Giant Pedunculated Hepatic Hemangioma: A Case Report and Literature Review

Surgical Resection of a Giant Hepatic Hemangioma in a Hepatitis B-positive Patient: A Case Report

This case report describes the successful surgical removal of a giant hemangioma in a 41-year-old female with hepatitis B. The patient came with stomach distension, right upper quadrant, and right lumbar region pain. Imaging studies showed a mass measuring 12x7.6x11 cm emerging from the left lobe of the liver, causing compression of surrounding structures. The patient has undergone a laparotomy with successful anatomical resection of the hemangioma. Postoperative recovery was uneventful, and the patient was discharged on the fifth postoperative day. This case highlights the significance of considering surgery for symptomatic giant hemangiomas and normal follow-up to screen for recurrence and aims to present the successful surgical management of a giant hemangioma.

Giant pedunculated hepatic hemangioma accompanied by a 10-year history of taking oral contraceptive: A case report and literature review

Key Clinical Message

Giant pedunculated hepatic hemangiomas, mostly seen in women, are considered a rare type of giant hepatic hemangioma, with challenging diagnosis. Unlike other types of liver hemangiomas, they can manifest different kinds of symptoms, and are prone to life-threatening manifestations like rupture or torsion.

Abstract

Hemangioma is the most common benign liver primary tumor. Hepatic hemangioma >4 cm (some studies suggest >10 cm) is referred to as a giant hemangioma. Although hepatic hemangioma does not manifest symptoms in most cases, a giant hepatic hemangioma can manifest different kinds of symptoms. Giant pedunculated hepatic hemangiomas are considered a rare type of giant hepatic hemangioma, with challenging diagnosis, as the thin pedicle could be hard to be detected on imaging. A 41-year-old woman was admitted to our hospital, with dull discomfort of the right upper quadrant and epigastric region and early satiety for the past 7 months, with the history of taking oral contraceptive (OCP) for 10 years. Ultrasound and computed tomography revealed a 130 × 124 × 76 mm solid mass, with central cystic lesion, located in the midline of the epigastric region, attaching to the inferior surface of the third segment of the left lobe of the liver. Due to the potential risk for torsion, and rupture of the hemangioma, the management of the patient proceeded to surgical excision. Pathological examination of the specimen confirmed the diagnosis of hepatic hemangioma. Giant pedunculated hepatic hemangioma is a rare benign tumor. It demonstrates higher incidence rate in women, as some hemangiomas have estrogen receptors, and estrogen can lead to endothelial cell proliferation and organization in vascular structure. Most hemangiomas do not express any symptoms; therefore, no treatment is needed except for the patients who manifest symptoms, or in giant pedunculated hemangiomas, as they are prone to rupture or torsion. In this review most cases were female, and most of them presented with abdominal pain, in most cases the tumor located in the left lobe of the liver. Almost all the reviewed cases underwent surgery. Giant hepatic hemangioma is a differential diagnosis of palpable mass, or other symptoms of the right upper quadrant, and epigastric region specially in women taking OCP. Imaging is needed to rule out these tumors, and most often, pedunculated hemangioma is harder to be defined on imaging. It requires surgery because of the risk of acute problems, such as torsion and rupture.

Rare Benign Focal Lesions of the Liver: Report of 2 Cases and Literature Review

Introduction

Benign lesions of the liver are very common findings, usually randomly discovered, especially during examinations for other indications. The frequent use of imaging modalities may be responsible for the statistical increase in the incidence of these findings.

Case Presentation

In this publication, we present the cases of 2 female patients with benign liver lesions, the occurrence of which is considered rare, and only a few dozen cases have been described worldwide. In both cases, clinical symptoms, diagnostic approach, and surgical treatment are presented.

Conclusion

Due to increasing availability of imaging methods, the occurrence of previously considered rare benign liver lesions increases as well. In many cases, the malignant potential of these findings remains unclear. Decision-making process should include a multidisciplinary board.

Case Report: Giant abdominal hemangioma originating from the liver

BACKGROUND

Hepatic hemangioma is among the most common benign liver lesions. However, giant pedunculated hepatic hemangiomas are exceptionally rare and associated with additional risks, such as torsion.

CASE PRESENTATION

We present the case of a 63-year-old female patient who presented with abdominal distension and pain. Barium meal examination and gastroscopy revealed a large, smooth-surfaced submucosal bulge located at the fundus of the stomach. Subsequent MRI examination identified a mass measuring approximately 6.4 x 7 cm in the left upper abdomen. Surgical intervention was planned for mass removal. However, intraoperative exploration revealed the origin of the mass to be the liver, and subsequent histopathological examination confirmed it as a hemangioma.

CONCLUSION

We systematically summarized the characteristics of our case along with 31 previously reported cases. Giant pedunculated hepatic hemangiomas typically occur in the left lobe of the liver. Due to their atypical presentation, a combination of imaging methods such as ultrasound, CT, and/or MRI is essential for accurate diagnosis. Furthermore, surgical intervention is recommended due to the potential risks of bleeding, rupture, and torsion.

