Hemangioma hepático gigante único: serie de casos con seguimiento de pacientes tratados quirúrgicamente / Single giant liver hemangioma: case series with follow-up of patients treated surgically

El tratamiento del hemangioma hepático gigante (HHG), sigue siendo motivo de controversia. El objetivo de este estudio fue reportar los resultados de pacientes con HHG resecados quirúrgicamente en términos de morbilidad postoperatoria (MPO). Serie de casos con seguimiento. Se incluyeron pacientes con HHG, sometidos a cirugía de forma consecutiva, en Clínica RedSalud Mayor, entre 2011 y 2020. La variable resultado fue MPO. Otras variables de interés fueron: tiempo quirúrgico, estancia hospitalaria y mortalidad. Las pacientes fueron seguidas de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión. Se intervinieron 5 pacientes, con una mediana de edad de 38 años. La medianas del tiempo quirúrgico y estancia hospitalaria; fueron 75 min y 4 días respectivamente. La MPO fue 20 % (1 caso de seroma). Con una mediana de seguimiento de 41 meses, los pacientes se encuentran asintomáticos y no se ha verificado morbilidad alejada. La resección quirúrgica de un HHG se puede realizar con escasa morbilidad, tanto en términos numéricos como de gravedad de la complicación observada.

SUMMARY: Treatment of giant hepatic hemangioma (GHH) remains controversial. The aim of this study was to report the outcomes of surgically resected GHH patients in terms of postoperative morbidity (POM). Case series with follow-up. Patients with GHH who underwent surgery consecutively at the RedSalud Mayor Clinic between 2011 and 2020 were included. The outcome variable was POM. Other variables of interest were surgical time, hospital stay and mortality. The patients were followed up clinically. Descriptive statistics were used, with measures of central tendency and dispersion. Five patients underwent surgery, with a median age of 38 years. The median surgical time and hospital stay; were 75 min and 4 days respectively. The MPO was 20 % (1 case of seroma). With a median follow-up of 41 months, the patients are asymptomatic, and no distant morbidity has been verified. Surgical resection of GHH can be performed with low morbidity, both in terms of numbers and the severity of the complication observed.

Tumores hepáticos fetales, a propósito de un caso de hemangioendotelioma gigante / Fetal hepatic tumors, apropos of a case of giant hemangioendothelioma

RESUMEN Se comunica el caso de una tumoración hepática fetal gigante diagnosticada en el tercer trimestre de embarazo, que cursó con signos de inminencia de falla cardiaca. Las pruebas posnatales confirmaron la sospecha de hemangioma hepático. Actualmente, se encuentra en manejo expectante con evolución hacia la regresión. Adicionalmente, revisamos las características de los principales tumores hepáticos primarios fetales.

ABSTRACT Case report of a giant fetal hepatic tumor diagnosed in the third trimester of pregnancy that presented signs of imminent cardiac failure. Postnatal tests confirmed the suspicion of hepatic hemangioma. Currently, the patient is under expectant management, evolving towards regression. We review the characteristics of the main fetal primary liver tumors.

Analysis of therapeutic efficacy and treatment model of interventional treatment in hepatic hemangiomas with poor blood supply / 中华消化杂志

