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Path to patient image quiz| Volume 98, ISSUE 3, P489-491, March 2023

Hepatic Hemangioma

      A young woman had a liver mass resected. The lesion was diagnosed as a cavernous hemangioma of the liver (Figure 1).
      Figure thumbnail gr1
      Figure 1Liver involved by a cavernous hemangioma.
      What statement is most accurate about liver hemangioma?
      • a.
        Hepatic hemangiomas are common benign liver tumors.
      • b.
        Hepatic hemangiomas are exceptionally rare benign liver tumors.
      • c.
        Hepatic hemangiomas are rarely discovered incidentally.
      • d.
        Hepatic hemangiomas most often occur in elderly men.
      Answer: a. Hepatic hemangiomas are common benign liver tumors.
      A spectrum of vascular lesions can occur in the liver, from hemangiomas to hepatic epithelioid hemangioendothelioma and angiosarcoma. Unlike hepatic epithelioid hemangioendothelioma and angiosarcoma, hepatic hemangiomas are benign tumors. Hepatic hemangiomas are common benign liver tumors.
      • Choi B.Y.
      • Nguyen M.H.
      The diagnosis and management of benign hepatic tumors.
      Although hepatic hemangiomas are often identified incidentally, they can be associated with pain or compressive symptoms and rarely bleeding and rupture, and they can be associated with Kasabach-Merritt syndrome.
      • Aziz H.
      • Brown Z.J.
      • Baghdadi A.
      • Kamel I.R.
      • Pawlik T.M.
      A comprehensive review of hepatic hemangioma management.
      Hepatic hemangiomas most commonly affect women and are often identified in individuals 30 to 50 years of age but can occur over a wide age range, including in children.
      • Ajay P.S.
      • Tsagkalidis V.
      • Casabianca A.
      • et al.
      A review of hepatic epithelioid hemangioendothelioma—analyzing patient characteristics and treatment strategies.
      Hepatic hemangiomas have a spongy, honeycomb texture grossly and may have firm white areas if they thrombose and have sclerosis (Figure 1). On histologic evaluation, most hepatic hemangiomas are cavernous hemangiomas with cavernous vascular channels with fibrous stroma lined by a single layer of endothelial cells (Figures 2 and 3).
      Figure thumbnail gr2
      Figure 2Cavernous hemangioma identified in the lower left aspect of the photomicrograph. Liver parenchyma is present in the upper right aspect of the photomicrograph.
      Figure thumbnail gr3
      Figure 3Cavernous hemangioma of the liver composed of endothelial cell–lined blood-filled spaces.

      References

        • Choi B.Y.
        • Nguyen M.H.
        The diagnosis and management of benign hepatic tumors.
        J Clin Gastroenterol. 2005; 39: 401-412
        • Aziz H.
        • Brown Z.J.
        • Baghdadi A.
        • Kamel I.R.
        • Pawlik T.M.
        A comprehensive review of hepatic hemangioma management.
        J Gastrointest Surg. 2022; 26: 1998-2007
        • Ajay P.S.
        • Tsagkalidis V.
        • Casabianca A.
        • et al.
        A review of hepatic epithelioid hemangioendothelioma—analyzing patient characteristics and treatment strategies.
        J Surg Oncol. 2022; 126: 1423-1429