Exophytic hepatic hemangioma: a case report

Hepatic hemangiomas may rarely arise outside the extra-hepatic capsule. It appears as a pedunculated mass. We report the case of a 58-year-old female presenting with abdominal chronic pain. Incidental diagnosis of a pedunculated hepatic hemangioma was suggested by ultrasonography confirmed by typical imaging features on computed tomography. Dynamic contrast- enhanced computed tomography and MR scan are relevant to approach the diagnosis of hemangioma, showing its origin from the liver edge and typical radiological features Surgical removal of the mass was performed to prevent volvulus along the pedicle. Pathological analysis confirmed the diagnosis of pedunculated benign hepatic hemangioma.

Giant pedunculated liver mass: primary hepatocellular carcinoma masquerading as hepatic haemangioma

A woman in her mid-60s was referred to surgeons with a 2-week history of worsening right-sided abdominal pain. CT demonstrated a large encapsulated, pedunculated hepatic lesion with active intracapsular bleeding and free fluid but nil further lesions. Findings suggested giant hepatic haemangioma; surgical excision took place the following day. Histopathology however confirmed malignancy. Pedunculated hepatocellular carcinoma (HCC) is rare but characteristically large and encapsulated. Sporadic case reports indicate that diagnosis is typically challenging and delayed with liver metastases at presentation. This case describes a patient with no clear risk factors for HCC found to have a well-defined, encapsulated and pedunculated mass but no detected metastasis or other lesions on initial CT. In this instance, subsequent MRI did identify further lesions in the liver. Such cases are limited in the literature: much remains to be learnt regarding presentation, differential diagnoses, investigation and management.

Torsion of a giant pedunculated liver hemangioma: Case report

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Torsioned pedunculated giant liver hemangioma should be considered in the differential diagnosis of acute appendicitis.

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Giant liver hemangioma size may be related to the elevation of liver enzymes.

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Surgery is the first-line treatment in patients with giant liver hemangioma.

Introduction

Hepatic hemangioma (HH) is the most common benign neoplasm affecting the liver. Most cases are asymptomatic and incidentally found at imaging studies. Giant hepatic hemangiomas are uncommon, but pedunculated giant hemangiomas are even rarer, making their clinical and imaging diagnosis a challenge for the surgeon.

Presentation of case

Herein; we report the case of a 26-year-old male patient, who presented to the emergency ward with acute abdominal pain associated with a palpable mass, mimicking a complicated appendicular plastron, additionaly were found it liver enzymes elevated. Then the patient was taken the operating room. An exophytic pedunculated liver tumor that projected towards the right iliac fossa was identified. It had undergone torsion on its pedicle. Transfixing hemostatic sutures were placed, proceeding with its exeresis. The patient tolerated the procedure and was discharged without complications on the third postoperative day. Pathological anatomy confirmed the diagnosis.

Discussion

Giant pedunculated HH is an infrequent entity that generates mass effect on intra-abdominal organs causing pain depending on its location. In our case, HH size was 13 cm with elevated liver enzymes, only previously reported in one case of a 20-cm hemangioma. Surgery is indicated for cases of giant and symptomatic lesions.

Conclusion

Torsioned pedinculated giant liver hemangioma may be part of the differential diagnosis of a patient with acute appendicitis with elevated liver enzymes. The elevation of liver enzymes may be related to the size of the HH.

Giant Mesenteric Mixed Hemangioma Misdiagnosed as Ovarian Cyst: A Case Report and a Literature Review

Hemangiomas are congenital vascular disorders that occur primarily in the face and neck, extremely rare in the mesentery. Here, we report a rare small mesenteric mixed hemangioma. A 34-year-old woman was admitted to the gynecology department for an extended menstrual cycle. A cystic multi-atrial mass at the right anterior of uterus was observed by ultrasound examination, which was about 12.5 × 9.5 × 14.9 cm in size. The gynecologist mostly considered the possibility of the ovarian cyst. However, there was a huge multi-atrial cyst in the small intestine mesentery without the right ovarian cyst in the surgical exploration. The grape-like cystic mass about 15 cm in diameter adhered to the mesenteric root of the small intestine. The cyst was diagnosed as the mesenteric mixed hemangioma in the final histopathology.

Imaging of hepatic hemangioma: from A to Z

The hemangioma is the most common solid lesion of the liver. Therefore, radiologists must know the typical and atypical imaging findings of this lesion in order to reach a correct diagnosis and avoid diagnostic errors. However, only few papers have comprehensively described the entire spectrum of atypical and uncommon imaging features. In this updated review, we provide the imaging features of hepatic hemangioma, in both typical and atypical forms, as well as its association with abnormalities in the adjacent hepatic parenchyma and other hepatic lesions, and its complications.