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Hepatic Giant Hemagiomas; Surgery or Endovascular Treatment?

H Timur Sindel*
Department of Radiology and Interventional Radiology, Akdeniz Üniversitiy, Antalya, Turkey


*Corresponding author: H Timur Sindel, Department of Radiology and Interventional Radiology, Akdeniz Üniversitiy, Antalya, Turkey


Published: 20 Dec 2017
Cite this article as: Sindel HT. Hepatic Giant Hemagiomas; Surgery or Endovascular Treatment?. Clin Surg. 2017; 2: 1831.

Clinical Image

Hemangiomas are the most common primary tumors of the liver, with a prevalence ranging from 3% up to 20% being reported in the literature [1-2]. Most lesions are asymptomatic and detected incidentally [1]. Lesions greater than 4 cm are called giant hemangiomas, in which case they might be symptomatic and thus require treatment [1,3]. When and how to treat hepatic hemangiomas is a controversial topic? With treatment generally being considered only in cases of symptomatic lesions, hemagiomas that are progressively growing or at high risk of bleeding [4]. Corticosteroids, radiotherapy, cytotoxic agents and surgery have been used for treatment, with surgical resection being the traditional treatment method [1,2,4]. But the resection complication rate is relatively high. Transcatheter Arterial Chemoembolisation (TACE) using bleomycin has been reported in the literature [1]. According to our studies, when minimally invasive endovascular treatment of giant hepatic hemangiomas is considered, TACE should be preferred over surgery.

Figure 1

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Figure 1
Digital subtraction angiography image showing the sinusoids of multiple hemangiomas filled with lipiodol-bleomycin mixture.

Figure 2

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Figure 2
Arterial phase CT image of a hepatic giant multiple hemangiomas before TACE.

Figure3

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Figure 3
Arterial phase CT image of hepatic hemangiomas 12 months after TACE (same patient as Figure 2).

References

  1. Giavroglou C, Economou H, Ioannidis I. Arterial embolization of giant hepatic hemangiomas. Cardiovasc Intervent Radiol. 2003;26(1):92-6.
  2. Toro A, Mahfouz AE, Ardiri A, Malaguarnera M, Malaguarnera G, Loria F, et al. What is changing in indications and treatment of hepatic hemangiomas: A review. Ann Hepatol. 2014;13(4):327-39.
  3. Bozkaya H, Cinar C, Besir FH, Parıldar M, Oran I. Minimally invasive treatment of giant haemangiomas of the liver: embolisation with bleomycin. Cardiovasc Intervent Radiol. 2014;37(1):101-7.
  4. Srivastava DN, Gandhi D, Seith A, Pande GK, Sahni P. Transcatheter arterial embolization in the treatment of symptomatic cavernous hemangiomas of the liver: a prospective study. Abdom Imaging. 2001;26(5):510-4.