Objective To analyze the efficacy and complications of interventional treatment in hepatic hemangiomas with poor blood supply,and to explore the mode of treatment.Methods From May 2013 to October 2016,at Tianjin Third Central Hospital,82 patients with hepatic hemangiomas with poor blood supply were enrolled and divided into intervention group,puncture group and combination group.Conventional hepatic artery intubation was performed in intervention group,using a microcatheter to superselect to hemangioma and injecting pingyangmycin-lipiodol emulsion into the tumor of hemangioma.Patients of puncture group underwent the ultrasound-guided percutaneous liver puncture,and the pingyangmycin-lipiodol emulsion was injected into the tumor.The patients of combination group first received intervention treatment,and the pingyangmycin-lipiodol emulsion were injected again into the tumor area lacking of iodized oil deposition through percutaneous transhepatic puncture.After treatment,the complications and clinical efficacy of patients in three groups were evaluated and the reasons of patients lost to follow-up were analyzed.The analysis of variance,Chi-square test and Fisher's exact test were performed for statistical analysis.For patients lost to follow up,intention-to-treat (ITT) analysis and per protocol (PP) analysis were used.Results Among 82 patients with hepatic hemangiomas with poor blood supply,there were 27 in intervention group,24 in puncture group and 31 in combination group.Seven patients developed serious complications such as liver failure.At three months after the treatment,the overall efficacy of combination group (20.9％,9/31) was higher than that of intervention group (7.4％,2/27) and puncture group (4.2 ％,1/24),and the differences were statistically significant (x2 =6.296,P =0.014;x2 =5.622,P =0.031).At six months after the treatment,the overall efficacy of combination group (ITT analysis 70.3 ％,26/37;PP analysis 71.0 ％,22/31) was still higher than that of intervention group (40.9％,9/22) and puncture group (7/18),and the differences were statistically significant (ITT analysis x2 =4.929 and 4.969,PP analysis x2 =4.789 and 4.851;all P＜0.05).At twelve months after the treatment,a total of 41 patients of three group were lost.Among them,the patients with ineffective treatment by clinical effect evaluation accounted for 63.4％ (26/41),which was higher than those with significantly effective treatment (12.2 ％,5/41) and those with effective treatment (24.4 ％,10/41),and the differences were statistically significant (x2=22.873 and 12.676,both P＜0.01).Conclusions The efficacy of the interventional treatment alone for hepatic hemangiomas with poor blood supply is poor and the complications should be considered when selecting the appropriate treatment methods.

Laparoscopic surgery for giant liver hemangiomas: a report of 40 patients / 中华肝胆外科杂志

Objective To analyze the clinical experience of laparoscopic surgery for giant liver hemangiomas.Methods The clinical data of 40 patients who underwent laparoscopic surgery for giant liver hemangiomas from August 2012 to January 2018 in the China-Japan Friendship Hospital were retrospectively analyzed.The diameters of the liver hemangiomas were more than 10 cm for all the patients.The liver functions of all the patients were Child-Pugh class A.The follow-up was up to the end of February 2018.Results Laparoscopic treatment of giant liver hemangioma was successfully performed in 37 patients.Three patients were converted to open hepatectomy.The mean diameter of the giant liver hemangiomas was (10.8± 1.3) cm (ranged 10.0～15.0 cm).The mean operative time for laparoscopic therapy was (154.7±68.0) min (range 70～ 390 min).The mean intraoperative blood loss was 200 (100 ～ 400) ml.20 patients received autologous blood transfusion.Of these 2 patients received in addition allogeneic blood transfusion.The postoperative hospital stay was (6.9t2.0) days (range 4～14 days).Postoperative complications occurred in 3 patients (8.1％).Two patients developed postoperative pleural effusion and one pelvic effusion.Two patients responded well to puncture drainage and one to conservation management.There was no postoperative hemorrhage,bile leakage or air embolism.All patients were followed-up and no liver hemangioma recurrence was detected.Conclusion Laparoscopic surgery was a safe and efficacious procedure in selected patients with giant liver hemangioma.

Super-selective hepatic artery embolization and bleomycin in treatment of liver hemangioma / 中华肝胆外科杂志

Objective To evaluate the long-term efficacy and safety of super-selective hepatic artery embolization (TAE) and bleomycin hydrochloride in treatment of liver hemangioma.Methods A retrospective analysis was conducted on 132 patients treated for liver hemangioma from January 2011 to December 2014.The patients underwent super-selective TAE.There were 26 men and 106 women.The age ranged from 29.0 to 65.0 (46.0±8.0) years.An emulsion of iodized oil and bleomycin and polyvinyl alcohol particle (PVA) was used for the TAE.Routine follow-up visits on post-treatment Days 3 and 7 were carried out to detect complications and changes in liver function.The diameters of the lesions pre-TAE and at 6,12 and every 12 months thereafter were monitored.Results TAE was technically successful in all these patients.The range of follow-up was 3～6 years.The successful rates of treatment at 6 month,12 months,24 months,and 36 months,were 100％,100％,96.9％ and 90.6％,respectively.Conclusion TAE with an emulsion of iodized oil and bleomycin and PVA was a safe and efficacious treatment for liver hemangioma on long-term follow-up.

