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Liver hemangioma

Q:What is a liver hemangioma?

Liver hemangioma is a noncancerous liver tumor comprised of a cluster mesh network of widened malformed (dilated) blood vessels. Although, they are oftentimes referred as tumors, they are entirely benign in nature.

Q:What are some other names for liver hemangioma? What are the types of liver hemangioma?

Hepatic hemangioma, Cavernous hepatic hemangioma, Hepatic venous malformations, Infantile hemangioendothelioma, Multinodular hepatic hemangiomatosis

Q:How common is the problem? Who is more likely to be affected?

A hepatic hemangioma is the most common noncancerous tumor of the liver. It is estimated to be present in as many as 2 – 7% of healthy individuals.

Although liver hemangiomas may be present since birth, they are commonly detected at 30 – 50 years of age. Women are affected more often than men, and usually have bigger tumors than men.

Women who have been pregnant, those taking oral contraceptives or those on hormone replacement therapy for menopausal symptoms are more likely to have liver hemangioma.

Babies may develop a type of liver hemangioma called benign infantile hemangioendothelioma (also called multinodular hepatic hemangiomatosis). Infants are usually diagnosed when they are 6 months old and may result in unusual problems such as heart failure or even death.

Q:Why does it happen? How does it progress?

Although the cause of liver hemangioma is not known, it is believed to be congenital (birth defect). Usually, it occurs as a single mass about 4 – 5 centimeters in size. When they are small, they are harmless and do not require any extensive testing or treatment. Occasionally, they can be larger or occur in multiples.

If left untreated, liver hemangioma does not grow in size or lead to liver cancer over time. These lesions can change in size slightly and also in color due to cycles of clotting within the lesion. But in a small number of people, there may be bleeding inside the hemangioma or rupture of the hemangiomas. Pregnancy and estrogen-based medications (female hormones) such as birth control pills or hormone replacement therapy (HRT) can cause cavernous hemangiomas to grow. The female hormone estrogen, which increases during pregnancy, is believed to cause some liver hemangiomas to grow larger. A growing hemangioma can cause signs and symptoms and may require treatment. It is also known to increase in size following ovarian stimulation therapy with clomiphene citrate and human chorionic gonadotropin (HCG). Having a liver hemangioma doesn't mean that one can't become pregnant or take birth control pills. However, discussing the possible complications with your doctor can help you make a more informed choice.

They may be seen in 5-10% of children aged 1 year, but they typically regress during childhood.

Q:What are the signs and symptoms of liver hemangioma?

Most liver hemangiomas very small, do not produce symptoms and are usually not discovered until an abdominal scan (ultrasound, CT scan or MRI) is performed for some other medical problem. In most people, a small liver hemangioma does not cause any signs and symptoms. It would be reasonable to periodically check your liver for potential complications that may arise in the hemangioma.

In a small number of people, it might grow or cause complications. Patients with larger tumors, thrombosis or bleeding within the hemangioma or compression of surrounding structures may have symptoms, although they may be non-specific, such as:

Rarely, depending of their location, larger hemangiomas can rupture, either spontaneously or after trauma, causing severe pain and bleeding into the abdomen. Such an episode may even be life threatening.

Babies with benign infantile hemangioendothelioma may have a lump in the abdomen, anemia (low hemoglobin) or even signs of heart failure.

Q:Which tests and examinations are required to diagnose / evaluate this disease?

In addition to routine blood tests, the most important challenge is to differentiate the hemangioma from a malignant (cancerous) lesions of the liver. Following imaging tests are most useful in above:

Rarely, hepatic arteriography or and digital subtraction angiography may be required.

A liver biopsy should not be performed as it may lead to severe internal bleeding, especially if the lesion is large and peripheral.

Q:What is the best treatment for liver hemangioma?

Most people never need treatment for liver hemangioma. They are treated only if they produce pain or makes one uncomfortable with having a mass in ones liver, even if it is benign. One might however have periodic scheduled follow-up exams to check ones liver for change in size or complications.

One of the following treatments may be needed for the hemangioma:

Treatment for infantile hemangioendothelioma depends on the child's growth and development. It may involve medications for heart failure until the child becomes suitable for an operation.

Q: What are the precautions to be taken?

Living with a liver hemangioma, even a small, dormant one, can be unsettling at first. One may be anxious about the hemangioma is growing or its complications in the future. Learn about liver hemangioma and discuss the same with a liver specialist may dispel some of the anxiety.

Know the signs and symptoms that may indicate that your liver hemangioma is growing or causing complications. If one experiences any such symptoms, they should promptly checkup with their doctor. Regular check-ups helps in ruling out the possibility and offers peace of mind.

However, potential risks such as bleeding exist particularly in liver hemangiomas that are large and located near the periphery of the liver. In these cases, excessive physical activities or potential trauma sources should be avoided. One is also advised to wear a medical alert bracelet that will alert medical personnel to their condition during an emergency.

In infants whose tumor is only in one lobe of the liver, surgery is curative, even if the child has heart failure.

Q:What is the expected prognosis (Outlook) after various treatments?

Generally, the outlook of people with hemangioma is very good.