619328 DOI: 10.1016/j.radcr.2022.09.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
Hepatic hemangiomas are common benign liver tumors. While the majority are small and require no treatment, giant hemangiomas are characterized as measuring greater than 4-6 cm in size and may require intervention. Surgical resection and enucleation have been described historically as the treatment for giant hemangiomas requiring intervention. Additionally, limited data exists about the treatment of hemangiomas measuring greater than 20 cm, particularly in regards to transarterial chemoembolization. We present a case of a super-giant hemangioma measuring greater than 20 cm treated with transarterial chemoembolization alone.
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24
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A Comprehensive Review of Hepatic Hemangioma Management. J Gastrointest Surg 2022; 26:1998-2007. [PMID: 35705835 DOI: 10.1007/s11605-022-05382-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/01/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hepatic hemangiomas (HHs) are benign liver lesions often discovered incidentally on imaging for various unrelated pathologies. We herein review the etiology, classification, diagnostic imaging, and management of HHs. METHODS A comprehensive systematic review was performed utilizing MEDLINE/PubMed and Web of Science databases, with the end of search date being March 1, 2022, regarding HH diagnosis, imaging, and management. RESULTS HHs can be broadly classified as capillary hemangiomas or cavernous hemangiomas. While the exact pathophysiology related to the development of HHs remains largely unknown, hormone exposure has been postulated to cause HH growth. HHs appear homogenously hyperechoic on US with distinct margins and posterior acoustic enhancement. While cavernous hemangiomas appear as well-defined hypodense lesions on pre-contrast CT images with the same density as the vasculature, one of the most reliable imaging features for diagnosing cavernous hemangiomas is high signal intensity on T2 weighted images. While most HHs are asymptomatic, some patients can present with pain or compressive symptoms with bleeding/rupture being very rare. Kasabach-Merritt syndrome is a rare but life-threatening condition associated with thrombocytopenia and microangiopathic hemolytic anemia. When HHs are symptomatic or in the setting of Kasabach Merritt syndrome, surgery is indicated. Enucleation is an attractive surgical option for HH as it spares normal liver tissue. Most patients experience symptom relief following surgical resection. CONCLUSION HHs are very common benign liver lesions. High-quality imaging is imperative to distinguish HHs from other liver lesions. Surgery is generally reserved for patients who present with symptoms such as pain, obstruction, or rarely Kasabach-Merritt syndrome. Surgery can involve either formal resection or, in most instances, simple enucleation. Patients generally have good outcomes following surgery with resolution of their symptoms.
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25
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Medium and Long-Term Outcome of Superselective Transcatheter Arterial Embolization with Lipiodol-Bleomycin Emulsion for Giant Hepatic Hemangiomas: Results in 241 Patients. J Clin Med 2022; 11:jcm11164762. [PMID: 36013000 PMCID: PMC9409947 DOI: 10.3390/jcm11164762] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/08/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose: To evaluate the medium and long-term efficacy of superselective transcatheter arterial embolization (TAE) with lipiodol−bleomycin emulsions (LBE) for giant hepatic hemangiomas. Methods: A total of 241 patients who had underwent TAE with LBE for hepatic hemangiomas from January 2010 to December 2016 were retrospectively reviewed. Blood tests were performed 3 and 7 days after TAE and procedural-related complications were recorded. The patients were followed up by enhanced CT or MRI imaging at 6, 12, 36, and 60 months post-TAE, respectively. Technical success of TAE was defined as successful embolization of all identifiable arteries supplying to the hemangiomas. Clinical success was defined as improvement of the abdominal symptoms and indications on the imaging examinations that the hemangiomas had decreased by more than 50% in maximum diameter. Results: TAE was performed successfully in all patients without serious complications. Improvement of the abdominal symptoms was recorded in 102/102 cases (100%). The reduction rate of the tumor maximum diameter with >50% at 6, 12, 36, and 60 months was 88.1% (190/210), 86.7% (170/196), 85.2% (124/142), and 86.5% (45/52), respectively. There was a significant change from pre-TAE to follow-up values in maximum diameter (p < 0.05). Conclusion: TAE with LBE was feasible and effective for giant hepatic hemangiomas. The reductions of the tumor maximum diameter with >50% at medium (≥3 years) and long-term (≥5 years) follow-up were satisfactory, with 85.2% and 86.5%, respectively.