Hepatic hemangioma: an analysis on the impact of the differences in blood supply on interventional effectiveness and complications / 中华肝胆外科杂志

Objective To analyze the impact of the differences in blood supply to hepatic hemangiomas on interventional treatment effectiveness and complications.Methods A retrospective study was conducted on 322 patients with liver hemangiomas treated from January 2008 to December 2015 in Tianjin Third Central Hospital.The hemangiomas were diagnosed and classified into 3 groups according to the blood supply to the hemangioma:the rich blood supply group (n =128),the moderate blood supply group (n =104) and the poor blood supply group (n =90).The hemangiomas were embolized via the hepatic artery,and the therapeutic effect and complication were compared and analyzed among the 3 different groups.The mean follow-up was 12 months.Results The therapeutic effect of hepatic artery embolization was optimal for the rich blood supply group in the first 3-months of follow-up (the significant efficiency,effective rates were 18.8％ and 35.2％ respectively).There was no significant difference between the rich blood supply group and the moderate blood supply group at 12th month follow-up.The treatment effect on the poor blood supply group was significantly worse than the other two groups on follow-up.Complications after treatment occurred most commonly in the rich blood supply group and it was the least common in the poor blood supply group (the incidence rates were 43.8％,36.6％ and 8.9％ respectively).However,severe post-treatment complications were apparently more common in the poor blood supply group than the other two groups.Conclusions The therapeutic effects of transcatheter arterial embolization on hepatic hemangioma can differ because of the diversity in blood supply.In clinical practice,attention should be paid to the proper choice of treatment according to the blood supply to the lesion.Serious complications can occur after treatment.

Application analysis of MSCT multiphase enhancement scanning in the atypical hemangiomas / 中国生化药物杂志

Objective To analyze multislice CT (MSCT) multiphase multiphase enhancement scanning in the atypical hemangiomas. Methods During February 2013 from January 2014, chosing125 cases of patients with atypical hemangiomas in our hospital were retrospectively analyzed. Results There was a total of 240 lesions in 125 patients, multiple (2 or higher) in a total of 70 cases, 55 cases of single. A total of 170 were located in the right lobe, 70 were located in the left lobe, lesions was 0.8 to 4.5 cm in diameter, the average was (2.53±0.21) cm. A total of 205 lesions were circular, a total of 35 as lobulated or irregular. CT scan, a total of 155 were low density, 85 in equal density. A total of 120 state clearly, realm for part of the fuzzy and parts out of a total of 35, 85 was fuzzy. A total of 45 lesions density uneven, a total of 195 was lesions density uniformity. In 240 intrahepatic lesions, a total of 145 lesions present performance1, 80 lesions belong to 2 kinds of forms, 15 lesions characterized by 3 kinds of forms. Conclusion Although a few hemangiomas reinforcement is not typical, by the mutiperiodic enhanced MSCT scanning remain their respective characteristics, in identification of its pathological changes has important diagnostic value.

A Case of Diffuse Neonatal Hemangiomatosis Successfully Treated with Propranolol / 임상소아혈액종양

We present a case of a 41-day-old girl with diffuse hemangiomatosis on her chin, right thigh, occipital area, and liver. She also had hepatomegaly, heart failure, and hypothyroidism. Hemangiomatosis did not respond to 2 weeks of oral administration of prednisolone, but was successfully treated with propranolol. After 2 years of propranolol treatment, the lesions of hemangiomatosis nearly disappeared. Hypothyroidism was controlled by levothyroxine replacement. As hemangiomatosis regressed, thyroid function was normalized. Propranolol may have adverse effects including hypotension, hypoglycemia, bronchoconstriction, and restlessness, but she did not experience such adverse effects. Propranolol could be the first choice for diffuse neonatal hemangiomatosis (DNH). Our case also suggests that thyroid function test is needed in patient with DNH.

