Major hepatectomy for a symptomatic giant liver cavernous hemangioma
Images in Clinical Medicine

Major hepatectomy for a symptomatic giant liver cavernous hemangioma

Edoardo de Werra, Giuseppe Maria Ettorre, Giovanni Battista Levi Sandri, Marco Colasanti, Emanuele Felli, Giovanni Vennarecci

Digestive and Transplant Liver Surgery Unit, S. Camillo Hospital, 00151 Rome, Lazio, Italy

Correspondence to: Giuseppe Maria Ettore, MD. Division of General Surgery and Liver Transplantation, S. Camillo Hospital, Circ.ne Gianicolense 87, 00151 Rome, Lazio, Italy. Email: gmettorre@scamilloforlanini.rm.it.

Submitted Nov 10, 2014. Accepted for publication Jan 06, 2015.

doi: 10.3978/j.issn.2304-3881.2015.01.08

Liver hemangiomas (LH) are the most common benign tumor of the liver, usually diagnosed as incidental findings, and their incidence ranges from 5% to 20% (1). LH are defined as “giant” if their diameter exceeds 4 cm (2). LH are usually asymptomatic while in some cases they occur with an abdominal pain, hemorrhage, biliary compression or consumptive coagulopathy.

Herein we report a case of a 40-year-old man with symptomatic giant LH. Medical history was unremarkable. Liver function was normal. Imaging revealed the presence of giant mass in the left lobe of the liver with gastric compression, and multiple similar lesions in the right lobe (Figure 1). A left hepatectomy was performed (Figure 2). Histopathology report described a cavernous hemangioma. Post-operative course was uneventful.

Figure 1 (A) Computed tomography (CT) revealed the presence of giant mass in the left lobe of the liver that causes gastric compression, and multiple similar lesions in the right lobe; (B) magnetic resonance imaging (MRI): the right anterior and posterior hepatic veins are visualized.
Figure 2 Surgical specimen of major hepatectomy was 150 mm × 220 mm × 70 mm for 4,900 gr.

Indications for surgical resection of LH include a palpable mass, gastrointestinal symptoms, rapid growth, intraperitoneal bleeding and shock due to rupture, or thrombocytopenia (3-5). Considering the benign types of tumors when possible a liver sparing resection should be performed.

Acknowledgements

Disclosure: The authors declare no conflict of interest.

Informed Consent: Written informed consent was obtained from the patient for publication of this article and any accompanying images. A copy of the written consent is available for review by the editor-in-chief of this journal.

References

  1. Weimann A, Ringe B, Klempnauer J, et al. Benign liver tumors: differential diagnosis and indications for surgery. World J Surg 1997;21:983-90. [PubMed]
  2. Adam YG, Huvos AG, Fortner JG. Giant hemangiomas of the liver. Ann Surg 1970;172:239-45. [PubMed]
  3. Erdogan D, Busch OR, van Delden OM, et al. Management of liver hemangiomas according to size and symptoms. J Gastroenterol Hepatol 2007;22:1953-8. [PubMed]
  4. Yoon SS, Charny CK, Fong Y, et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg 2003;197:392-402. [PubMed]
  5. Duxbury MS, Garden OJ. Giant haemangioma of the liver: observation or resection? Dig Surg 2010;27:7-11. [PubMed]
Cite this article as: de Werra E, Ettorre GM, Levi Sandri GB, Colasanti M, Felli E, Vennarecci G. Major hepatectomy for a symptomatic giant liver cavernous hemangioma. HepatoBiliary Surg Nutr 2015;4(3):218-219. doi: 10.3978/j.issn.2304-3881.2015.01.08

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