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26
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Wang MQ, Duan F, Guan Y, Yuan B, Wang Y, Yan J, Zhang JL, Fu JX, Yuan K, Sun X, Zhang H, Ye HY, Cai SW, Duan W, Meng L, Huyan X. Long-term outcomes of transarterial embolization with lipiodol-bleomycin emulsion plus polyvinyl alcohol particles versus the particles alone for large symptomatic focal nodular hyperplasia: a propensity score-matched analysis. Eur Radiol 2022; 32:6840-6849. [PMID: 35763092 DOI: 10.1007/s00330-022-08972-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the efficacy of transarterial embolization (TAE) with polyvinyl alcohol (PVA) particles alone and lipiodol-bleomycin emulsion (LBE) plus PVA particles for patients with unresectable large symptomatic focal nodular hyperplasia (FNH). METHODS We performed a retrospective analysis of patients who underwent TAE either with PVA particles alone (group A, n = 46) or LBE plus PVA particles (group B, n = 35) for large (≥ 7 cm) symptomatic FNH between January 2002 and February 2019. Propensity score matching (PSM) (1:1) was performed to adjust for potential baseline confounders. Technical success, adverse events (AEs), symptom relief, and changes in the lesion size after TAE were evaluated. Statistical analysis included Wilcoxon rank sum test and χ2 test. RESULTS After PSM, no significant differences in baseline characteristics were found between the groups (31 in group A and 31 in group B, with a mean age of 31 years). Technical success was achieved in all patients (100%), without major AEs in both groups. Complete resolution of the abdominal symptoms was reported in 77.4% in group A and 100% in group B (p = 0.037) during a mean follow-up period of 72 months; complete resolution (CR) of the FNH rate was significantly higher in group B than in group A (93.6% vs. 67.7%; p = 0.019). CONCLUSION Compared with the use PVA particles alone, TAE with LBE plus PVA particles in the treatment of patients with large symptomatic FNH had a significantly higher rates of CR of the FNH and complete relief of the symptoms. KEY POINTS • Transarterial embolization (TAE) with lipiodol-bleomycin emulsion (LBE) plus PVA particles for the large symptomatic FNH yielded better results than with PVA particles alone, in terms of complete resolution of FNH lesions (93.6% vs 67.7%) and complete relief of the abdominal symptoms (100% vs 77.4%) during a mean follow-up period of 72 months (38-170 months). • No major complications were recorded in both groups, and no significant difference in the incidence of postembolization syndrome were observed between the two groups.
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Affiliation(s)
- Mao Qiang Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.
| | - Feng Duan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yang Guan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Bing Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yan Wang
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jieyu Yan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jin Long Zhang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, People's Republic of China
| | - Jin Xin Fu
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Kai Yuan
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Xuedong Sun
- Department of Interventional Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Heng Zhang
- Department of Radiology, The Second Medical Center, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Hui Yi Ye
- Department of Diagnostic Radiology, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Shou Wang Cai
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Wedong Duan
- Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Limin Meng
- Department of Medical Imaging, Air Force Medical Center of PLA, Beijing, People's Republic of China
| | - Xiaoyuan Huyan
- The First Health Care Department, The Second Medical Center & National Clinical Research Center for Geriatric disease, Chinese PLA general Hospital, Beijing, 100853, People's Republic of China
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27
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Torkian P, Akhlaghpoor S. Considerations Regarding Image-guided Treatment of Liver Hemangioma. Radiology 2022; 304:E45. [PMID: 35579523 DOI: 10.1148/radiol.212302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Pooya Torkian
- Department of Radiology, University of Minnesota, Minneapolis, Minn
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28
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Lin Z, Zhu X, Zhou J. Ultrasound-guided percutaneous sclerotherapy versus surgical resection in the treatment of large hepatic hemangiomas: a retrospective study. BMC Surg 2022; 22:130. [PMID: 35392876 PMCID: PMC8991895 DOI: 10.1186/s12893-022-01574-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND It is no consensus on the best management for patients with large hepatic hemangiomas. This study was designed to evaluate the efficacy and safety of percutaneous sclerotherapy compared to surgical resection for large hepatic hemangiomas. METHODS A total of 89 patients with large hepatic hemangiomas from single center underwent either percutaneous sclerotherapy (n = 14) or surgical resection (n = 75) as first-line treatment was retrospectively studied, followed up for 9-24 months using ultrasound. Terms of intraoperative and postoperative information, postoperative complications, and treatment effectiveness were compared between the two groups. RESULTS Percutaneous sclerotherapy had shorter operative time (p < 0.001), less blood loss, lower rate of prophylactic abdominal drainage (97.3% vs. 0%, p < 0.001), fewer minor complications (48.0% vs. 7.1%, p < 0.01), shorter hospital stay (p < 0.001), lower hospital cost (p < 0.001), higher Alb level (p < 0.001) and lower postoperative clinical index including ALT, AST and WBC (p < 0.001 for both) than did surgical resection. The major complications were demonstrated no significant difference between the two groups. In addition, the mean maximum cross-sectional areas of hemangioma dropped from 5044.1 ± 2058.0 mm2 to 1924.6 ± 1989.5 mm2 (65.2% reduction) during 9-24 months follow-up (p < 0.001) in the percutaneous sclerotherapy group, while all patients in the surgical resection group achieved complete response. CONCLUSION Percutaneous sclerotherapy is the preferred method for the treatment of large hepatic hemangioma over surgical resection when compared with the items of postoperative recovery, blood loss, complications, hospital stays, and lower hospital costs. The reduction of the maximum cross-sectional area of hepatic hemangioma in the percutaneous sclerotherapy group is satisfactory.