A Case of Diffuse Neonatal Hemangiomatosis Successfully Treated with Propranolol / 임상소아혈액종양

We present a case of a 41-day-old girl with diffuse hemangiomatosis on her chin, right thigh, occipital area, and liver. She also had hepatomegaly, heart failure, and hypothyroidism. Hemangiomatosis did not respond to 2 weeks of oral administration of prednisolone, but was successfully treated with propranolol. After 2 years of propranolol treatment, the lesions of hemangiomatosis nearly disappeared. Hypothyroidism was controlled by levothyroxine replacement. As hemangiomatosis regressed, thyroid function was normalized. Propranolol may have adverse effects including hypotension, hypoglycemia, bronchoconstriction, and restlessness, but she did not experience such adverse effects. Propranolol could be the first choice for diffuse neonatal hemangiomatosis (DNH). Our case also suggests that thyroid function test is needed in patient with DNH.

Relationship between diameter of liver hemangioma and operation risk / 中华消化外科杂志

Objective To explore the relationship between diameter of liver hemangioma and operation risk.Methods The clinical data of 362 patients with liver hemangioma who were admitted to the PLA General Hospital from January 2006 to January 2014 were retrospectively analyzed.All patients were divided into the 3 groups according to diameter of gross specimen,217 with tumor diameter≥5 cm and ≤ 10 cm in the large hemangioma group,119 with tumor diameter ＞ 10 cm and ≤20 cm in the giant hemangioma group and 26 with tumor diameter≥20 cm in the extremely large hemangioma group.The operation method included open surgery and laparoscopic surgery.Hepatectomy and enucleation of liver hemangioma were major operation procedures.The operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,number of patients with postoperative complications and duration of hospital stay were evaluated.Count data were analyzed using the chi-square test.Measurement data with normal distribution were presented as (x) ± s,and comparison among groups was analyzed using the ANOVA.Skewed distribution data were described as M (P25,P75),comparison among groups was analyzed by Kruskal-wallis test and pairwise comparison was done by the MannWhitney U test.Results All patients underwent operation successfully without perioperative death,including 315 receiving open surgery (175 in the large hemangioma group,114 in the giant hemangioma group and 26 in the extremely large hemangioma group) and 47 receiving laparoscopic surgery (42 in the large hemangioma group and 5 in the giant hemangioma group).The operation time,volume of intraoperative blood loss,number of patients with blood transfusion,number of patients with postoperative complications and duration of hospital stay were 160 minutes (125 minutes,205 minutes),300 mL (100 mL,500 mL),31,5 and 8 days (7 days,9 days) in the large hemangioma group,220 minutes (175 minutes,275 minutes),500 mL (300 mL,1 000mL),36,5 and 9 days (8 days,10 days) in the giant hemangioma group,330 minutes (280 minutes,420 minutes),1 975 mL (800 mL,4 000mL),20,7 and 11 days (9 days,13 days) in the extremely large hemangioma group,respectively,with significant differences (x2 =84.24,80.94,53.65,31.54,47.67,P ＜ 0.05).The operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion and duration of hospital stay were compared,showing significant differences between large hemangioma group and giant hemangioma group (Z =6.39,6.51,x2 =11.29,Z =4.73,P ＜ 0.05),with significant differences between large hemangioma group and extremely large hemangioma group and between giant hemangioma group and extremely large hemangioma group (Z =7.28,6.91,x2=51.22,Z =5.57,P ＜ 0.05;Z =5.33,4.86,x2=17.69,Z =3.5 1,P ＜ 0.05).Seventeen patients had postoperative complications with an incidence of 4.70％ (17/362),intra-abdominal hemorrhage were detected in 7 patients,perihepatic effusion in 4 patients,pleural effusion in 3 patients,bile leakage in 2 patients and fat liquefaction of abdominal incision in 1 patient.There was no significant difference in the number of patients with postoperative complications between large hemangioma group and giant hemangioma group (x2 =0.41,P ＞ 0.05).There were significant differences in the number of patients with postoperative complications between large hemangioma group and extremely large hemangioma group and between giant hemangioma group and extremely large hemangioma group (x2 =24.96,11.67,P ＜ 0.05).Conclusions Diameber of liver hemangioma is associated with operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,number of patients with postoperative complications and duration of hospital stay,and there is a high risk in the surgical treatment of patients with liver hemangioma diameter≥20 cm.

