Hepatic Hemangioma: Review of Imaging and Therapeutic Strategies

Hepatic hemangiomas mimicking gastrointestinal stromal tumors: A case report

BACKGROUND

Hepatic hemangiomas can be challenging to diagnose, particularly when they present with atypical features that mimic other conditions, such as gastrointestinal stromal tumors (GISTs). This case highlights the diagnostic difficulties encountered when imaging subepithelial lesions, especially when conventional methods such as computed tomography (CT) and endoscopic ultrasound (EUS) are used.

CASE SUMMARY

A 44-year-old woman presented with intermittent abdominal distension and heartburn for three months. Her medical history included iron deficiency anemia, menorrhagia, and previous cholecystectomy. One week prior to admission, an endoscopy suggested a bulging gastric fundus, which was likely a GIST, along with chronic nonatrophic gastritis and bile reflux. CT and EUS revealed nodules in the gastric fundus, which were initially considered benign tumors with a differential diagnosis of stromal tumor or leiomyoma. During surgery, unexpected lesions were found in the liver pressing against the gastric fundus, leading to laparoscopic liver resection. Postoperative pathology confirmed the diagnosis of hepatic cavernous hemangiomas. The patient recovered well and was discharged five days later, with normal follow-up results at three months.

CONCLUSION

This case underscores the challenges in the preoperative diagnosis of GISTs, particularly the limitations of the use of CT and EUS for the evaluation of subepithelial lesions. While CT is the primary tool for visualizing abdominal tumors, it is difficult to detect smaller lesions and assess the layers of the gastrointestinal wall on CT. EUS is recommended for the evaluation of nodules smaller than 2 cm and is useful for distinguishing GISTs from other lesions; however, its accuracy with regard to the differential diagnosis is relatively low. In this case, the gastric distension observed on imaging led to the compression of a liver tumor against the stomach, resulting in the misinterpretation of the tumor as a gastric wall lesion.

Research Progress on Contrast-Enhanced Ultrasound (CEUS) Assisted Diagnosis and Treatment in Liver-Related Diseases

Liver-related diseases, such as hepatocellular carcinoma (HCC) and cirrhosis, are globally prevalent and significantly contribute to mortality rates. Despite the availability of various imaging techniques for liver evaluation, a consensus regarding the selection of an accurate and safe method remains elusive. As a non-invasive imaging approach, the effectiveness of contrast-enhanced ultrasound (CEUS) in assisting the diagnosis and treatment of liver-related diseases has been established. Compared to conventional methods, CEUS offers notable advantages, including high safety, convenience, accuracy, and cost-effectiveness. Recent advancements have demonstrated the expanded utility of CEUS in liver-related diseases. In addition to diagnosing focal liver lesions, CEUS is increasingly employed for guiding local treatments, assessing liver transplantation suitability, and planning surgical interventions. However, its application requires caution due to the high technical proficiency demanded of operators, time-sensitive imaging processes, and susceptibility to visual interference. This review summarizes the current applications and recent advancements in CEUS-assisted diagnosis and treatment of liver-related diseases, explores its future potential, and proposes possible improvements. The objective is to enhance the accuracy and versatility of non-invasive liver assessments and provide a reference for the broader and more effective utilization of CEUS in liver disease diagnosis and management.

Nontarget Hemangioma Size Reduction after Bleomycin-Ethiodized Oil Embolization of Primary Hepatic Hemangioma

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 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.

Evaluation of Predictive Factors for Transarterial Bleomycin-Lipiodol Embolization Success in Treating Giant Hepatic Hemangiomas

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.

Reconsideration of the clinical management of hepatic hemangioma

In this letter, we comment on the article by Zhou et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery. This article proposes a new clinical grading system based on a multidisciplinary team, which prompts us to rethink the clinical management of hepatic hemangioma. Hepatic hemangioma is the most common benign solid liver tumor. In general, follow-up and observation for the vast majority of hepatic hemangioma is reasonable. For those patients with symptoms and severe complications, surgical intervention is necessary. Specific surgical indications, however, are still not clear. An effective grading system is helpful in further guiding the clinical management of hepatic hemangioma. In this article, we review the recent literature, summarize the surgical indications and treatment of hepatic hemangioma, and evaluate the potential of this new clinical grading system.

Identification of hepatic metastasis from an unrevealed adenoid cystic carcinoma by PET/CT: A case report

RATIONALE

Adenoid cystic carcinoma is a rare malignant tumor of the salivary glands, with few reports of metastasis to the liver in the literature. We present a case where an isolated hepatic lesion of adenoid cystic carcinoma was identified using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT).

PATIENT CONCERNS

A 76-year-old male experienced abdominal pain and underwent an enhanced CT scan and magnetic resonance imaging, which revealed a liver mass. Subsequent 18F-FDG PET/CT identified hypermetabolic lesions in both the left and right lobes of the liver, suggesting malignancy, with no other abnormalities detected.

DIAGNOSES

A liver biopsy confirmed the diagnosis of adenoid cystic carcinoma.

INTERVENTIONS

No intervention.

OUTCOMES

Following confirmation of the diagnosis, the patient chose to discontinue treatment and was discharged.

LESSONS

Hepatic metastasis from adenoid cystic carcinoma may be detected before the identification of the primary lesion. 18F-FDG PET/CT plays a critical role in differentiating benign from malignant liver tumors, selecting potential biopsy sites, and assessing the extent of metastatic disease.