Surgical management of liver haemangioma

Dr Chris Yau

Dept of Surgery

PWH

Clinical scenario --- pitfall 68 F USG: 3cm hyperechoic lesion rig

ht lobe Typical haemangioma Hepatitis marker –ve, AFP CEA n

ormal FU CT scan:

7cm after 3 yr Trisegmentectomy: cholangiocarc

inoma

67 F USG: 4cm lesion left lobe Typical haemangioma Hepatitis marker, AFP CEA norm

al FU USG 1 yr

8cm mass left lobe, multiple satellite lesions right lobe

Palliative care

ContentContent

Pathology Prevalence / Etiology Clinical presentation Diagnostic tools Surveillance Surgical management Take home message

Liver Haemangioma --PathologyLiver Haemangioma --Pathology

First prescribed by Amboise Pare 1570 (Paris)

Benign tumour Size up to 30cm

Giant Haemangioma if size > 10cm

Liver Haemangioma --PathologyLiver Haemangioma --Pathology

Macroscopically: red wine colored mass with lob

ulated appearance

•Microscpically:

•large endothelium lined vascular channels packed with red blood cell

Prevelance / EtiologyPrevelance / Etiology

0.7% to 7.3 % in autopsy finding * Female predominance 1.5 – 6 : 1 ** Present most often between 3rd and 4th decade Positive correlation with female sex hormone

* Belghiti, Management of haemangioma, Stuttgart: 1993: 78-85** Yan et al, US guided percutanceous RFA for hepatic haemangioma. World J Gastroenterol, 2003 Sept 2132-2134

Clinical PresentationClinical Presentation

Asymptomatic Epigastric pain Spontaneous hemorrhage Traumatic hemorrhage Cardiac failure

Dignostic tools

USG: Homogenous hyperechoic

CT scan: Pre-contrast: Relative hypoden

se Early phase : Perilesional incre

ase in contrast Delayed: isodense / hyperdens

e

Diagnostic toolsDiagnostic tools

MRI scan: T1 : hypointense T2 : heavily hyperintense

Arteriography: Golden standard Cotton Wool appearance

SurveillanceSurveillance

NANilNilComplications

1NilNilMalignancy

NANil1Change of lesion

12 yrs12-114 months12-60 monthsFollow up period

170NilNADrop out

38323123No of pt

Leifer (US)Nippon (Japan)Gandolfi (Italy)

Surgical TreatmentSurgical Treatment

Treatment method: Laparoscopic Vs Open Resection Vs Enucleation RFA

Indications of Surgery Uncertain diagnosis Symptomatic Lesion with documented increase in size +/- Giant haemangioma

Surgery resultSurgery result

2.4%

12%

0

0

42

42

Ozden et

NA00Mortality

NA13%25%Morbidity

000Malignancy

1551163Conservative tx

81552Surgery

16326115No of pt

Farges et alMoreno et al

Yoon et al

Take home message

Majority haemangioma can be treated conservatively

Existence of mimicker Repeat scan / FNAC / Surgery if uncertain di

agnosis