Feasibility of laparoscopic liver resection for giant hemangioma of greater than 6 cm in diameter

BACKGROUNDS/AIMS: Liver hemangioma, the most common benign liver tumor, can be safely managed by clinical observation. However, surgical treatment should be considered in a subset of patients with giant hemangioma with abdominal symptoms. We reviewed the feasibility of total laparoscopic liver resection for giant hemangioma of >6 cm in diameter. METHODS: Nine consecutive patients who underwent total laparoscopic liver resection for giant hemangioma between August 2008 to December 2012 were included in this study. Medical records were retrospectively reviewed for demographic data, laboratory findings, and perioperative results. RESULTS: The median age of patients was 36 yrs (range, 31-63). Eight females and 1 male were included in the study. The median size of hemangioma was 11 cm in diameter (range, 6-18) and 5 patients had a hemangioma >10 cm. Indications for surgical treatments were abdominal symptoms in 4 patients, increased size in 5 patients, and uncertain diagnosis in 1 patient. The median operation time was 522 minutes for right hepatectomy, 220 minutes for left lateral sectionectomy, and 90 minutes for wedge resection. The median estimated blood loss was 400 ml (range, 50-900). There was no postoperative morbidity, including Clanvien-Dindo grade I. CONCLUSIONS: The resection of giant hemangioma demands meticulous surgical technique due to high vascularity and the concomitant risk of intraoperative hemorrhage. Laparoscopic liver resection is feasible with minimal operative complication. Therefore, laparoscopic liver resection can be considered as an option for surgical treatment for giant hemangioma.

Cisto broncogênico em hemicúpula diafragmática esquerda / Bronchogenic cyst in left hemidiaphragm

É descrito o caso raro de mulher com 46 anos de idade portadora de hemangioma de fígado e cisto broncogênico localizado na hemicúpula diafragmática esquerda, tratada com ressecção por cirurgia torácica videoassistida. A paciente teve boa evolução após a remoção de ambas as lesões e encontrase assintomática 21 meses após os procedimentos.

We described a rare case of a 46 year old female patient that had a liver hemangioma and a bronchogenic cyst located in the left hemidiaphragmatic dome treated through a video assisted thoracic surgery procedure. The patient had an uneventful recovery from both lesions and is asymptomatic 21 months following both procedures.

Adult liver hemangioma: natural course and treatment / 中华肝胆外科杂志

Objective To investigate the natural course and treatment of adult liver hemangioma (ALH).Methods The records of ultrasonography of 2422 patients with ALH were retrospectively reviewed.Results The patients were between 16 and 69 years of age (mean age 42,9± 11.4) with a male to female ratio of 1 ∶ 1.02 (1197/1225).The prevalence rate gradually increased with age after 30 years old.The highest prevalence rate occurred between 40-69 years.ALH was most commonly 1.1-3 cm in size,located in right liver with a solitary lesion.ALHs were bigger and were seen earlier in females than males.Concurrent illness was also more common in females than males.1427 patients had 3 to 8 repeat sonographies.At a follow-up of 42.7±9.5 months,1351 patients had no change in the ultrasonographic pattern or number of haemangiomas.Increasing in size of the lesions was demonstrated in 76 patients.154 patients received operation or interventional treatment.Conclusions The prevalence rate of ALH rose with age.Female sex hormones might accelerate ALH enlargement but they did not induce the formation of ALH.Most ALH remained stable in size and in patterns.Attention should be paid to rule out other illnesses in patients with ALH and with symptoms.

Surgical Management for Giant liver Hemangiomas Greater Than 20 cm in Size

BACKGROUND/AIMS: The aim of this study was to investigate the primary management experience for giant liver hemangiomas greater than 20 cm in size. METHODS: Records of patients referred for evaluation of radiologically and/or histopathologically proven giant liver hemangiomas between January 2007 and March 2010 were retrospectively analyzed. The reasons for referral, results of imaging studies, preoperative and surgical treatments, and outcome were reviewed. RESULTS: A retrospective analysis was performed for 14 patients diagnosed with a giant hemangioma on the basis of an imaging study and/or a histopathological examination. All cases were diagnosed as giant liver hemangioma with at least one lesion greater than 20 cm in size. Abdominal discomfort was the main presenting complaint for the referral in 9 patients (64.2%). Abdominal ultrasound established the diagnosis in 12 patients (85.7%). Twelve patients underwent liver resection, 2 of whom underwent staged resection. Enucleation was performed in 2 patients. Selective transcatheter arterial embolization was implemented in 9 patients. Postoperative morbidity occurred in 3 patients (21.4%). No complications related to the hemangiomas occurred during follow up. CONCLUSIONS: Liver resection is indicated for giant liver hemangiomas with abdominal discomfort, especially for lesions greater than 20 cm in size. Staged operations are performed for patients with multiple lesions. Preoperative selective transcatheter arterial embolization alleviates progressive abdominal pain.