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Affiliation(s)
- Zepeng Lin
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaofeng Zhu
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Jian Zhou
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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29
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Liu Q, You N, Zhu J, Li J, Wu K, Wang Z, Wang L, Zhu Y, Gu H, Peng X, Zheng L. A Nomogram Model for Predicting the Response to Transcatheter Arterial Embolization in Patients With Symptomatic Hepatic Hemangioma. Front Mol Biosci 2021; 8:722864. [PMID: 34901150 PMCID: PMC8661031 DOI: 10.3389/fmolb.2021.722864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Transcatheter arterial embolization (TAE) is regarded as an effective treatment for patients with symptomatic hepatic hemangioma. However, few studies have evaluated the efficacy of TAE alone for treating hepatic hemangioma. The aim of this study was to identify the factors that influence the response to TAE and formulate a quantitative nomogram to optimize the individualized management of hepatic hemangioma. Methods: We retrospectively studied 276 patients treated with TAE for hepatic hemangioma at our center from January 2011 to December 2019. The full cohort was randomly divided into training and validation cohorts. After assessing the potential predictive factors for the efficacy of TAE in the training cohort, a nomogram model was established and evaluated by discrimination and calibration. Results: During follow-up, the symptom relief rate was 100%. The tumor blood supply (p < 0.001), tumor number (p = 0.004), and tumor size (p = 0.006) were identified as significant predictors of the failure of tumor shrinkage in response to TAE. The nomogram model showed favorable discrimination and calibration, with a C-index of 0.775 (95% CI, 0.705–0.845) in the training cohort, which was further confirmed in the validation cohort (C-index 0.768; 95% CI, 0.680–0.856). The side effects of TAE were relatively minor and included mainly abdominal pain, nausea, vomiting, fever, and the presence of elevated hepatic transaminases. Conclusion: TAE is a safe and effective treatment for symptomatic hepatic hemangioma. The established nomogram performed well for the estimation of the effect of TAE in patients with hepatic hemangioma and can facilitate the selection of patients who would benefit most from the treatment.
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Affiliation(s)
- Qinqin Liu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China.,Department of Biliary-Pancreatic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Nan You
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jiangqin Zhu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Jing Li
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Ke Wu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zheng Wang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Liang Wang
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yinan Zhu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Huiying Gu
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xuehui Peng
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Lu Zheng
- Department of Hepatobiliary Surgery, the Second Affiliated Hospital of Army Medical University, Chongqing, China
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30
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Nunes TF, Tibana TK, Morais Neto R, Marchiori E. Interventional treatment of symptomatic giant hepatic hemangiomas: initial results of the use of a combined technique. Radiol Bras 2021; 54:418-419. [PMID: 34866703 PMCID: PMC8630945 DOI: 10.1590/0100-3984.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Reinaldo Morais Neto
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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31
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Trans-Arterial Embolization for Liver Hemangiomas: It's a New Dawn; It's a New Day; It's a New Life? Cardiovasc Intervent Radiol 2020; 44:92-94. [PMID: 33205292 DOI: 10.1007/s00270-020-02707-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 10/31/2020] [Indexed: 10/23/2022]
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