EP.TH.74An incidental finding of liver haemangioma on diagnostic laparoscopy for right sided abdominal pain in a young woman

Introduction Cavernous liver haemangiomas or hepatic haemangiomas are the most common benign neoplasm of the liver. They are more common in women with a male to female ratio of 2.5-5.1- likely due to estrogenic influence. They are composed of hepatic endothelial cells and are usually small in size (< 4 cm). They are asymptomatic in most of the cases and incidentally discovered on diagnostic tests. Occasionally haemangiomas can exceed a size of 5 cm where they can cause symptoms such as nonspecific abdominal pain. Their exact aetiology is not well understood; they are thought to be vascular malformations with hormonal or congenital background. Haemangiomas belong to ‘Incidentaloma’ tumours, since they can be found incidentally while investigating for other unrelated pathologies. Although rare, but rupture and hemorrhage of liver hemangiomas can be fatal. Case presentation A 33-year-old woman was presented with abdominal pain which was started in central abdomen and then shifted to right lower abdomen abdomen. No other significant symptoms at presentation or past medical history. On serial physical examination, the patient was more tender at the right lower quadrant of the abdomen. Although her inflammatory markers were normal the decision was made to proceed with diagnostic laparoscopy to rule out acute appendicitis. During laparoscopy normal appendix was found with multiple liver lesions. Appendix was not removed. Postoperatively CT Thorax, Abdomen and Pelvis with contrast and CT Liver Triple Phase was performed which confirmed benign liver haemangioma. The patient recovered well after surgery and was discharged home with no routine surgical follow up.

Massive liver haemangioma causing Kasabach–Merritt syndrome in an adult

Liver haemangiomas are common, but their size very rarely exceeds 40cm. Most people with liver haemangiomas are asymptomatic, and diagnosis is usually made incidentally during imaging for other complaints. When a liver haemangioma is symptomatic or produces complications, surgical intervention may be warranted. Kasabach–Merritt syndrome is an uncommon complication reported in certain rare vascular tumours in children, with only a few cases reported in adults. The syndrome describes a consumptive coagulopathy initiated within a vascular tumour, mainly tufted angiomas and kaposiform haemangioendotheliomas and, less commonly, giant haemangiomas. The process can extend beyond the tumour and become disseminated in certain cases due to trauma or surgery. The definitive treatment for giant liver haemangiomas can include arterial embolisation, surgical excision, hepatectomy or even liver transplantation. We report the case of a 32-year-old woman with a 42 × 32 × 27cm (18,870ml) liver haemangioma associated with Kasabach–Merritt syndrome. The diagnosis was challenging, even with proper imaging, owing to the rarity of the condition. It was achieved with an exploratory laparotomy with biopsy.

Thermoablatiós lehetőségek a benignus térfoglaló képletek gyógyításában

Introduction: Depending on their size and location, some benign tumors can cause prolonged discomfort and even rupture and fatal bleeding in severe cases. Hitherto the therapeutic strategies for such lesions were observation, surgery and in selected cases transarterial embolization. Aim: Our aim was to present the possibilities of thermoablation for treating lesions. Method: Here we present interventions of four patients in Semmelweis University Department of Transplantation and Surgery. A thyroid adenoma and a kidney angiomyolipoma were treated with radiofrequency ablation. Two patients with a liver haemangioma were treated with microwave thermoablation technique. Results: Complications were not observed in any of the cases. In most cases, the size of the treated lesions decreased. The mean decrease in volume was 32.7%. The contrast enhancement of the lesions also decreased, the mean reduction in contrast enhancing volume was 75.3%. Conclusions: Thermoablational procedures for the benign tumors presented above are safe. The therapy shows excellent cosmetic results, a shorter hospital stay and quicker recovery. Orv. Hetil., 2016, 157(51), 2040–2047.