Hemangioma hepático subcapsular com realce perilesional: achados de RM / Hepatic subcapsular hemangioma with perilesional enhancement: MRI features

OBJETIVO: Descrever os achados de imagem de RM no hemangioma hepático com realce perilesional. MATERIAIS E MÉTODOS: Realizou-se uma pesquisa no banco de dados da unidade de RM para identificar todos os casos de hemangioma hepático com realce perilesional entre março de 2008 e julho de 2009. Todos os pacientes foram submetidos a RM pré-contraste em imagens ponderadas em T1 e T2 e em imagens dinâmicas após injeção de gadolínio. Características do hemangioma e do realce perilesional foram avaliadas nas imagens de RM. RESULTADOS: Sete hemangiomas em sete pacientes (cinco homens, duas mulheres; faixa etária entre 41-69 anos; média de 57 anos) foram incluídos no presente estudo. O tamanho das lesões variou de 7 a 20 mm (média de 12,4 mm). Na fase dominante arterial hepática, todos os sete hemangiomas mostraram realce perilesional cuneiforme que se atenuou nas imagens dois minutos após injeção de gadolínio. Quatro dessas lesões demonstraram realce capsular adjacente. CONCLUSÃO: Todos os hemangiomas hepáticos com realce perilesional eram lesões capsulares medindo menos que 2 cm. Tal localização sugere que esses hemangiomas podem recrutar vasos capsulares responsáveis pelo realce perilesional.

OBJECTIVE: To describe the MR imaging features of hepatic hemangioma with perilesional enhancement. MATERIALS AND METHODS: A search was performed of the MRI section database to identify all cases of hepatic hemangioma with perilesional enhancement between March 2008 and July 2009. All patients underwent MR examinations including precontrast T1- and T2-weighted images and postgadolinium dynamic images. On MR images, characteristics of the hemangioma and perilesional enhancement were evaluated. RESULTS: Seven hemangiomas in seven patients (five men, two women; age range, 41-69 years; mean, 57 years) were included in this study. Lesion size ranged from 7 to 20 mm (mean, 12.4 mm). On hepatic arterial dominant phase, all seven hemangiomas exhibited wedge-shaped perilesional enhancement which faded on two minutes postgadolinium images. Four of these lesions demonstrated adjacent capsular enhancement. CONCLUSION: All hepatic hemangiomas with perilesional enhancement were < 2 cm capsule-based lesions. This location suggests that these hemangiomas may conscript capsular vessels to account for the perilesional enhancement.

Laparoscopic left lateral hepatectomy: the first case at Thammasat University, Thailand

Background: A large incision of opened hepatectomy may cause many complications. Minimally invasive surgery of liver is challenging. Objective: To present the first case of a benign liver tumor, hemangioma, operated with a novel technique of laparoscopic hepatectomy in Thailand. Method: We report a 48-year-old female patient with chronic epigastric pain. A study of esophago-gastroduodenoscopy was normal. Ultrasound examination showed a mass of 6.5 cm in a left lobe of a liver. MRI and RBC scans showed hemangioma. Laparoscopic left lateral hepatectomy was performed. Result: Duration of the operation was 4 hours with approximately 300 cc of blood loss. Post-operative recovery was good. The patient could return home within 5 days after the operation. There were no complications. Conclusion: Laparoscopic left lateral hepatectomy for benign tumor case may be appropriate.

The Treatment of Liver Hemangioma Associated with Kasabach-Merritt Syndrome in Neonates

Hemangioma is the most frequent liver tumor in infancy. The treatment of hepatic hemangioma includes medical, surgical, and non-operative interventional therapy. There are no standard medical regimens currently considered consistently effective. MDMP (megadose methylprednisolone) and alpha-interferon can be used for medical treatment. Interventional occlusion of feeding arteries in symptomatic hepatic hemangioma is considered a safe and effective alternative to early open surgery. Untreated symptomatic patients with heart failure have a high mortality rate. For this reason symptomatic patients with heart failure may require non-operative treatment such as interventional embolization, because hepatic resection is burdened with high risk. We report our experiences of two patients with neonatal liver hemangiomas whose clinical courses were complicated by cardiac failure to whom medical treatment and/or interventional vascular occlusion were done. Both patients had Kasabach-Merritt syndrome complicated with cardiac failure. Initially, the masses were considered unresectable. In one case, we performed interventional therapy in addition to medical treatment. In another case, we tried medical therapy with megadose steroid and alpha-interferon. Unfortunately, in spite of the treatments, the patients died of severe hemorrhage.

Evaluation of efficacy and prognosis of radiofrequency ablation for the treatment of hepatic hemangiomas / 重庆医科大学学报

3.5cm in diameter were given multiple overlapping ablations that encompassed the entire les- ions.The operation was performed under local anesthesia in association with systemic analgesia. Results:The procedure was successfully accomplished in all the 16 patients. Adverse reactions happened at 2 ～5 postoperative days,including local pain and discomfort,pyrexia,and elevations of ALT levels. No bile leakage or hemorrhage occured.Follow-up observations in 16 patients for 1～3 years (mean,1 years and 8 months)showed a complete response (CR)in 15 patients and a partial response (PR)in l patient by one mission of RFA,the effective rate (CR+PR)being 100%.The hepatic hemangiomas decreased by a mean of 62.0%(range,50.1%～84.7%)in diameter. Conclusion:RFA is a safe and effective therapy for liver hemangiomas in properly selected patients by experienced hands.

Evaluation of Various Hepatic Lesions with Positron Emission Tomography / 대한간학회지

BACKGROUND/AIMS: [18F]FDG-PET is a functional imaging modality reflecting cellular glucose metabolism. In most malignant cells, accumulation and trapping of [18F]FDG allows the visualization of increased uptake compared with normal cells. The aim of this study was to assess the value of PET in differentiating benign from malignant hepatic lesions and to determine in which types of hepatic tumors PET can help evaluate stage, monitor response to therapy, and detect recurrence. METHODS: Eighty patients with liver lesions were enrolled (hepatocellular carcinoma 34, cholangiocarcinoma 8, metastatic liver cancer 25, hemangioma 6, liver abscess 7). Liver metastases were 22 adenocarcinoma, 2 lymphoma, 2 squamous cell carcinoma. The PET images of these patients were analyzed. SUV and lesion-to-normal liver background SUV ratio were obtained and compared among the disease groups. RESULTS: All liver metastases and all cholangiocarcinomas had increased uptake value, with SUV ratios greater than 2. Hepatocellular carcinoma had SUV ratios greater than 2 in 20 of 34 patients (59%). All hemangiomas had poor uptake, a SUV ratio of less than 2. All liver abscesses showed definite uptake. CONCLUSIONS: The PET technique using FDG static imaging was useful in differentiating malignant from benign lesions of the liver in limited situations. Limitations included false negative results in some patients with hepatocellular carcinoma. Liver abscesses raised problems in differential diagnosis from malignant liver tumors. The findings of this study suggest that the PET technique might be applied in tumor staging and the detection of recurrence, as well as monitoring responses to therapy for all adenocarcinomas and some hepatocelluar carcinomas.

The Treatment with Selective Hepatic Arteriography and Embolization in Liver Hemangioma / 实用放射学杂志

Objective We searched for optimal methods of embolization according to the images of selective hepatic arteriography to improve the efficiency of intervention.Methods 40 patients were selected to embolic with lipiodol ultra-fluida and PYM and followed by 6～48 months.Results According its shape and sign of stainangtime,liver hemangioma was distincted from liver cancer.The hemangioma sizes of 30 cases reduced beyond 50 percent and 4 cases had no change.All diminished hemongioma signs can been detected by ultrasound.The effective rate reached 85 percent.All patients had no side-effect.Conclusion The treatment of hepatic hemangioma with selectic arteriography and embolization is a good way in diagnosis and handle.